Accountable Care Organizations and the (Lack of) Depression Remission

The average rate of depression remission at twelve months for people not receiving any mental health treatment in this country is 53 percent. But in Accountable Care Organizations (ACOs), it’s only 9 percent. Mental Health America (MHA) wants to know why.

ACOs were the first big innovation in the value-based payment movement. Here’s how they work: A group of providers get together and make a deal with an insurance company. If they achieve certain quality objectives and end up costing less than the insurance company expected to spend that year, they get half of the money they saved back.

The idea is that then everyone wins: the patients get better outcomes, the doctors get additional revenue, and the insurance company saves money.

One of the quality measures that ACOs are scored on is Depression Remission at Twelve Months – for those people that screen positive for depression, what percent of them screen negative by the end of the year?

For now, ACOs only need to say how they’re doing on this measure; they don’t (yet) get paid based on this. But the data from last year – newly available as of last month – are beginning to paint a picture. It isn’t pretty.

Using the public data, across all ACOs that reported this measure, the average rate of depression remission at twelve months across the population they served was a little over 9 percent. Only nine out of every hundred people who screened positive for depression improved clinically by the end of the year. By comparison, a recent study found that the average rate of depression remission at twelve months for people not receiving any treatment was likely around 53 percent.

We don’t think that ACOs are making people sicker, but the data suggest that something is probably going wrong.

First, if someone screens positive for depression and then the ACO doesn’t screen them a second time later, that still counts against the ACOs score. That could be what is happening in many cases – they screen once but don’t screen again. This means that we don’t know if these people are getting better, which was supposed to be part of the goal of the new value-based payment models.

It could also be other issues, like the population of people being screened for in the ACOs are sicker and have more need than most. But again, we don’t really know from the sparse data available.

MHA thinks the value-based payment movement holds great promise for mental health. Based on these early results, MHA is exploring how to better support ACOs and ensure that the future of value-based payment is one that, first and foremost, values acting before stage 4 in mental health (you can see another paper we wrote on this subject here). While we’re working on a longer academic paper and responding to an open comment period on ACOs, we wanted to share some of our goals:

• We need to make screening easier and ubiquitous. If people screen regularly and have the option to share their results with their doctor, then it will be easier for doctors to see how the people they’re treating are doing, and we will have more reliable information about whether people are getting better;
• Doctors need more help in treating mental health. At MHA, we think peer support specialists could be a critical part of recovery in more settings, including ACOs, along with other options like digital apps or telehealth to connect people with mental health providers. More providers should also receive meaningful training in treating mental health conditions; and
• When ACOs are able to do a good job addressing mental health in their population, they should receive larger payments. Tying payments to improved mental health would elevate best practices, finance further improvements, and get more systems to invest in mental health treatment.

Over the coming months, MHA will be working to advance these changes, because 9 percent remission rates are far too low ever to be acceptable.

This post courtesy of Mental Health America.

from World of Psychology https://psychcentral.com/blog/accountable-care-organizations-and-the-lack-of-depression-remission/

Is Masturbation Bad for You?

It’s funny how many people feel awkward talking about masturbation. Because of that awkwardness, there’s also a lot of false beliefs about the pros and cons of masturbation, and whether it’s bad for you.

Masturbation is simply the act of self-stimulation for sexual pleasure. There’s nothing mysterious or weird about it. And in fact, although virtually nobody talks about it, most people have masturbated.

Masturbation is a completely normal behavior associated with our own sexuality. Whether done with or without the aid of a vibrator or other sex toy, when done in moderation, masturbation is a common, healthy sexual behavior. How many people engage in this behavior depends upon their cultural and religious background.

How Common is Masturbation?

In the U.S., studies show that masturbation is common. In one study of 1,047 men, over 69 percent had reported masturbating in the past 4 weeks. Of those men, nearly 32 percent reported masturbating 1-3 times per week, 22 percent acknowledged doing so less than once per week, 10 percent said they did it most days of the week, and 5 percent acknowledged doing it daily (Reece et al., 2009).

In women, masturbation is less common, with only about 38 percent of women reporting they did so in the past month (ages 18-60), rising to about 63 percent when looking at the past year (ages 18-60; Herbenick et al., 2010). This same research found higher numbers in men ages 18-60 — just over 62 percent in the past month, rising to 79 percent when looking at the past year (Herbenick et al., 2010).

In teens ages 14-17 in the U.S., 74 percent of males and 48 percent of females reported ever having masturbated. When looking at just the past 3 months, that number drops to 58 percent for teen boys and 36 percent for teen girls (Kott, 2011).

In a British survey sample of 11,161 people from the early 2000s, just under 37 percent of women and 73 percent of men reported masturbating in the past 4 weeks (Gerressu et al., 2008).

Is it Bad to Masturbate?

There are virtually no negative consequences from masturbation, and in fact, many sexual health researchers and experts suggest it is a normal part of human sexuality that can have many benefits. The myths that surround masturbation (or masturbating too frequently) include: automatic addiction, it’ll make regular partnered sex uninteresting, numbing of your sexual organs, cause infertility, or shrink your genitals. None of these are true.

Masturbation, however, does have many health benefits.

Masturbation, however, does have many health benefits. First and foremost, it is an important stress reliever for individuals, helping to relax a person and take their mind off of other things. It also helps relieve sexual tension and can help strengthen your pelvic muscles. Some research has shown an improvement in a person’s self-image and self-esteem, as well as helping a person get a better night’s sleep.

Humans gain new skills through practice and knowledge. Masturbation helps a person gain positive sexual health skills by learning how your body responds and what you like sexually, without the complications of another person’s feelings or reactions complicating your own feelings and responses. Self-knowledge is important in every aspect of your life, and so naturally this includes your sexuality as well. If you know what works best for you sexually, there’ll be less confusion and misunderstandings in future sexual encounters with others.

Ultimately, though, people masturbate because it feels good. For those who masturbate to orgasm (not everyone does!), it also provides a release of endorphins, the brain’s “feel good” hormones. And while it’s not uncommon, especially at an earlier age, to feel guilty about masturbating, that’s a feeling that’s often tangled up in the cultural or religious dogma we’ve been taught. Such guilt can be unlearned through practice and a reminder that you’re engaging in a normal, health, human behavior.

Masturbation and Relationships

Masturbation is also both common and normal when a person is in a long- or short-term relationship — even marriage. There’s nothing wrong with masturbation in a relationship, unless one partner has a problem with this behavior. In that case, it may be helpful to learn why it’s okay and normal to masturbate in a relationship or marriage.

Most importantly, masturbating takes the pressure off of the relationship to meet all of the sexual needs of both partners, since partners — no matter how perfect they are for one another — rarely share the exact same sexual drives. Masturbation allows the more sexually active partner to release their own sexual tension without constantly requesting sex from their partner. This is empowering and can result in a more healthy overall relationship.

When is Masturbating Bad for You?

Masturbation, like any human behavior, becomes a drawback in a person’s life when it’s done too frequently, or in an inappropriate manner (such as in public, or in front of non-consenting others). In terms of frequency, there’s no number that’s too much (although some might argue that masturbating multiple times a day, every day, for months on end is “too much”).

Instead, what therapists counsel is that when the behavior starts interfering and negatively impacting other areas of your life — or feels like a compulsion — it’s become a problematic behavior that needs attention. For instance, if you’re missing school or work due to your need to masturbate, that’s likely a problem. If you’re staying home rather than hanging out with friends all the time in order to masturbate, that’s likely a problem.

* * *

Remember, masturbation is a normal, health human behavior. Psychological research has shown for decades that this behavior improves most people’s sexual health and self-knowledge. Masturbation is rarely bad for a person, unless they’re doing it to the point of negatively impacting other areas of their life. And remember — not everyone masturbates. That’s okay too, because we all have different sexual needs and drives. Just remember that if you do choose to masturbate, it’s okay to do so without any long-term negative psychological consequences.

