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Children are, in my book, off limits when writing about personal experiences.  As an author and psychotherapist with an expertise in family estrangement, I have not hesitated to share my personal experiences with readers.  Other writers and clinicians have also contributed their stories because like me, we feel our experiences can help others.  In my writing, however, my children are off limits when it comes to public exposure.  I feel strongly that they’re entitled to this respect and privacy; after all, thought they’re all grown up now, they’re still my children. This week I was shocked and appalled by a story in a British newspaper, The Independent , about an acclaimed writer named Julie Myerson who decided to write the story of her decision to cut off all ties with her 17 year old son.  Myerson, by the way, is no hack; she’s a well-known and critically acclaimed writer in the UK.   Myerson’s son Jake had developed a habituation to a form of marijuana called “skunk. ”  For some reason, skunk smoking has become epidemic among British adolescents. I don’t know why this trend hasn’t migrated to the US, but fortunately it hasn’t, at least to my knowledge.  Skunk is extremely powerful cannabis that is grown hydroponically and is up to 25 times more powerful than the pot smoked in the U.S.  It’s created a serious public health problem in Britain and has caused a dramatic rise in psychosis and hospital admissions due to skunk abuse are at their highest level.  In Myerson’s soon to be released semi-autobiographical book, “The Lost Child”, she writes that her son Jake’s drug abuse was so out of control that he became violent and posed a threat to his two younger siblings and to her and his father.  Because he refused treatment and became unmanageable to live with, she took the advice offered by drug abuse experts to throw him out of their home and in effect, to disown him.  To put it another way, she resigned from her job as Jake’s mother.    Ironically Myerson had been disowned by her own father and had promised Jake when he was 12 years old that she would never cut him out of her life because “we think a parent’s relationship with their child is the parent’s responsibility – however old or bad the child is.”  Good for you Julie, I agree with you there.  A parent is a parent and is always a parent of their children.  Having been cut off by my parents, I couldn’t agree with you more.  I also don’t disagree with the professionals who advised her that she needed to throw Jake out of the house.  That’s the only way to stop enabling the addiction with the hope the addict will hit bottom and get treatment.  Apparently Jake did become abstinent from drugs after a period of time and this drama could have been used as a stepping-stone to repairing the rift between Jake and his family. Instead Julie chose to publicly expose her child’s drug problems and the related behavioral problems caused by the drug abuse.  Now that, in my opinion, is off limits, indecent and obscene.  No one with a heart would publicly expose their child’s personal struggles.  Any parent with respect for their child and human decency, love and kindness would not be critical of their child in their writing and publicly humiliate them for their own glorification as a writer.  She made a choice to do this, though and never even gave her son the choice to have his and the family’s dirty laundry aired out in public. Every adolescent challenges their parent’s self-control and engages in unpleasant defiance and sometimes abusiveness.  I was no picnic as a teenager and certainly adolescence was not the easiest of times for me as a parent. Julie Myerson, however, made two indefensible moves: she not only publicly defamed her son but she never, at least in public, reflected on her role in her son’s problem.  I’m not saying her son became a drug abuser because of bad parenting, not at all, but I am saying that as parents we always have to look honestly at our part in perpetuating our children’s very normal human challenges.   Julie, its time as they say in AA, to make a searching and fearless moral inventory.  Addiction is a family disease after all. 

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Once a Parent, Always a Parent: One Mother’s Resignation by Literary Defamation

If scientists ever come up with a physics of the psyche, one of its first axioms might be the above title. We humans crave stimulation, and on many different levels. To experience ourselves as fully alive, we all have various “arousal requirements”-whether physical, mental, emotional, or spiritual. And if we feel under-stimulated, we’ll generally complain of being bored, antsy, anxious, irritable, lonely, or even depressed. This post explores some of the less fortunate ramifications of our constant need for stimulation. Perhaps more than anything else, our arousal needs–and the negative emotions and states of mind we experience when these needs aren’t being met–can interfere with our better judgment. People who suffer accidents and injuries, for example, frequently do so because their personal arousal requirements compel them to take risks ranging from the not-entirely-prudent to the foolhardy or downright reckless. Others may join religious cults or fringe organizations because they’re frantically searching for a more fulfilling, spiritual life–but don’t really know where to turn. Their need to fit in somewhere , to fill the internal void of un-relatedness, drives them (at times, quite indiscriminately) to put their faith in an ideology, or charismatic leader, that can easily lead them astray. Since as a therapist I typically focus more on mental/emotional problems than physical or spiritual ones, I’ve become acutely aware of how experiencing an inner vacuum can lead people to make poor life choices, especially in relationships. Many people I’ve worked with who’ve gotten into bad or inappropriate relationships did so because at the time they felt alone, abandoned, or rejected. Consequently, they experienced an overwhelming need to prove to themselves they were still lovable. Perhaps they’d been having problems dating, or recently “loved and lost,” or maybe gone through a painfully one-sided divorce, which they’d strenuously sought to avert. Anxious to escape intolerable feelings of emptiness–the emptiness of loneliness or desertion–they rushed to embrace (as it were) the first person that came along. Unable to simply allow themselves to fully experience their disappointment, or grieve their loss, they propelled themselves headlong into a new relationship–one which they weren’t at all ready for. Additionally, they may have feared going within themselves (or, for that matter, eliciting professional help) to learn just why their relationship had gone sour. Feeling hollow, desolate and forsaken–and without the ability to self-soothe –they hastily paired up with the first available person they could find. It reminds me a little of the lyrics to B. J. Thomas’ song, “No Love at All,” in which he opines: “A little bit of love is better than no love/Even a bad love is better than no love/And even a sad love is better than no love at all.” In fact, in the mind of an individual unable to tolerate the emotional vacuum of dis-connectedness, it must certainly feel that almost anything is better than the unnerving void of being alone. But I myself would argue that if you can develop a secure, nurturing relationship with yourself , you’re in a much better position to “stabilize” your thoughts and feelings after a failed relationship and patiently wait for the right person. To me, such an alternative is far preferable to making any person the “right” person simply because he or she can immediately fill what is “abhorred” as an unbearable vacuum. Finally, the vacuum that some people strive so assiduously to avoid is really a “vacuum of self.” When we’re not enough for ourselves (i.e., can’t somehow fill our own vacuum), we can’t help but focus our attention on what we can import into ourselves to feel more whole and complete. Another PT blogger, Robert W. Firestone, recently made a similar point in a post entitled Emotional Hunger Vs. Love . As he put it, emotional hunger is the “pain and longing which people often act out in a desperate attempt to fill a void or emptiness.” When people precipitantly get into unhealthy relationships, it’s almost always to keep at bay some inner void they only vaguely understand. But to try to get from without what we haven’t yet learned to give ourselves from within is almost always an exercise in futility. Of course, there’s nothing wrong in striving to fulfill ourselves by pursuing people and things that might offer us what–personally–will afford us just the right degree of stimulation. As I stated earlier, although what is an optimal degree of stimulation varies with the individual, the basic need for such arousal is universal. And it’s certainly worthy of respect. But we still need to carefully monitor our behavior to ensure that our requirement for stimulation doesn’t ultimately end up jeopardizing our health or peace of mind. In instances where our best judgment is not available, we ought at least to confide in someone who cares about us as to whether we might possibly be getting ourselves into something questionable. Are we perhaps on the verge of making a decision that hasn’t really been thought out? that may be wrong-headed, or foolish? Many people I’ve worked with have told me that before they made what, ultimately, was a disastrous decision, friends and relatives had already warned them against it. So it’s not simply a matter of informing others about what you may be planning to do, but listening painstakingly to their feedback–whether it’s welcome or not. I’d caution anyone on the brink of acting impulsively to stop, reflect, and speak to people they trust before giving themselves final permission to embark on such a venture, or commit to such a relationship. Although it may be true that our need to fill a vacuum can productively direct our behaviors, it can also end up seriously threatening our welfare. To conclude, if you’re harboring some ambivalence about making a decision, most of the time it will be in your best interest not to until you’re able to resolve this ambivalence. At the very least, you might ask yourself the question, “Am I driven to do this because I’m desperate to fill a void inside me?” If the answer is “yes,” or “probably,” I’d suggest–before going any farther–that you talk to others. . . . Or, if at all possible, go within and consult your own wiser, more prudent self.