 

References

Gerressu, Makeda; Mercer, Catherine H.; Graham, Cynthia A.; Wellings, Kaye; Johnson, Anne M. (2008). Prevalence of masturbation and associated factors in a British national probability survey. Archives of Sexual Behavior, 37(2), 266-278.

Herbenick, D., Reece, M., Schick, V., Sanders, SA,- Dodge, B., Fortenberry, JD. (2010). Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14-94. The Journal of Sexual Medicine, 7, 255-265.

Kott, A. (2011). Masturbation is associated with partnered sex among adolescent males and females. Perspectives on Sexual and Reproductive Health, 43(4), 264.

Reece M, Herbenick D, Sanders SA, Dodge B, Ghassemi A, and Fortenberry JD. (2009). Prevalence and characteristics of vibrator use by men in the United States. J Sex Med, 6, 1867–1874.

 

Thanks to Elsevier and ScienceDirect for access to their research database that helps make articles like this possible.

from World of Psychology https://psychcentral.com/blog/is-masturbation-bad-for-you/

Why Work-Life Balance is Futile—and What to Focus on Instead

Many of us feel guilty, anxious or uneasy when our work overrides family time and vice versa. Maybe lately you’ve been working long hours to meet a variety of deadlines. Maybe you’ve also been working most weekends. Or maybe you’ve been focusing more on family time, which has meant that you’re working fewer hours. You’ve been closing up shop early so you can drive the kids to sports practice, and eat dinner together — and you’re too tired to pull the split shift. Which means email keeps piling up and projects remain unfinished.

Many of us feel guilty, anxious or uneasy because we’re not achieving that so-called work-life balance. We feel like it’s regularly out of our reach.

This is understandable, because we are trying to achieve something impossible, something that doesn’t exist.

Work-life balance is a “placeholder term,” according to Jones Loflin, a speaker and trainer who helps individuals and organizations who struggle with too much to do. It was the best descriptor at the time—“and it stuck.”

But trying to live this way—to have a balance between work and life—is utter futility, he said.

“There will always be days, weeks, or even months where more of our physical, mental, and emotional energy will be required in one area of our life than another.”

Loflin uses the analogy of a high-wire act: The person uses a balancing bar to help them walk across the wire, and that bar is constantly shifting.

So if work-life balance is futile, what is actually useful and helpful?

A better term and concept is “work-life satisfaction.” Because, as Loflin said, it’s really about “making the right choice about where our time and energy is needed right now based on our purpose, goals, values, or whatever principles guide our lives…If we are living our lives in close alignment with our purpose, we are more satisfied with our outcomes. And satisfaction can be measured much more accurately than balance.”

Work-life satisfaction is specific to each person, said Loflin, author of several books, including his latest Always Growing: How To Be A Strong(er) Leader In Any Season. Again, it depends on your values, goals and priorities. For Loflin work-life satisfaction is: “having the desired impact on my world each day.” “It’s the feeling I get when I put my head on my pillow at night and have the satisfaction of knowing I did my best to live this day in alignment with my values.”

To start exploring your own satisfaction, Loflin suggested finishing this statement, and identifying what needs to be changed: “I would be more satisfied with my life if….”

Below, he shared other ways we can explore and boost our work-life satisfaction.

Consider the three key categories. Loflin breaks his life down into these areas: work, self and relationships. He regularly asks himself honest questions about each area to understand his satisfaction. He shared these examples:

• Work: “What did I do to move a project forward today? If I used my time like I did today for the next 30 days, would my business grow or shrink?”
• Self: “Did I start my day in such a way that it provided me with the physical, emotional, and mental energy I needed? Am I a better person because of the choices I made today?”
• Relationships: “Did I do my best to be an encouragement to everyone I interacted with today? Did I do my best to grow at least one relationship today?”

You might create your own questions for each area based on what’s most important and essential to you. You might even come up with your own areas.

Next consider if you’d like to change anything in any of the categories. For instance, if Loflin finds he’s not satisfied with his progress in writing his next book, he explores why he feels stuck and takes action to get moving.

Maybe you’re feeling disconnected from your spouse, so you talk to them about scheduling a date night every Friday. Maybe you feel disconnected from yourself, so you decide to carve out 20 minutes in the morning to journal about your thoughts and feelings and stretch your body.

Identify what’s important to you. Figure out “what you truly want to create and experience,” and “what brings you your greatest joy and makes you feel most alive,” said Loflin. Then figure out what that looks like day to day—and what concrete steps you can take to make that happen.

For instance, Loflin worked with a client whose core value was adventure. Loflin helped the client see that building relationships can be an adventure, too. So one step his client took was creating more engaging conversations.

Take the time to celebrate. Loflin has found that too many people fixate on bashing themselves for what they’re not doing, instead of savoring and celebrating what they are doing. “If you are always chasing work-life satisfaction, you miss the chance to harness the incredible energy that comes when you take a moment to reflect on all the positive things that you have done or experienced.” So what is making you smile right now? What are you enjoying about work? What are you enjoying about your family? What do you feel good about?

Of course, life is fluid. The demands and needs of your job and your family are constantly shifting. So are your own needs.

When we use work-life balance as a barometer, we often end up feeling bad about every area. And that stress, anxiety and overwhelm dampen everything.

The better question is: Are you satisfied in the different areas of your life? Which you can follow up with other questions like: How satisfied? Do I want to make any changes?

Or perhaps this is simply a season where work has a bigger role, or your family does or your wellness does. Either way, it’s up to you—and it’s totally OK that it’s completely out of balance.

from World of Psychology https://psychcentral.com/blog/why-work-life-balance-is-futile-and-what-to-focus-on-instead/

Atypical Presentation of OCD in Children

I’ve been an advocate for OCD awareness for over ten years and have not seen much progress in the understanding and diagnosis of obsessive-compulsive disorder.

Estimates vary but still hover around 14-17 years from onset of symptoms to receiving a proper diagnosis and treatment. That’s 14-17 years of untreated OCD which becomes more entrenched and difficult to treat as time goes by. To me, and I’m guessing to most people, this is not acceptable.

In a July 2018 article published in Comprehensive Psychiatry titled “Atypical symptom presentations in children and adolescents with obsessive compulsive disorder,” the authors detail some lesser-known symptoms of OCD that children and adolescents might exhibit. Typically, clinicians who want to rate the severity of obsessive and compulsive symptoms in children and adolescents use the Children’s Yale Brown Obsessive Scale (CY-BOCS) checklist. This checklist contains the most common symptoms presented in youth with OCD and includes obsessions related to contamination, aggression, and magical thinking, to name a few. Compulsions listed include but are not limited to, checking, counting, cleaning, repeating, and ordering. The CY-BOCS can be an extremely helpful tool for clinicians, especially in diagnosing a more “straightforward” case of OCD. Still, many cases of childhood OCD are either undiagnosed or misdiagnosed. Sure, OCD experts know their stuff, but there just aren’t enough of them to go around. Unfortunately, many mental health providers simply do not know a lot about obsessive-compulsive disorder.

Back to the study mentioned above which describes two distinct types of atypical OCD symptoms found in 24 children. Researchers showed how these symptoms are part of a larger clinical picture, not a feature of an alternate condition such as psychosis or autism spectrum disorder. As explained here:

Twelve of the children had obsessions rooted in a primary sensory experience (such as auditory, olfactory, or tactile) that they found intolerable and which was sometimes linked to specific people or objects. To soothe or avoid the associated sensory discomfort, patients were driven to engage in time-consuming repeated behaviors. Many of these patients struggled with ordinary activities such as eating or wearing clothing and can be at risk of seeming to exhibit symptoms of autism spectrum disorder, especially when the patient has a level of self-awareness that leads them to conceal the obsession behind the behaviors.