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Human Nature Abhors a Vacuum, Too

The Seven Questions project welcomes the perfect guest for Valentine’s Week: Dr. Harville Hendrix, author of the international bestseller Getting the Love You Want and founder of Imago Relationship Therapy. Harville Hendrix (Ph.D. University of Chicago), in partnership with his wife, Helen Lakelly Hunt, Ph.D. created Imago Relationship Therapy and co-founded  Imago Relationships International, an international non-profit organization that offers training, support and promotion of the work of 2000 Imago therapists in 30 countries. Harville lectures, offers therapy intensives and workshops for couples internationally. Harville and Helen have authored nine books on intimate relationships, including Getting the Love You Want: A Guide for Couples , an international bestseller, Keeping the Love You Find: A Personal Guide and Giving the Love that Heals: A Guide for Parents . Their books are published in over 57 languages. Hendrix produced a PBS documentary on relationships, he’s appeared on numerous television shows (seventeen times on Oprah , winning for her the "most socially redemptive" award for daytime talk shows) and radio shows, and has been written up in numerous newspapers and magazines internationally. Now he can add PT Blogs to his resume. So what is this Imago stuff, and why is it so popular? The complete theory is a multifaceted model explaining attraction, conflict and healing within intimate relationships. Imago is Latin for image, as in the composite image of early childhood caregivers. According to  Hendrix , it is "the image of the person who can make me whole again." We find partners who help us complete the unfinished business of childhood. Our adult relationships and struggles feel familiar because they remind us of our primary caretakers. These relationships present us with the opportunity to heal past wounds and find deep relational fulfillment. But it’s an opportunity, not a guarantee. Hendrix writes: Our unconscious need is to have our feelings of aliveness and wholeness restored by someone who reminds us of our caretakers. In other words, we look for someone with the same deficits of care and attention that hurt us in the first place. So when we fall in love, when bells ring and the world seems altogether a better place, our old brain is telling us that we’ve found someone with whom we can finally get our needs met. Unfortunately, since we don’t understand what’s going on, we’re shocked when the awful truth of our beloved surfaces, and our first impulse is to run screaming in the opposite direction. (from Imago website ) Well, this popular theory has millions running to bookstores and thousands of therapists flocking to conferences to become certified Imago therapists. Supporters of the theory and technique tend to be passionate clinicians and clients who’ve experienced its effectiveness. Even Paul’s therapist on In Treatment uses Imago. It’s everywhere. Dr. Hendrix wins the Seven Questions award for Most Succinct Answers ( David D. Burns wins Most Elaborate). I appreciate how Dr. Hendrix boldly states his ultimate goals for therapy (Q4) and doesn’t sugar coat the hardest part of being a therapist (Q5). Enjoy the short and sweet answers from a modern master in the world of couples therapy, and happy Valentine’s Day. Seven Questions for Harville Hendrix: 1. How would you respond to a new client who asks: "What should I talk about?" Since I only see couples, I ask them to describe their dream relationship, what kind of marriage they would have if it were "perfect." 2. What do clients find most difficult about the therapeutic process? Surrendering their self rejection/hatred and letting themselves be accepted and loved. . 3. What mistakes do therapists make that hinder the therapeutic process? Allowing clients to spend most of their time processing negative feelings about themselves and others and spending too much time exploring the traumas of their childhood. 4. In your opinion, what is the ultimate goal of therapy? To surrender the judgmental mind, achieve sustainable connection with others and become loving of others and oneself. 5. What is the toughest part of being a therapist? Staying awake when clients are disassociating. 6. What is the most enjoyable or rewarding part of being a therapist? Terminating a couple who has achieved sustainable connection and unconditional love for each other. 7. What is one pearl of wisdom you would offer clients about therapy? The healing and wholeness which effective therapy facilitates is in the service of love. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Seven Questions for Harville Hendrix

"I almost die for food, and let me have it!" As You Like It by William Shakespeare How do we lose weight and keep it off? This is a big, big topic, and one that I’ll be covering piece by piece in this blog. So let me first tell you who I am and why this topic is mine. In my professional life I’m a professor of nutrition and a professor of psychiatry at Tufts University and have spent the last 17 years doing research on weight loss and how to make it work for real people in the real world. On a personal level, I was an overweight kid, had a mother who loved us with food, and was 55 pounds overweight in my 30′s after a difficult pregnancy. Researching weight has been my way to bring all the pieces of my life together. Like many people who struggle with control over what they eat, I’ve gained and lost, and gained and lost again, so I know the struggle up close. But I also know how to win on a personal level – I’ve been weight stable for the last 15 years, and with the help of things I’ve learned in my research program have achieved this without giving up the wonderful pleasures of food, comfort food and all the rest. I also love food – I was a chef in a French bistro and worked as a private chef as well, before becoming a researcher – and think that good food, comfort food and all the rest are legitimate, normal pleasures which should not be made hostage to weight control – indeed I believe that we can’t win our personal battle with weight unless we enjoy what we eat and stay satisfied. I’m also the author of the just-published The Instinct Diet, which has been endorsed by more leading obesity scientists than any diet book ever-including researchers who’ve never before been able to agree on the same recommendations. People who struggle with their weight report that the main reasons they give up on a diet are because they miss eating foods they love, they are hungry all or most of the time, and then hit a plateau and can’t get any further. So the central challenge in weight control is this: how do we cut calories while staying satisfied and eating things we enjoy? If we can do this, there is no reason we can’t gain permanent control over our weight! So let’s start with hunger control. I know that most everyone thinks that they have other problems as well, but in my experience really good hunger control 24/7 makes it much easier to deal with just about every other issue (such as emotional eating and craving, which I will cover in a future blog). In psychiatric terms of peeling the onion, hunger control is the outside layer – you can’t uncover other stuff until you get rid of it. And the good news here is that the diet wars of past years really are over. Really! Research studies are showing quite conclusively that there isn’t just one way to deal with hunger, there are at least 4 ways to put together a meal or snack to get satisfied on fewer calories. Eating the right foods isn’t the only way to control hunger (more on this later), but all of the following items are great for hunger control, and if you include 2 or more of these in each meal and each snack you will probably notice a rapid improvement in how satisfied you feel: • High fiber foods (such as high fiber cereals, legumes, green vegetables); • High protein foods (such as lean proteins like chicken breast, white fish, tofu); • High volume foods (such as green salads and vegetable or bean soups); • Low glycemic index carbs (such as legumes, again, and also wheat berries, barley, low carb breads, and non-starchy fruits). What if you don’t like these things? Practice (especially when you are hungry) and some good recipes are the key to growing enjoyment. Here is my favorite after-dinner cure for both hunger and late-night munchies. Think of it as the best diet medicine rather than an indulgent dessert, and enjoy! Chocolate Cereal Dessert ½ cup very high fiber cereal such as Original Fiber One, All Bran Extra Fiber or Trader Joe’s High Fiber Cereal 1 square (10 grams) chocolate of your choice 1% milk to serve, about 1/3 cup Optional: 2 drops mint essence, or a handful of frozen raspberries Place the chocolate on top of the cereal and microwave until the chocolate just melts, about 30 seconds. Mix the cereal and chocolate together really well. Add the milk and serve (preferably while you put your feet up and relax). Dr. Susan Roberts is professor of nutrition and professor of psychiatry at Tufts University and author of The Instinct Diet . © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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The Instinct Diet

Two hundred years ago on February 12, Adam Gopnik writes in Angels and Ages: A Short Book About Darwin, Lincoln, and Modern Life , two pebbles — Charles Darwin and Abraham Lincoln — were dropped into the sea of life. Their ideas and forms of eloquence have redirected the currents of humanity. One current of Darwin’s thought is well-known. His theory of evolution by natural selection would require new genesis stories about the origins of life forms, less arrogant notions about man’s place in the great chain of being, and a rethinking of our species as one in flux—and with rather hairy relatives. Less well-known is a second current of Darwin’s thought — his conception of human nature. Think of Darwin and "survival of the fittest" leaps to mind, as do images of competitive individuals — collections of selfish genes — going at one another bloody in tooth and claw. "Survival of the fittest" was not Darwin’s phrase, but Herbert Spencer’s and that of Social Darwinists who used Darwin to justify their wished-for superiority of different classes and races. "Survival of the kindest" better captures Darwin’s thinking about his own kind. In Darwin’s first book about humans, The Descent of Man , and Selection In Relation to Sex from 1871, Darwin argued for "the greater strength of the social or maternal instincts than that of any other instinct or motive." His reasoning was disarmingly intuitive: in our hominid predecessors, communities of more sympathetic individuals were more successful in raising healthier offspring to the age of viability and reproduction — the sine qua non of evolution. One year later, in The Expression of Emotion in Man and Animals , Darwin countered creationists’ claims that God had designed humans with special facial muscles to express uniquely human moral sentiments like sympathy. Instead, drawing upon observations of his children, animals at the London zoo, and his faithful dogs, Darwin showed how our moral sentiments are expressed in mammalian patterns of behavior. In his analysis of suffering, for example, Darwin builds from pure empirical observation to a radical conclusion: the oblique eyebrows, compressed lips, tears, and groans of human suffering have their parallels in the whining of monkeys and elephants’ tears. To be a mammal is to suffer. To be a mammal is to feel the strongest of Darwin’s instincts — sympathy. The expression of sympathy, Darwin observed, was to be found in mammalian patterns of tactile contact. Inspired by this observation, Matthew Hertenstein and I conducted a recent study of emotion and touch that was as much a strange act of performance art as hardheaded science. Two participants, a toucher and touchee, sat on opposite sides of a barrier that we built in a laboratory room. They therefore could not see nor hear one another, and could only communicate via that five digit wonder, the hand, making contact on skin. The touchee bravely poked his or her arm through a curtain-covered opening in the barrier, and received 12 different touches to the forearm from the toucher, who in each instance was trying to communicate a different emotion. For each touch, the touchee guessed which emotion was being conveyed. With one second touches to the forearm, our participants could reliably communicate sympathy, love, and gratitude with rates of accuracy seven times as high as those produced by chance guessing. Sympathetic touches are processed by receptors under the surface of the skin, and set in motion a cascade of beneficial