The other 12 children had obsessions rooted in people, times, or places they viewed as disgusting, abhorrent, or horrific, and which led to contamination fears connected to any actions or thoughts they saw as related to these obsessions. These kinds of contamination obsessions could result in concrete contamination concerns but more often resulted in abstract, magical-thinking fears of specific, highly ego-dystonic states of being. When the fear was a reaction to a particular individual or individuals, the obsession most often resulted in avoidance behaviors designed to placate a fear of acquiring a characteristic or trait of the individual by contagion. Patients exhibiting these symptom presentations are at risk of being diagnosed with psychosis.

Obsessive-compulsive disorder is complicated and I have connected with a number of people whose family members (or they themselves) have been misdiagnosed with autism spectrum disorder, schizophrenia, and even Bipolar Disorder. These misdiagnoses can have devastating effects on the person with OCD, not only because proper treatment is delayed, but because therapies used for other disorders can make OCD worse.

This case study is a good example:

Master A, 10-year-old male child, with uneventful birth and developmental history without past and family history of neurological and psychiatric illness presented with complaints of repetitive spitting, withdrawn to self, lack of interest in study, repeatedly closing his ears by hands from last 8 months and refusal to take food from last 7 days. He was hospitalized. On physical examination, all parameters were within normal limits except presence of mild dehydration. Intravenous (IV) fluids were started. On initial mental status examination, the patient was unable to express the reason behind this type of behaviour. On repeated evaluation, the patient expressed that he did not want to take food as he thinks that any word spoken by him or by nearby people or any word heard by him from any source were written on his own saliva and he cannot swallow the words with food or saliva. For this reason, he was spitting repetitively, avoiding interaction with people, avoiding food. To avoid any sound, he closes his ears by hands most of the times. He expressed that this type of thought was his own thought and absurd one. He tries to avoid this thought but he was unable to do so. After 6 months of onset of his illness, he was treated by a psychiatrist as a case of schizophrenia and was prescribed tablet aripiprazole 10 mg per day. After 2 months of treatment, instead of any improvement, his condition deteriorated and he visited our department. After evaluation, a diagnosis of OCD, mixed obsessional thought and acts was made… His CY-BOCS score dropped to 19 after 8 weeks of treatment and he was discharged from the hospital.

What I find particularly heartbreaking about cases such as this one is the fact that atypical antipsychotics (in this case aripiprazole) have been known to exacerbate the symptoms of OCD. How many people are misdiagnosed and never receive a correct diagnosis?

Health care professionals need to be better educated about OCD, so at the very least, it will be on their “radar screen” when evaluating patients. Obsessive-compulsive disorder has the potential to destroy lives, but it is also very treatable — once it is properly diagnosed.

from World of Psychology https://psychcentral.com/blog/atypical-presentation-of-ocd-in-children/

Rebel with a Cause? On Taking the Road Less Traveled

Rocking vintage tees throughout law school?

Sure thing.

Shunning a conventional legal job for a flexible writing gig?

You know it.

Turning down an all-expense paid family vacation to Cancun, Mexico for the Spring Break charms (I use that term very loosely) of frigid Duluth, Minnesota?

Of course.

Before reading Gretchen Rubin’s The Four Tendencies, I wondered if I was just different. Not in a creepy, peculiar way — more in a you zig, I zag type of way. My contrarian instincts have always been there, manifesting themself in an overwhelming (and overriding) desire to assert my own distinctive identity.

Call it Mattology.

In her informative book The Four Tendencies, Gretchen Rubin introduces and defines the concept of rebeldom. We rebels are proudly individualistic and iconoclastic — upending conventional wisdom with a knowing smirk on our faces. We revel in our own independence,  prizing autonomy over conformity — even when adhering to the status quo would be a wiser option.

As a self-professed rebel, I love my fiercely independent streak. It has provided an identity — and made my life that much more enriching and dynamic. From backpacking around the world to chronicling my mental health trials and tribulations in an all too public forum, my rebeldom has provided the impetus to flout, at times gleefully, expected social conventions. “Matt, you know, you are 37. You can’t keep crisscrossing the world on your budget flights. Isn’t it time to settle down — find a nice, little house and carve out your own slice of Americana?” my family gently urges.

And my smart aleck response: “Who says? But you know what — maybe you are right. I’ll settle down .. into my comfortable airline seat on my next far-flung adventure.” You can imagine how that response goes over (I will summarize: head-shaking disbelief).  

While I revel in my autonomy, rebeldom — as I imagine my fellow rebels know all too well–can cause tension — even strife. Chafing at constraints — either internal or external, we want the flexibility to do what we want to do when we want to do it. We will get the job done (relax, supervisor) but it needs to be on our schedule. Needless to say, this, ahem, scheduling flexibility can pose problems–particularly for more rigid, domineering types. Case in point: a former supervisor, who incidentally had a military background, wasn’t exactly enamored with my scheduling ideas. Shuffling into his office for his daily 8:30 AM (don’t be late!) monologue, I realized — perhaps all too well — that not everyone operates on my idiosyncratic timeline.

There is a solution to this — as Mrs. Rubin hints in her thoughtful exploration of the rebel prototype. We rebels need a cause — something worthy of devoting our creative energy. In my case, mental health awareness serves as my cause celebre. My mental health advocacy efforts have reinforced my identity–that of impassioned advocate committed to something bigger than myself. But before consummating my employment marriage with Psych Central (yes, I will be approaching year four of, I hope, thought-provoking contributions), it has taken years — even decades — of employment search and discover to pinpoint that true passion. And, at least in my case, that has meant a decade plus languishing in mind-numbing jobs — feigning interest over squabbling insurance companies as I counted down the nanoseconds to 5:00 PM. Happy Hour indeed.

You see, we rebels are part contrarians and part idealists. We scorn convention but crave something — a cause, an organizational mission — that stirs our soul. And while we may be contrarians — priding ourselves on rejecting society’s seemingly capricious rules, ultimately we want something — anything — that we just can’t say “No” to.

from World of Psychology https://psychcentral.com/blog/rebel-with-a-cause-on-taking-the-road-less-traveled/

Psychology Around the Net: September 29, 2018

Happy Saturday, sweet readers!

This week’s Psychology Around the Net gives tips on how to spot unnecessary opioid prescriptions, offers ideas for emotional self-care you might not have thought of, takes a look at legislation requiring mental health disclosures by students, and more.

Parents Are Leery of Schools Requiring ‘Mental Health’ Disclosures by Students: Legislation passed after the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida requires Florida school districts to ask whether a new student has ever been referred for mental health services, and some parents are wondering: Will this actually help troubled students, or increase the stigma of mental illness?

How Netflix’s ‘Maniac’ Uses Mental Illness to Interrogate What It Means to Be Normal: Without giving anything away, Netflix’s new show Maniac “tackles the idea of achieving normalcy despite mental illness by thrusting its characters into bizarre, otherworldly landscapes.” [SPOILER ALERTS IN ARTICLE]

How to Spot an Unnecessary Opioid Prescription: Opioid addiction is devastating so much of our country; it’s no secret, and if you live in an area that’s suffering particularly hard, you don’t need any fancy studies to prove it. According to new research, one thing that could be contributing to opioid addiction is an inappropriate prescription. Here are a few ways you can talk with your doctor and determine whether an opioid prescription is necessary.

8 Ground Rules for Better Emotional Self-Care: These tips go way beyond just taking some time to yourself.

Octopuses On Mood Drug ‘Ecstasy’: By giving particularly unfriendly octopuses the mood-altering drug ecstasy, scientists say they’ve found preliminary evidence of an evolutionary link between the social behaviors of humans and the sea creature. Says lead investigator Gül Dölen, M.D., Ph.D., “The brains of octopuses are more similar to those of snails than humans, but our studies add to evidence that they can exhibit some of the same behaviors that we can […] What our studies suggest is that certain brain chemicals, or neurotransmitters, that send signals between neurons required for these social behaviors are evolutionarily conserved.”

Why Emotional Labor May Be Physically Hurting Women: Despite the strides we’ve made in equality, studies show the bulk of the “second shift” (all the family- and household-related work — everything from physical work like cooking and cleaning to mental tasks like planning vacations and coordinating schedules) falls on women. Not only does this affect women mentally by increasing stress and anxiety, but also it can hurt them physically.

from World of Psychology https://psychcentral.com/blog/psychology-around-the-net-september-29-2018/

The Power of One: A Supportive Adult Has Huge Impact in the Life of an Abused Child

One person.

One act of kindness.

One changed perspective.

One acknowledgement of pain.

One offer of support and encouragement.

Both in my work as a child psychotherapist and personally as a survivor of childhood abuse, I’ve seen what a difference these “ones” can make to a child who is living with domestic violence. Children are resilient. They can survive and even thrive after unthinkable trauma. But that resilience generally comes from having a caring adult in their life who supports them and helps them make sense of the situation.

For me, that person was my paternal grandmother, a hearty, hardworking, no-nonsense New Englander who never complained despite the abuse she received from my grandfather. She sheltered me and gave me tools to avoid his and my father’s wrath. But more importantly, she was a kind, gentle woman who loved me unconditionally, encouraged me, and helped me feel safe.

Children’s responses to domestic abuse are varied and impacted by numerous factors. Age, birth order, temperament, innate coping strategies, the severity of the abuse and the relationship with the abuser can all impact a child’s reaction. Some children find ways to cope and may not show any outward signs of distress, others may exhibit extreme behavioral changes, and yet others may fall somewhere in between. Withdrawal, clinging, tantrums, sleep disturbances and increased fear and anger are some of the reactions that can emerge at home or at school. Depression, anxiety, difficulty concentrating and hypervigilance can impact academic and social functioning. Lifelong health or behavior problems often result.

As the oldest child, I shouldered the responsibility of protecting not only my mother but my younger siblings as well. I would take my younger sister into a closet to escape my father, something she experienced as a fun game, thankfully unaware of my more serious motivations. Taking on this caretaker role is a common coping strategy, especially of eldest children. It is fueled by the mistaken assumption that they are to blame and that by understanding triggers and changing their behavior they can predict and mitigate the abuse.

Another strategy that children adopt is to become “bad” to divert attention away from the abused parent in an effort to protect them. Still others identify with the abuser and become disrespectful and aggressive toward the non-violent parent. All children receive flawed messages about relationships that may be interpreted in a variety of ways. Many repeat the domestic abuse in their later relationships, either as the abuser or the abused, believing that problems are solved by either aggression or passivity.  It’s what they’ve learned and they don’t have a framework for anything different.

Others grow into their futures determined to do things differently. And that determination and resilience is often due to having had someone in their life — a parent, grandparent, teacher or coach — who acknowledged the reality of their situation, who showed them a different way, and who helped them feel safe and secure. My grandmother was the initial “one” who protected, guided and encouraged me. Others would follow, reflecting my strengths and reinforcing the seeds of resilience that my grandmother had sown.

Working with children and teens I’ve heard many stories, similar to mine, of people who made a difference to them when they were a child. Often it was a relationship with a teacher for a year or a family member or friend for many years. In other instances, it was as simple as a random kind word or gesture. There are many circumstances in our lives today in which we feel powerless, including trying to change the abusive behavior of some adults. Nevertheless, we all have the capability to protect, support and validate a child who needs that “Powerful One” in their lives.

*If you concerned that a friend, family member, coworker or someone else you know may be in an abusive relationship, contact the National Domestic Violence Hotline.

from World of Psychology https://psychcentral.com/blog/the-power-of-one-a-supportive-adult-has-huge-impact-in-the-life-of-an-abused-child/

#MeToo: The Psychology of Sexual Assault

As more and more men in powerful positions find themselves suddenly out of a job because of the women who’ve bravely come forward to share their traumatic experiences in public, it’s easy to forget how much of an ongoing, serious problem sexual assault is today. It’s easy for many men (and even some women) to brush off such accusations or behaviors with trite but insulting excuses, such as, “Boys will be boys.”

Sexual assault is a serious and devastating violent criminal behavior. It often leaves a traumatic scar on the victim that no amount of time heals or lets the victim forget. It is time our culture stopped making excuses for these dishonorable (mostly male) criminals.

Sexual assault (and its twin, sexual abuse) is not about the act of sex to the abuser. Rather it is about the power differential between the abuser and the victim. Most of these crimes are committed by men toward women, and most people know their abuser. Sexual assault usually refers to the behavior when it is of short-duration or infrequent, but for the victim of such crimes, such distinctions don’t matter much.

Sexual assault in the United States is sadly common. According to the National Sexual Violence Resource Center, 1 in 5 women have reported being raped at one point in their lives (and 1 in 71 men). On college campuses, that number rises to 1 in 4 women (and 1 in 7 men). Over 92 percent of the time, it is either by their intimate partner, or by an acquaintance. About 91 percent of victims of rape and sexual assault and rape are women, while nine percent are men.

Sexual violence is even more common. One in three women have reported an incident of sexual assault in their lifetime, as well as 1 in 6 men. Few victims formerly report these crimes to the police. According to one popular model about sexual violence, “men with a strong impersonal sex orientation (i.e., greater engagement in sexual activities with more casual sexual partners) are at increased risk of perpetrating sexual violence” (Davis et al., 2018).

Sexual abuse can take many forms, but it always includes a component of unwanted sexual activity forced on the victim. That activity can and most often does involve direct contact with the victim, but may also be forcing the victim to watch the perpetrator engage in a sexual activity on their own or inappropriately show their genitals. Perpetrators of sexual abuse think nothing of making threats to get what they want, using force, or taking advantage of a victim’s role (such as an employee).

Perpetrators of sexual abuse take pleasure in inflicting their will onto the victim, as well as the victim’s powerlessness. Some sexual abusers use alcohol or drugs to ensure a compliant, intoxicated victim. Using drugs and alcohol seems to reduce the likelihood of the victim reporting the crime to the police, as the victim will often blame themselves for taking the drugs or alcohol (although the administration of drugs is often non-consensual).

Many powerful, prominent men who engage in sexual assault believe they are owed the right to both verbally harass and sexually abuse whomever they want, whenever they want. They believe their position of power — whether it comes through wealth, family background, work role, politics, or corporate leadership — negates ordinary cultural and societal norms. “I’m owed this, and you can’t do anything about it — who would believe you over me?” is a common refrain for these men.

Trauma Can be Lifelong, Relentless

Criminal sexual assault behavior by a perpetrator onto their victim usually results in the victim dealing with the aftermath of the trauma throughout their life. According to the National Sexual Violence Resource Center, 81 percent of women (and 35 percent of men) will suffer from post-traumatic stress disorder, anxiety, major depressive disorder, or some other disorder due to the assault.

“Survivors of sexual assault appear to be at substantially increased risk for suicidal ideation and attempts; indeed, relative to other conditions, sexual assault was associated with the highest increases in risk for suicidality” (Dworkin et al., 2017). These same researchers, in a comprehensive analysis of the sexual assault research literature, also found that victims are at increased risk for obsessive-compulsive disorder (OCD) and bipolar disorder.

Perpetrators rarely think of, much less care, about the impact of their behavior on their victim. When they do think about it, it is almost always in the context of believing the victim only has themselves to blame for putting themselves into a situation with the perpetrator.

Psychotherapy can often help a victim of sexual assault. The healing process is usually lengthy, as many victims blame themselves (as society too often does as well) for somehow helping to bring on the sexual assault. Nobody would ever want such a thing to happen to their best friend, much less themselves, but this kind of cognitive distortion is common among victims. Time also helps to heal the pain caused by sexual assault, but in most people, it is usually not enough on its own.