physiological responses. In one recent study, female participants waiting anxiously for an electric shock showed activation in threat-related regions of the brain, a response quickly turned off when their hands were held by loved ones nearby. Friendly touch stimulates activation in the vagus nerve, a bundle of nerves in the chest that calms fight-or-flight cardiovascular response and triggers the release of oxytocin, which enables feelings of trust. Research by Darlene Francis and Michael Meaney reveals that sympathetic environments — those filled with warm touch — create individuals better suited to survival and reproduction, as Darwin long ago surmised. Rat pups who receive high levels of tactile contact from their mothers — in the form of licking, grooming, and close bodily contact — later as mature rats show reduced levels of stress hormones in response to being restrained, explore novel environments with greater gusto, show fewer stress-related neurons in the brain, and have more robust immune systems. Were he alive today, Darwin would likely have found modest delight in seeing two of his hypotheses confirmed: sympathy is indeed wired into our brains and bodies; and it spreads from one person to another through touch. Darwin, the great fact amasser that he was, would no doubt have compiled these new findings on sympathy and touch in one of his many notebooks (now a folder on a laptop). He may have titled that folder "Survival of the kindest." © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Darwin’s Touch: Survival of the Kindest

Reading groups are a great activity whether you are an undergraduate looking for ways to pad your CV and get good letters of recommendation, or a graduate student wanting to be more involved in your program. Seeking out groups that read, discuss and critique peer-reviewed articles is also a great way to immerse yourself in the literature of your field. In this post I will discuss three of the reading groups that I have participated in, as well as suggest some ways to choose and participate in these types of reading groups. The first reading group I was involved in at my current institution was called the Biological Basis of Behavior (BBoB) , a multi-domain (Neuroscience, Clinical Psychology, Philosophy, and more) discussion group sponsored by the Behavioral Neuroscience division of the psychology department. The discussion leader sends out an article 1-2 weeks before the group meets, and discussants email in comments and questions about the article. Every three weeks during the 1 hour meeting the leader begins by summarizing the paper, and then attempts to address the comments of the group. There is a mix of mainly faculty, some graduate students and a few undergraduates present. The discussion leaders are generally faculty in the fall and graduate students in the spring. The most advantageous aspect of BBoB is the option to e-mail in comments, this allows students to contribute even if they don’t have enough personality to compete with faculty in the actual meeting. It is also refreshing to see what papers students choose to present in the spring, and is a great opportunity for graduate students to advertise their interests to faculty. The disadvantage is the high proportion of faculty to students, which means that discussions can sometime revolve around minutiae of interest only to the most invested of readers, and domination of the discussion by faculty. Of course it is also worthwhile to hear faculty debate amongst themselves, and often quite entertaining. The second reading group I have been attending is the Animal Behavior Discussion Group (ABDG), sponsored by the biology department. This group is similar to BBoB, except that it meets every week, and has a much smaller faculty presence. While not always directly pertinent for my own studies, this discussion group has provided lots of valuable information on the perspectives of a field of science that is distinct but related to my own discipline. The big student presence means that discussions tend to focus on the methods and topics of the paper being presented, and often revolve around understanding the unique features and flaws of the science as published. It is also advantageous to network with students and faculty in related fields as they may be good choices for collaborators on future work. The last reading group I’ve been involved with is a grant writing group that hasn’t created an acronym yet. The goal of the group is to get students and faculty to help each other read and write grant proposals in an effort to secure more funding for the individuals and the institution. While this group has met irregularly and infrequently I have to say it has certainly been the most valuable. The grant writing process is both arcane and arduous, and having some guidance from those that have been through it has proven invaluable. So I would highly recommend any sort of skill-building group that can help you get an edge when entering unfamiliar territory. While this post has been entirely biased by my personal experiences, I’m hoping that it will help you recognize the advantages of getting involved in reading groups at your school. It’s a great way to become known by your professors and to learn about the recent events in psychology. If your school doesn’t have a reading group, check nearby schools, or start your own! © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Reading Groups