Why don’t most sexual assault victims report the crime to the police? Because victims often feel like they are victimized a second time, by having to go through the details of the incident (often more than once) with law enforcement officers. Most of these folks are well-meaning, but not all of them are properly trained on how to handle sexual assault reports, and how to do so in a compassionate and empathetic manner. Nearly every such law enforcement contact will include questions that suggest the victim might be partially to blame, such as, “What were you wearing at the time of the assault?” and “Did you have anything to drink?”¹

Society’s Role in Perpetrating Sexual Assault

Society needs to stop re-victimizing the victims of sexual assault (“What were you wearing?” “Did you drink too much?” “Did you resist?” “Are you sure he knew you didn’t want to?”) and focus its efforts on teaching perpetrators of this crime that people’s boundaries and rights must be respected at all times. Lack of consent during sexual activity is not consent.

Just because a person is in a position of powerful over another person doesn’t give them the right to act out their violent behaviors. Society and family members need to stop making excuses for perpetrators behaving badly (“Oh, that’s just locker-room talk” or “They were only 18, what do they know?”), and start enforcing the idea that honor and respect carry far more weight and value. Women are not there to be subjugated or victimized.

Get Help & Helping Others

If you’re a victim of sexual assault, there are many resources available to you. The first and best place to start is at the National Sexual Violence Resource Center. Their “Find Help” resource page offers a directory of resources for your area, including victim support organizations that can be of further help.

The Rape, Abuse, & Incest National Network, organizes the National Sexual Assault Telephone Hotline, a referral service that can put you in contact with your local rape crisis center. You can call the Hotline at 1-800-656-4673, or access their online chat service.

If you’re a perpetrator of sexual assault, you need to get help immediately. This dysfunctional behavior has likely caused significant harm to one or more people in your life — harm that will likely never go away completely for them. There are many psychologists and other therapists who specialize in helping perpetrators of sexual assault. Reaching out to one today is a proactive sign of strength.

If someone comes to you to share with you that they’ve been a victim of a sexual assault, please listen to them without judgment. Be an active listener and offer them unreserved emotional support. Help them figure out what kind of help they want and need, and then, if they need it, offer to help them with accessing those resources. Do not ask questions about the assault unless they indicate that they’d like to talk about it. Encourage them to get help — but don’t nag them or suggest there’s only one “right” way to react to the assault.

Remember that, if you’re a victim, help is available. And if you’re a victim of sexual assault, please know that it is not your fault. Professionals and your friends will believe you, even if your own family or certain people in your life don’t. Please, reach out and get help today.

 

References

Dworkin, ER, Menon, SV, Bystrynski, J, Allen, NE. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. Clinical Psychology Review, 56, 65-81.

Davis, KC, Neilson, EC, Wegner, R, Danube, CL. (2018). The intersection of men’s sexual violence perpetration and sexual risk behavior: A literature review. Aggression and Violent Behavior, 40, 83-90.

Footnotes:

1. These are insulting, dumb questions. Do police ever ask victims of a mugging, “Well, did you wave your wallet or purse around in public?” and “How much did you have to drink?” Of course not. It’s a ridiculous double-standard that is one of the reasons victims don’t want to go to the police.

from World of Psychology https://psychcentral.com/blog/metoo-the-psychology-of-sexual-assault/

Best of Our Blogs: September 28, 2018

Do you ever feel so busy that when you wake up you feel about a day behind?

There’s so much things that can easily occupy your time especially now that we’re in the fall season. If you’ve got kids, there’s another load of to-dos with school, homework and extracurricular activities.

There’s podcasts to listen to. There are all those books on your nightstand. There’s that unfinished project you need to get to and oh yeah, exercise!

Instead of wiping yourself out before the holidays, try doing one of the rituals in our top post this week. It’ll ground, calm and remind you where you really should be devoting your time.

How To Get Rid of Negative Energy Through Mindfulness
(Reaching Life Goals) – Ready to shake off all that negative energy? This post is bursting with unique ways to do so.

Why Small Talk Causes Anxiety
(Relationships in Balance) – Hate small talk? Read this.

Oh, the Subtle Disrespect of Narcissists
(Narcissism Meets Normalcy) – Here’s what it looks like when your houseguests are narcissists.

20 Nourishing Rituals to Try
(Make a Mess: Everyday Creativity) – It takes, but a few of these to inspire calm and remind us what’s important.

Mothers and their Adult Daughters: Should They Be Friends?
(Full Heart, Empty Arms) – Why are mother and daughter relationships so hard? If moms could do this, an adult friendship could be possible.

from World of Psychology https://psychcentral.com/blog/best-of-our-blogs-september-28-2018/

Should I Write to Ask the Therapist?

The team at Psych Central’s Ask the Therapist is part of a stream of history that started almost 300 years ago.

The first recorded advice column was in 1690! For centuries, people have looked to sometimes anonymous “experts” for advice about love and romance, family relationships, social and work problems, and internal distress. Over time, the format has been much the same: People write in their questions and the advisors advise.  

Every day, PsychCentral’s four-member team of psychologists and social workers answer questions from people all over the world.

There are about 270,000 page views each month by about 108,000 viewers. Why?

I’m sure that, for some, it is curiosity about other people or interest in comparing their own answers to ours. Others have not yet found the courage or think they don’t have the ability to write about their own situation. They therefore look for our responses to other people who have problems similar to their own.

But hundreds of people do write.

Our inbox contains letters from teens, young and not so young adults, every gender, and many different countries. They come from all economic, religious, and ethnic groups. Writers are people who are worried about how they are feeling or upset about interactions with people they care about or confused about how to handle a stressful situation. Some are merely curious about psychology. Some are in deep distress.

Should you send us an email too? There are many positive reasons to do so:

To organize your thinking. Just writing a problem down is often helpful. Explaining anything to someone else requires slowing down and thinking about what you need to say and how to say it. You may be surprised, when you look at what you’ve written, to see the problem in a new and sometimes solvable way. If not, we can perhaps offer another way to look at the situation or direct you to appropriate sources of support.

To dump some of your distress: Sometimes it helps just to “dump” or “vent.” Writing to us can get something off your chest and into our mailbox. Sometimes that’s enough. You don’t want to bother friends or family. You do want a place where you can express yourself freely – and anonymously.  We’re here for that. We’re here to let you know you are not alone. We might even have some ideas about how you can manage the problem.

To sort information: The internet is a wonderful source of information. But it can sometimes be difficult to sort through the sheer volume of sites. What is legitimate research? What is sensationalism? What is really applicable to you? How can you reconcile contradictory opinions?  If you are having difficulty making sense of what you are reading or if what you are finding online is stressing you out, we can help you sort it out.

To get a diagnosis: I’m sorry. It is unethical for us to diagnose on the basis of a short letter. But if you have been attempting self-diagnosis, you might find it reassuring or enlightening to write to us. Self-diagnosis is often incomplete, at best, and often inaccurate. Often it is anxiety-provoking. In cases where we think symptoms are consistent with a particular diagnostic category, we will encourage you to seek a mental health assessment to confirm it. On the other hand, our experience may lead us to suggest that your suffering is attributable to something besides mental illness. Feelings and behaviors that might indicate a mental illness can often be explained by medical, developmental and/or cultural issues. If that’s the case, we’ll refer you to professionals or resources who can help. Sometimes we may suggest that you are going through a perfectly normal, though uncomfortable, developmental phase. Sometimes we may remind you that being anxious or depressed is a normal response to an abnormal situation.

To spare your support people: Yes, we all can and should reach out to the people who count in our lives when we are troubled. But sometimes they have listened and listened and done their best to be helpful but you have a sense that they just can’t take in more of your stress. Sometimes they have troubles of their own. Sometimes they feel helpless to help. Writing to us spreads out your distress and expands your support circle.  In addition, we may encourage you to join one of the PsychCentral forums, to explore support services in your community, and/or to make an appointment with a professional.

What the Ask the Therapist team offers:

Credentials: In my opinion, it is unfortunate that many advice columns have been written by people with no credentials in psychology or mental health, or who have advanced degrees in an irrelevant profession. In contrast, all of us are licensed psychologists or social workers. All of us have years of experience working directly with people from all walks of life and with the full range of diagnoses. For detailed information about each of us, click on the Help tab on the home page, then click on “About our Therapists.”

Respectful answers: There are advice columnists who seem more interested in using people’s letters for their entertainment value than in providing real help. Not so at PsychCentral. We think witty responses to someone’s pain aren’t funny. Blaming or shaming people may play into the negativity currently permeating our culture but we think it is disrespectful and rude. We never call people names or bully. Yes, there is sometimes a place for humor, but never at a writer’s expense. Although a glib response might be more hip or entertaining, we believe letter writers deserve better than a pop, slap dash, way cool answer. Our team has always treated serious problems seriously.

Hope. Yes, hope. As a team, we believe in the resilience and potential for recovery and growth of our writers. We do the best we can to respond to the immediate problem and to offer encouragement, support and hope. Whenever we can, we identify next steps and encourage people to take positive action.

Should you write to us?

If you are asking that question, you probably already have the answer. You have a problem you haven’t been able to solve on your own. If you could, you would have done it already.

You have nothing to lose by sharing the problem with us. There are no guarantees that our advice will be helpful but we’ll do our best. Chances are we can provide a new perspective on the situation, some practical ideas, new resources to explore, or some peace of mind.

You deserve it. You are worth it.

from World of Psychology https://psychcentral.com/blog/should-i-write-to-ask-the-therapist/

Trapped in the Mirror: The Pain and Performance of Narcissism

Apparently it’s everywhere.

In the millennial selfies.

In slickly constructed and curated instagram accounts showcasing sex appeal and perfect lives.

In the boardroom, the seats of power and at the highest levels of government.

The narcissist is your ex-partner who fights you over the children, the boss who has no empathy for your mistakes, the co-worker who steals your ideas, the neighbor who stymies your extension.

But the reality of narcissism is far different.

In “The Life of I,” cultural theorist Anne Manne provides an account of our current ills as a society sick with self-aggrandizement and solipsism. 

Ranging from the evil of Nordic mass murderer Anders Behring Breivik to the phenomena of selfies and celebrities, Manne describes our obsessions and weaknesses  —  and that we all have a tendency towards narcissism.

In developing her argument, Manne takes on the diagnostic picture of NPD, including an allusive analysis of the DSMV, but neglects the wider clinical picture, which can be both more subtle and more complex.

Although Manne’s is one of the more thoughtful explorations of narcissism, she unfortunately adds to the current conception of narcissism as a cultural phenomenon rather than an illness.

The clinical is in danger of being subsumed by the cultural.

The real problem with this kind of cultural analysis is that it adds to the public discourse around the idea of narcissism and posits narcissism as an idea, a concept, rather than a human failing, and an illness.

People with an axe to grind, the newly divorced and the already abused — anyone with a social media account and an inconvenient ex, have created a wave of internet fury that tips everyone they don’t like into the hateful (and hated) pit of narcissism. 

There is not much room in this pervasive vitriol for the reality of living with a serious illness like NPD. 

The lack of substance and identity that lies at the heart of narcissism creates ongoing pain and, yes, the need to perform socially in order to be seen, and seen well. Dependent on the feedback and approval of others to keep themselves together, people with Narcissistic Personality Disorder (NPD) struggle for recognition and selfhood, two things that were denied them in their often abusive childhoods. 

NPD sufferers were often the victims of parental narcissism; emotional abuse from which there was no escape. Constantly belittled, bullied and rejected by those who should have offered love and acceptance, they develop defenses which can make them unattractive — and socially challenging. 

As adults, people with NPD usually find it almost impossible to be vulnerable.

Vulnerability is associated with shame and sufferers will usually do anything to avoid the terrible feelings accompanying any hint of humiliation or criticism, often dissociating in response to unexpected feedback from an important other, making them appear defensive and difficult. (Which they no doubt are.) 

Those struggling with NPD don’t always present in the ways suggested by the popular stereotypes.

They are not always flamboyant or gregarious.

Nor do they always have to be the life of the party, charismatic and self-obsessed.

The shy or “covert” narcissist can be more challenging to pick and is often subtly self-deprecating, whilst still desperately seeking the assurance and approval of others to bolster their shaky sense of self.

People with NPD find it hard to come to (and stay in) therapy. They are reluctant to share their vulnerabilities and will often project difficult feelings onto others  —  including their therapist. They can respond with cold rejection and sometimes rage to being questioned or challenged. It can be almost impossible for employees to survive a manager with this disorder and trying to have a relationship with someone who has NPD is tough.

It’s not an easy or a pretty picture. 

People close to those with NPD are often left to pick up the pieces after trying to make a relationship with a narcissist work, wondering what happened and how they got sucked into the vortex. Often there is very limited give and take, and people with severe narcissism find it hard to accept or make room for another’s world view or emotional needs  — they are too constrained by their own needs for reassurance and acknowledgement, without being aware of their limitations — or their underlying lack of identity.

People with this disorder have a model for relationships that is skewed towards mutual exploitation rather than real mutuality  —  as that is how they were treated by their caregivers.

It can be a very lonely existence.

In contrast to those with BPD, people with NPD will avoid any acknowledgement of the need for others, although the two groups of people share a common core deficit in identity caused by early emotional abuse.

Although they overtly deny dependence needs, the reality for people with NPD is that they do need others and are critically reliant on social feedback to manage their self-esteem.

Recent studies looking at empathy in NPD have found that (in contrast to common perceptions) people with the disorder are fully capable of experiencing empathy. However, because they have experienced early relationships which were exploitative and in which they were not acknowledged as separate and autonomous beings, the pathways to feeling empathy are compromised.

Feelings of any kind other than anger can be a source of pain for some people with NPD and in extreme cases certain feelings will flood and overwhelm their system. They may experience dissociation as an unconscious coping mechanism to deal with the leftovers of primitive panic and abuse. For this reason from the outside, sufferers can appear shallow. It is easier for them not to feel anything. But, of course this is not a long-term solution and will compromise their ability to have meaningful relationships.

For those around them, people with NPD can seem to be a world unto themselves, with limited emotional connection or shared acknowledgement of the frailty that is part of being human.

For sufferers, life is an endless treadmill without any sense of connection or trust. People with NPD are prone to anxiety, perfectionism and workaholism to the point of exhaustion and self-harm. They can compromise their health in pursuit of acknowledgement and worldly success and will suffer depression when their dreams of grandeur are deflated by reality.

References: 

Manne, Anne, “The Life of I: the New Culture of Narcissism”, Carlton, Victoria, Australia : Melbourne University Press, 2015. 

Ronningstam, Elsa, Baskin-Sommers, A.R. and Krusemark,Elizabeth “Narcissistic Personality Disorder: Clinical and Empirical Perspectives”, PRACTICE REVIEW, Personality Disorders: Theory, Research, and Treatment 2014, Vol. 5, №3, 323–333

from World of Psychology https://psychcentral.com/blog/trapped-in-the-mirror-the-pain-and-performance-of-narcissism/

TPCS Podcast: 100th Episode Extravaganza

Okay, “extravaganza” might be a bit of an exaggeration. But it really is the 100^th episode of The Psych Central Show. As such, we thought it would be fun (and maybe a bit educational) to take a look back on The Psych Central Show, from its conception to the current day. Michelle Hammer, co-host of A Bipolar, a Schizophrenic, and a Podcast, joins the show as “host for a day” to ask Gabe and Vincent to share their perspectives on the show as its hosts and to answer some common questions. Listen in for some inside scoops and a lot of laughs.