The Seven Questions project welcomes renowned brain expert and bestselling author Daniel Amen. You may have seen him preach his message of change on PBS , on bookshelves or at professional conferences. He’s not simply suggesting you can change your attitude or behavior, he actually believes you can change your brain. In an effort to illuminate the various clinical approaches to psychotherapy, this series asks the same seven questions to influential authors, theorists and policymakers. Dr. Amen, a revered and sometimes controversial figure in popular psychiatry is our honored guest today. Daniel G. Amen (MD, Oral Roberts University, 1982) is a psychiatrist, brain imaging specialist and the CEO and medical director of Amen Clinics , Inc. (ACI) in Newport Beach and Fairfield, California, Tacoma, Washington and Reston, Virginia. ACI has the world’s largest database of functional brain scans related to psychiatric medicine, now totaling nearly 50,000 scans, and the clinics have seen patients from 75 countries. Dr. Amen is an Assistant Clinical Professor of Psychiatry and Human Behavior at the University of California, Irvine School of Medicine. No stranger to the public sphere, Dr. Amen is one of the hardest working and most diverse MD’s out there, sharing his wisdom in nutrition columns , on the Men’s Health Q & A forum and even paid a visit to  The View  to discuss brain-based gender differences. Dr. Amen is the author of 22 books , including two New York Times bestsellers, Change Your Brain, Change Your Life and Magnificent Mind at Any Age . He has also written and produced two highly successful specials for public television. His method employs a balanced approach to treating mood, attention and relational problems. A review of Magnificent Mind  states: "Dr. Amen has rendered the growing trend of not treating the whole person, and of using prescription medicine as the first or only choice for mental and physical health, completely obsolete." Dr. Amen shares his opinions on psychotherapy with us today. As a psychiatrist who believes in : "using the least toxic, most effective treatments for our patients, … from natural supplements, medications, dietary interventions and targeted forms of psychotherapy," I knew he’d contribute some unique thoughts to the discussion. For example, his answer to Q3 is an important reminder that many psychological symptoms can have a biological etiology. Please enjoy Dr. Amen’s responses to the Seven Questions. Seven Questions for Daniel Amen: 1. How would you respond to a new client who asks: "What should I talk about?" His or her biggest concerns. A good history is so critical to the therapeutic process. It starts with someone’s concerns and then expands from there. I take a bio-psycho-social-spiritual approach to my patients and want them to talk to me about all of these issues. 2. What do clients find most difficult about the therapeutic process? Being confused as how to help themselves. Most people who see me want to be better, but the therapeutic process is so foreign to them. I think they need very clear direction on how to be most effective in using the process. 3. What mistakes do therapists make that hinder the therapeutic process? The biggest mistake I see is that they rarely consider the brain. I often say psychiatrists are the only medical specialists that never look at the organ they treat. How crazy is that! How do we know unless we look? We call people who have brain damage personality disordered? We call people with toxic exposure resistant to treatment? We think of depression as a singular illness, when it has many types, like chest pain. We need to do much better and it will start when we really take brain function seriously. 4. In your opinion, what is the ultimate goal of therapy? Better brain function. I am convinced therapy goes much faster, and patients are better able to do their own lives when you help your patients have better brain function. 5. What is the toughest part of being a therapist? Not having enough information to be helpful. 6. What is the most enjoyable or rewarding part of being a therapist? Helping people change their lives in a positive way. I have so many stories of how when a person’s brain is better that they become more effective, more loving, more passionate … that it brings me joy on a regular basis. 7. What is one pearl of wisdom you would offer clients about therapy? Think about the brain, how to improve it and you will be more effective in all you do. ——– My gratitude to International Psychoanalysis , The Library of Economics and Liberty , Introductory Psychology Resources , Psychlinks Online and the American Psychological Association for blogging about or linking to the Seven Questions. There’s even a European magazine named  Charaktery asking seven questions to influential Polish psychotherapists. My goal was to get people talking about psychotherapy so it’s nice to see interest from such diverse venues. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Seven Questions for Daniel Amen

Aside from being a psychologist in nursing homes, I also had the pleasure of being a caregiver to my own aging parents–as a consumer of the same services I provide, the personal meets the professional. I work both sides of the streets. My father spent the last years of his life in a nursing home descending into deeper and deeper dementia. It’s time for the quarterly care plan meeting at Dad’s nursing home. My father, who has a right to be there, is not there. He wouldn’t have a clue. I’m sitting at a table squeezed into an office not meant for conferences, fiddling with my cell phone. My brother, Robert, attends via speakerphone. I chat up a nurse about her golf game. This is the functional equivalent of a parent-teacher conference. We’re going over the functional equivalent of a report card. The golfing nurse–the care plan coordinator–chairs the meeting. Every three months, each of the departments files a report for Dad’s chart. Usually the staff moves along the agenda along minus the impediment of family, like my brother and me. First up, the dietitian. But before she begins, we hear an impediment from Robert on the speaker. "I was in town from Boston last weekend, and there was a banana on my dad’s lunch tray." Dad’s kidney has been slowly failing for most of his adult life–slowly enough so something else will likely kill him first. But bananas and other high potassium foods are poison. He loves bananas. "Sorry, I’ll look into it," says the dietitian. I’m personally not at the top of the charts when it comes to caregiving time; I’m not spending hours a day or even every week with Dad, but I worry about the bad kidneys of residents whose families never show up. The doctor never attends care planning. Unlike the nurse, he might be actually golfing. A nurse drones on about Dad’s vital signs and the ups and downs of his meds. There’s no physical therapist, either. My dad has "plateaued." There is no hope of additional progress for his fractured hips. Medicare won’t pay for plateaus. Exercise would still be good for his hips, but he’ll have to get someone other than Medicare to pay for him to walk across a plateau. Pushing ninety, he’s a Medicare orphan. My brother and I pester the recreational therapist and the social worker about exercise, having the aides walk him. This is when we get the lines about staffing shortages, and how he doesn’t want to go on walks, anyway. Neither does he want to go to recreation. "Forget about his rights and just wheel him down to the damn sing-along!" I implore. They write that down. Reminds me of the patient who asked, "Do you write down everything I say?" "What do you think?" I ask, as I write that down. For those who remember Lawrence of Arabia, "Everything is written." Maktub in Arabic. You may think you’re in something like a home, but you’re a 24/7 patient for the rest of your life. It is written. Maktub . To mix metaphors. Sysiphus has nothing on me. *                                           *                                            * This post was adapted from my forthcoming book, Nasty, Brutish, and Long:Adventures in Old Age and the World of Eldercare (Avery/Penguine, March 2009). © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Maktub: It is Written