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Show Highlights:

“It is nice to be popular enough that people want to attack us.” ~ Gabe Howard

• How did The Psych Central Show come to be?
• How did Vincent get the job as co-host?
• What are some favorite episodes?
• Michelle Hammer’s crappy pitch.
• How guests are chosen for the show.
• Unmet expectations of the show.

 

About Our Guest Host

Michelle Hammer was officially diagnosed with schizophrenia at age 22, but incorrectly diagnosed with bipolar disorder at 18. Michelle is an award-winning mental health advocate who has been featured in press all over the world. In May 2015, Michelle founded the company Schizophrenic.NYC, a mental health clothing line, with the mission of reducing stigma by starting conversations about mental health. She is a firm believer that confidence can get you anywhere. To work with Michelle, visit Schizophrenic.NYC.

About The Psych Central Show Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

 

 

Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.

 

 

from World of Psychology https://psychcentral.com/blog/tpcs-podcast-100th-episode-extravaganza/

How Do You Get What You Want in Relationships — Do You Rebuke or Request?

In a good relationship, partners express appreciation for each other often. They also say in kind ways what they want and what they don’t want. They don’t expect their partner to read their mind.

So don’t be afraid to ask for what you want.

Keeping a grievance inside can result in a relationship-destroying grudge. Calmly bringing up a matter that distresses you can clear the air and renew the warm feelings that were there before knots started tying up your insides.

This doesn’t mean you should point out every little fault or mistake. For a relationship to remain healthy, it’s important to tolerate minor annoyances and focus on the big picture of how well the two of you get along.

Virtually no one wants to feel criticized, so it helps to process your thoughts and emotions before speaking up. Instead of holding on to feeling wronged by the person, you’ll be able to focus more on what you’d like him (or her) to do differently. Your words, voice tone, and body language can convey your request in a way that shows loving concern. You’re wanting him to stop doing something that is harmful to himself, yourself, or others.

Examples of How to Request

Lynne liked Hunter very much. The first time he seemed to be flirting with the waitress who served their dinner, she thought she might be imagining it. Not wanting to make a big deal over what could be nothing, she held her tongue. But it happened two more times, and she felt insecure.  He was thirty-five and ready to settle down, he’d said, but he wasn’t acting that way. Lynn told herself he couldn’t be couldn’t be serious about her if he enjoyed chatting it up with waitresses. She was tempted to stop seeing him, but wasn’t quite ready because he has so many good qualities.  

Finally, she told Hunter, “I like being with you very much, so I think you’d want me to tell you about something I find disturbing. When you flirt with a waitress, I’m uncomfortable. I want to feel special to you, not like you’re attracted to someone else, whether or not I’m present.”

Hunter took her message to heart. He said, “It’s a bad habit. I’m sorry I made you uncomfortable. It’s my insecurity showing. I think I do the flirting to prove that women find me attractive. I won’t do it again.”

Had she withheld her feelings and her request, Lynn probably would have built up a grudge and ended the relationship. Instead, she gave him a gift: the opportunity to correct his behavior.

Maybe you feel annoyed by someone who regularly interrupts you, is often late, or forgets your birthday. Whatever is important enough to address in order to keep the two of you on an even keel is grist for a respectful conversation that focuses on what you would like him to do next or from now on.

Accepting Requests Graciously

In a good relationship, requests go both ways. What if he says, for example, that he dislikes being interrupted by you, that it makes him lose his train of thought? You may have a knee-jerk reaction to feel offended. But if he’s telling the truth respectfully, thank him, even if he doesn’t add the ideal, “I’d like you to be patient so I can finish speaking before you respond.”

Constructive feedback, offered in a loving way, helps us grow. When we become more aware of when we’re about to behave in a way that we’ve learned upsets someone, we’ll be more likely to switch gears and do better. Consequently, we’ll probably also improve our relationships with friends, family members, and others.

Polishing the Rough Edges

Partners in lasting, fulfilling relationships focus mostly on each other’s positive qualities. But they also respond to each others imperfections constructively and graciously. If they didn’t, they could stay stuck behaving in ways that could distance themselves from each other emotionally.

Rebuke is like sandpaper. Couples who use it wisely, stating it as a request, smooth out each other’s rough edges over time while remaining emotionally close.

Jen explains how she does this with her husband. He leave crumbs on the counter, which annoys her. She simply tells him nicely, “It would help me out if you would wipe the crumbs off the counter.”

A friend told her fiancé about an engagement ring she liked, “It would make me happy if you would get me this one.”

Regardless of how nicely you put it, however, there’s no guarantee that the person will do what pleases you.

But how will you know if you don’t try? Regardless of the outcome, you’re likely to learn something. It may be to accept minor imperfections, or it may be that the world doesn’t come to an end when we ask for what we want. Or, as often happens, we learn that our partner wants to please us and to do his best to make us happy.

from World of Psychology https://psychcentral.com/blog/how-do-you-get-what-you-want-in-relationships-do-you-rebuke-or-request/

Trusting Her Voices: Trusting My Own

There was something different about this seven-year-old who at such a tender age had already lost her father. And if that adversity was not enough, Christine was struggling to fit in and keep up. Yet, there was something about this lost and lonely girl, some palpable sense I had of her resilience. After a psychoeducational evaluation, carefully chosen recommendations, and consultation with her mother, it would be 15 years before I next saw this girl. She was now a woman who was, perhaps not unsurprisingly, still struggling to fit in and keep up, this time with a far-less accepting college crowd and the rigors of an academic curriculum that was really of little interest to her.

I was immediately struck by how she was at the same time both young for her age and an old soul- isolated, enigmatic. In her “backpack of wonders,” as I silently called it, she had a number of amulets drawn from characters of popular culture; wore T-shirts advertising her fascination with or perhaps identification with popular teen icons, and soon revealed to me that she had learned to populate the empty rooms of her life with what she called her ‘All-Girls Group.’ “Voices in her head, damn!”, I thought to myself. Could I have so badly wanted to see that struggling child in the most benign light all those years ago, denying the possibility of early onset schizophrenia? A rising sense of panic muddled my thoughts. Critical, self-questioning voices.

What to do? Query her mother more deeply? Do a thorough psychological evaluation? Refer her immediately to a psychiatrist? Consider the possibility of hospitalization? These were the voices in my head, and while I did not ignore them, I addressed each of them, ruled out immediate danger, and opened myself to Christine’s inner world. In the process, I got to know Laura, a “real” young woman who chronicled her lifelong battle with cystic fibrosis in the book Breathing for a Living. I met Lisa, the take-no-prisoners character from Susanna Kaysen's Girl, Interrupted. And after being granted membership as the “only boy” in Christine’s exclusive private club, went to work with her, following her lead, suspending my voices, getting to know hers, and following her lead in trying to plot a therapeutic path for us and for her.

That phase of therapy ended abruptly following a surgical procedure for Christine and loss of the family dog, which I imagine were very destabilizing for her. I later found out that she had joined the Army. “Of all places to go… They will eat her alive.” When she arrived several years later to reconnect and reinitiate our work, I found out that Christine’s group had abandoned her to the military thinking it the wrong decision. But with some creative re-framing, she accepted the notion that her support team thought the Army would be an important test for her and that she had to go it alone.

And, as to be expected, Christine experienced considerable adversity during her short stay with Uncle Sam-a belligerent drill instructor, unaccepting platoon-mates, brutal physical rigors and loneliness Broken and alone, Christine hobbled back into her life and somehow her “girls” found her, flocked to her side, lifted her on their backs and marched her back to school...and life. Along the way, their numbers increased to include a few new select members, this time a few male figures- all strong, all supportive, all with stories of survival and resilience, just what she needed.