    On January 11, 2009 Mickey Rourke won the Golden Globe Award for best actor for his performance in Darren Aronofsky’s "The Wrestler." When actors give acceptance speeches for such awards it is quite common for them to thank God and their family for the win, but Mickey Rourke thanked his dogs. If it had not been for the therapeutic effects of his relationship with his dogs, Mickey Rourke might not have been alive to accept this award.    In the film, "The Wrestler," Rourke plays the part of Randy "The Ram" Robinson, a professional wrestler who is now well past his prime, holding on to the remains of a once-famous career, and presented with the opportunity for a comeback. These are circumstances that run more than little parallel to the actor’s own life story.     Rourke seemed destined to be a superstar in the 1980′s. Most critics agreed that his performances in "Diner" (1982), "Rumble Fish" (1983) "9 ½ Weeks" (1986), and "Angel Heart" (1987) seemed to contain signs that the world was witnessing the appearance of another James Dean or even Robert De Niro.    Unfortunately Rourke’s acting career eventually became overshadowed by his personal life and some seemingly eccentric career decisions. Directors such as Alan Parker found it difficult to work with him. Parker stated that "working with Mickey is a nightmare. He is very dangerous on the set because you never know what he is going to do". In addition Rourke began to show the effects of substance abuse. He associated with motorcycle gang members and was involved in several aggressive instances including a charge of spousal abuse (later dropped). Ultimately he virtually disappeared from the cinematic world.     Rourke’s career was revived when director Robert Rodriguez cast him in the role of a sinister hit man in "Once Upon a Time in Mexico" (2003). Two years later Rodriguez again called upon him, this time to play Marv, one of the antiheroes from writer-artist Frank Miller’s crime noir comic book series "Sin City" (2005). In that film Rourke delivered a unforgettable performance, alternately chilling and amusing, that reminded any doubters that he was still a force to be reckoned with. However to get to this stage in his life Rourke required the intervention of a dog.    The possibility that dogs can produce major psychological and health benefits for their human companions has been a subject of much recent serious psychological research. Scientific evidence about the health benefits of a relationship with a dog was first published about 30 years ago by a psychologist, Alan Beck of Purdue University and a psychiatrist, Aaron Katcher of the University of Pennsylvania. These researchers measured what happens physically when a person pets a friendly and familiar dog. They found that the person’s blood pressure lowered, his heart rate slowed, breathing became more regular and muscle tension relaxed-all of which are signs of reduced stress.    A recent study published in the Journal of Psychosomatic Medicine not only confirmed these effects, but showed changes in blood chemistry demonstrating a lower amount of stress-related hormones such as cortisol. These effects seem to be automatic, they do not require any conscious efforts or training on the part of the stressed individual. Perhaps most amazingly, these positive psychological effects are achieved faster-after only five to 24 minutes of interacting with a dog-than the result from taking most stress-relieving drugs. Compare this to some of the Prozac or Xanax-type drugs used to deal with stress and depression. Such drugs alter the levels of the neurotransmitter serotonin in the body and can take weeks to show any positive effects. Furthermore, the benefits that build up over this long course of medication can be lost with only few missed doses of the drug. Petting a dog has a virtually immediate effect and can be done at any time. Recently, researchers extended this research by looking at a group of people aged 60 and older, living alone, except for a pet. Non-pet owners were four times more likely to be diagnosed as clinically depressed than pet owners of the same age. The evidence also showed that pet owners required fewer medical services and were more satisfied with their lives.    Depression was, indeed, Mickey Rourke’s problem in the 1990′s. In his case when all friends left him he was left with only his dog, for solace. Rourke admits that things had gotten bad enough so that went into a closet with his beloved dog Beau Jack, locking the door and planning to commit suicide with a drug overdose. In the end he just couldn’t go through with it because of his relationship to his little Chihuahua-cross dog. Rourke describes the scene saying, "(I was) doing some crazy s**t, but I saw a look in Beau Jack’s eyes, and I put the s**t down. That dog saved my life."    Rourke’s life took a major turn after these events. He became active in animal welfare issues, including an involvement with PETA and its spay and neutering campaign. He increased the number of dogs in his house, first by adding Beau Jack’s daughter, Loki. The depth of his bond to his dogs became obvious when Beau Jack died in 2002. He recalls, "I gave him mouth-to-mouth for 45 minutes before they peeled me off. Depressed? He died at my home, and I didn’t go back for two weeks."    Rourke’s canine family has continued to grow. He says "I have five now – Loki, Jaws, Ruby Baby, La Negra and Bella Loca–but Loki is my number one." In describing his relationship to Loki he added, "My dog [Loki] is very old, she is 16 and she is not going to be around for long so I want to spend every moment with her. When I was filming "Stormbreaker" in England, I had to have her flown over because I missed her so much. I had to get her from New York to Paris and Paris to England, and also pay for someone to come with her. The whole thing cost about $5,400."    Rourke seems to understand the therapeutic value of dogs. He says of Loki, "She’s like a giant Xanax, you know? I’m not going to get religious on your ass, but I truly believe God created dogs for a cause. They are the greatest companions a man could ever have."    So it was that following his remarkable comeback to a successful acting career, and following his rise from the depth of depression, that Mickey Rourke was able to stand in front of colleagues to accept his Golden Globe award. However his speech was different from the others. It not only included references to the contributions and the support of colleagues and professional associates, but also contained the lines, "I’d like to thank all my dogs, the ones that are here, the ones that aren’t here anymore, because sometimes when a man’s alone that’s all you got is your dog, and they meant the world to me."     © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Dogs as Therapists: The Case of Mickey Rourke

I don’t know about you, but no one ever taught me how to fail successfully. There was no course in college called, "Failure 101". I’m not sure if they would grade you as Pass/Fail in such a course, but that course wasn’t offered. But as we all know, failure is an inevitable part of our lives-and no one has gone out of his or her way to get us prepared. We’ve heard unhelpful ideas such as, "Winning is everything" and "How to win and never lose" and "There are winners and losers". It’s a lot of hype. Everyone loses sometime. Even the people we admire most have had big losses. Whether it’s sports, finance, relationships, academics, medicine, law, construction, or business—we all have to face some losses. We are not "winners" or "losers". But we do have some experiences, some moments, when we lose and some when we win. You worry in order to avoid failure Your worry may be driven by your perfectionistic idea that you should never fail or that failure is horrible or that failure is humiliating. You worry to "be sure" you don’t fail. You think that if you worry you will avoid any failure. But what is so bad about a failure—now and then? I’ll give you an example of someone I know. Let’s call him Larry. Now, Larry got his PhD in psychology and took the licensing exam. Much to his surprise he didn’t pass the exam. Larry thought he was stupid, a failure, and that everyone who knew him would think he was loser. But, much to his credit, he actually decided to study really hard before he took it the next time. He passed. Years later, he is very successful, with a large practice. Larry was able to bounce back from an experience of failure, try harder, learn more and finally have a successful experience. Larry overcame an obstacle. Larry was a student of mine years ago and his experience encourages me every time I think about how we need to face failure. His experience with failing at the exam taught me something. The question for you, when you think about the possibility of failing, is, "What about failure is so bad?" What’s so bad about failing? If you think that FAILURE IS A CATASTROPHE then you will be reluctant to try new things, you will avoid any risks, and you will worry about failing in the future. Do any of the following sound like you? • I can’t stand failing • If I fail at something, I think that "I AM A FAILURE" • People will think I’m a loser if I fail. • I shouldn’t try something unless I am sure I won’t fail • If I fail, I might as well give up   Twenty ways to overcome your fear of failing We could go on, but you get the point. You just "can’t stand" failing. But that intolerance of difficulty–your inability to fall down and get back up— keeps you stuck in your worrisome mind. But what if you no longer feared failure? What if you accepted the idea that sometimes you will fall down-only to get back up? What if you thought you could learn from failing, try harder, be proud of overcoming an obstacle? What then? Your fear of failure has kept you trapped. The good news is that you can change it. I’ve developed twenty coping ideas that you might use to help you confront your fear of failure. In fact, you can think about confronting failure as an opportunity to let go with your worry. Let’s see if any of the following twenty coping statements could help you. 1. I didn’t fail, my behavior failed 2. I can learn from my failure 3. I can be challenged by my failure 4. I can try harder 5. Maybe it wasn’t a failure 6. I can focus on other behaviors that will succeed 7. I can focus on what I can control 8. It wasn’t essential to succeed at that 9. There were some behaviors that did pay off 10. Everyone fails at something 11. Maybe no one noticed 12. Did I have the right goal? 13. Failure is not fatal 14. Were my standards too high? 15. Did I do better than before? 16. I can still do everything I always did, even though this failed 17. Failing at something means I tried. Not trying is worse. 18. I’ve just begun 19. Tomorrow is another success 20. Tomorrow is today Think about something you are worried about. Perhaps you are worried that you won’t do well on a test, or that someone might not like you, or that you might lose some money, or…whatever. Then go through the coping ideas listed above and think about how you could use these. Let us know. Let us know about what you think is so bad about failing. Let us know how you have learned to cope with that fear. And , let’s learn from failing. This is FAILURE 101. I discuss these coping ideas in my book, The Worry Cure: Seven Steps to Stop Worry from Stopping You . More later. © 2009 Psychology Today. This RSS Feed is for personal non-commercial use only. If you are not reading this material in your news aggregator, the site you are looking at is guilty of copyright infringement. Please contact blogs@psychologytoday.com so we can take legal action immediately.

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Fifth Week: Overcome Your Worry by Overcoming Your Fear of Failure