Christine finished her college degree, tried a few different jobs in the computer field, and as of this writing, was still searching for the very same things she was looking for when I first met her as a child. I see her whenever she calls, trust that she is never alone, and long since separated myself out from the voices in my head that did not trust the voices in hers. I don’t believe that Christine ever dis-trusted her voices - that was me, although I never showed it to her. I think I was only able to accept hers when I was finally able to subdue my own.
 

from http://www.psychotherapy.net/blog/title/trusting-her-voices-trusting-my-own

Taking Care of Your Mental Health at Work

Given how much time people spend at work (usually about half our waking hours during the week), we probably should be thinking and talking more about mental health at work. Few small to medium-sized companies pay much attention to this topic, feeling that employees should just come to work, do their jobs, and be easy to work with. Usually the reality is much different.

That’s why it’s great to see Britain’s Prince William addressing this issue head-on with a new website in the U.K. that acts as a clearinghouse to better understand mental health at work. It’s a great effort and one I’m happy to highlight today.

Earlier this month, the U.K. charity Mind released the results of its workplace survey finding that half of workers have experienced a mental health problem in their current job. That’s an eye-opening statistic and should be cause for concern by most employers.

[…M]ore than 44,000 employees also revealed that only half of those who had experienced poor mental health had talked to their employer about it, suggesting that as many as one in four UK workers is struggling in silence.

Talking to your employer about your mental health is not always recommended, as varying employers will have different levels of sensitivity to the issue. In some jobs, there may be little they could do even if you did talk to them about it. In other jobs, acknowledging mental health concerns may get you suspended — or even fired (even though that’s against employment laws; they get around the laws by claiming diminishing work performance without mention of the mental health concern).

But you shouldn’t ignore your mental health at work, either, or try to sweep it under the rug. If you’re being bullied at work, feel stressed-out by a boss’s inappropriately aggressive or sexual behavior, or haven’t found productive ways to deal with disagreeable co-workers, you need to take action. For some, that may mean trying to work it out directly with the individual who’s causing you stress. If ineffective, it may mean taking it up a level to your supervisor or boss, to try and work it out amicably.

Sometimes, however, we can’t actually change much about our work situation or environment (outside of changing jobs or companies, which may not always be easy or possible). If that’s the case, you can still change how you approach work and how you deal with the stress it causes in your life. This may mean roping in your company’s Employee Assistance Program (EAP, if your company has one), a free service that offers (usually confidential, but check first) counseling to an employee. If an EAP isn’t an option, you can also consider talking to a therapist (either face-to-face or online, right now).

Mental Health at Work Website

The new website features a variety of content and resources for people who are looking to better navigate mental health at work:

• Toolkits
  Collections of resources from other websites that can give you a good sense of the topic, which range from workplace stress and dealing with stress in specific types of workplaces (like the financial sector, emergency services, volunteer organizations, etc.), to tips for managers and how to promote a positive culture.
• Resources
  Currently 133 specific resources are listed here, and are specific articles that may help you learn more about supporting mental health in the workplace. You can filter resources by type, workplace sector, type of workplace setting, or the role you hold at the workplace.
• Case Studies and Blog
  These areas of the website are more sparse, but could offer valuable case studies and additional information and updates in the months to come.

This new effort builds upon Prince William’s previous work for a mental health campaign called “Heads Together.” Launched in 2016 with his brother, Prince Harry, that campaign continues and offers additional mental health resources for people at all stages in life.

The more we continue the conversation in talking about our mental health, the more we reduce the discrimination and prejudice that can still be found in society today.

 

Learn more: Mental Health at Work

from World of Psychology https://psychcentral.com/blog/taking-care-of-your-mental-health-at-work/

Understanding the Link Between Anxiety and Problem Behavior in Young Kids and How You Can Help

We now know that children’s behavior is always driven by emotions, but what if whatever is driving those emotions is invisible? There are many reasons why kids sometimes behave in ways that leave us in despair and one of these reasons is anxiety.

One thing we know is that many children will go through anxiety at some stage in their lives. Although many of these anxious phases may be difficult to deal with, they are normal phases that mark children’s development. According to the Anxiety and Depression Association of America, few children under 13 suffer from anxiety disorders. In other words, normal anxiety is a part of childhood.

It is not uncommon for kids to portray anxiety-related behaviors when they have to leave their parents, meet new people, or participate in specific activities such as swimming or even going to school. Few parents have escaped the stress associated with separation anxiety. Fear is one of the most common feelings children experience and this often leads to anxiety-related behaviors. An anxious child may be a worrier, she might fear messing up, or she might act clingy especially around difficult situations such as attending school for the first time.

There are times, however, when anxiety in children leads to problem behavior. The biggest problem when dealing with difficult emotions such as anxiety is that, just like for adults, navigating difficult emotions is not always easy. Your child may not know what emotion he is feeling and what that means, and this may lead him to act in inappropriate ways in an attempt to deal with his difficult emotions.

Peter had always been a relatively calm child, but he would frequently throw tantrums that seemed to come out of nowhere. For example, he would be doing a puzzle and all of a sudden, he would be in the middle of a tantrum for no apparent reason. The same pattern continued when he joined school. In the middle of an activity, Peter would suddenly begin to speak or sing loudly and would not leave his classmates in peace. He would throw things around the classroom, clown around, and do almost anything to disrupt the class.

A few sessions with a therapist revealed that Peter’s behavior was driven by anxiety. Peter’s inability to complete an activity gave rise to feelings of shame and fear and his behavior was an attempt to camouflage these feelings. Whenever he was asked to do an activity he felt he was unable to do, Peter became anxious.

Several researchers are now saying that there is a strong link between anxiety and problem behavior. For instance, one study has found that working to decrease anxiety greatly reduces problem behavior in children. In other words, feelings such as shame or fear of embarrassment may explain your child’s disruptive behavior.

Most studies focusing on problem behavior in children have found that promoting low-anxiety environments is a first important step when dealing with problem behavior. Here are a few tips to keep in mind when dealing with your child’s anxiety:

1. Remember that navigating big emotions is difficult, even for adults.

Emotions are a big deal and they can sometimes lead us to behave in ways that surprise even those closest to us. People who have always been taught that emotions should be hidden struggle with difficult emotions all their lives. What is rarely foreseen is how hiding one’s emotions alters one in unaccountable ways.

Helping your child navigate big emotions is an important step toward helping him learn to deal with difficult emotions. This may mean having to learn to deal with your own emotions first. Providing an environment in which emotions are viewed as normal and holding conversations around those emotions is an important phase in helping foster low-anxiety environments. Numerous age-appropriate resources now make it possible to help children learn to identify their emotions, understand what triggers those emotions, and find appropriate strategies to express those emotions.

2. Create emotionally safe environments.

Emotional safety refers to environments in which individuals are able to identity their feelings and feel safe enough to experience those feelings. Although the concept of “emotional safety” is more commonly used in couple’s therapy, it also works in parent-child relationships because it promotes the development of environments in which both parties feel comfortable enough to express themselves.

3. Talk about your personal experiences.

A child suffering from anxiety often believes that she alone experiences this emotion. Talking about your personal experiences with anxiety can help her see that anxiety affects everybody. Beyond talking about anxiety, talk about what you do to handle anxious situations. Helping your child see that anxiety affects everybody and can be managed may help give her the tools she needs to deal with her own anxiety.

4. Know when to worry about your child’s anxiety.

Normal anxiety is rarely excessive. If you feel that your child’s anxiety-related behavior is excessive, disruptive, disproportionate to actual situations and negatively affects her social life or her academic performance, seeking professional help may enable your child to identify an appropriate strategy to help reduce anxiety.

from World of Psychology https://psychcentral.com/blog/understanding-the-link-between-anxiety-and-problem-behavior-in-young-kids-and-how-you-can-help/