All or Nothing Thinking

With “All or Nothing Thinking” you see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure. “Always”, “never”, and “forever” are terms that are used in this type of thinking. A person who thinks like this can sometimes be hard to get a long with. One minute the person thinks that he can’t do anything wrong (all) and the next minute the person may think that he can’t do anything right (nothing). The person thinks in extremes.

 

Instead of thinking this way, limit the use of such terms as “always”, “nobody” and “never”. Look at the situation more accurately and say to yourself “It is not as bad as it could have been. It’s not the end of the world. I can get over this.” Have gratitude for what you do have and what you have accomplished. Just because something didn’t go your way does not mean that it never will go your way. Is it accurate that “no one” likes you? Is it true that you screw up “everything”? Take a mental step back and re-look at the situation. Much of life happens in between “all” and “nothing”.

-RC

 

 

Three S’s to Discipline

Parents are constantly trying new and “innovative” parenting techniques.  One that seems to always work, no matter what kind of discipline is used is the rule of The Three S’s to Discipline.  All discipline, to be effective, must have all three of these qualities. 

   Swift: The discipline should be swift.  It should be dished out as soon as possible.  When Johnny disobeys, immediately give him the designated consequence.  Do not say “Wait until your father gets home…” or “That’s it, this weekend, no tv!”  “This weekend” does not come swiftly enough for children.  Children like to get rewards right away, and the same works for punishments.  They need it now!

   Severe: The discipline needs to be severe enough to have an impact on the child.  If Johnny writes on the walls, them simply putting him in the corner for a few minutes will not do.  As a parent, you are trying to teach him to do right.  For children, they need to understand first, that what they did was wrong!  And Johnny will not understand that, if you do not give him a punishment that fits the crime.  The punishment needs to deter similar behavior in the future. 

   Sure:  The discipline needs to be sure, or certain to occur.  Johnny needs to know that if he does behavior “x” then you will most certainly give him a punishment.  This is by far the most important component to discipline for children.  If you are inconsistent in you punishment, then the child is less likely to change his behavior.  If one day Johnny says an inappropriate word and is punished, but the next day he says it he is not, what you are teaching him is that you are not consistent. 

  An example may help.  A young child may put his hand on the stove burner while it is on.  As soon as the child does, he gets burned.  What happens?  The child instantly pulls away and learns never to do that again.  Why?  The burner was swift (it instantly caused pain), severe (the pain is major), and sure (the child learns that the burner… burns!)

   So remember, Swift, Severe, Sure, and your punishments will have much more effectiveness. 

-RC

Teenage Self Harm

The following is a response to a mother asking about her teenage daughter’s self-harm.

   Self-harm or self-injury is more and more prevalant and should cause serious concern with any loved ones. It occurs about the same as eating disorders but is more stigmatized leading to less reporting of it. Both males and females engage it in, especially in the teenage years. Drugs and alcohol as well as social isolation and a history of abuse are highly correlated with self-harm. However, as you stated, Goth is the #1 predictor of self-harm in teenagers. In fact, in one recent survey, 53% of those who identified themselves as being interested in Goth admitted to self-harm. Even more alarming, 47% of that group admitted to attempting suicide

   Self-harm can mean all sorts of abusive behavior. Biting, scratching. branding, pulling hair and eye lashes, bruising, burning, and cutting are some examples of such self-abusive behavior. Before we go any further, it is important to note that all of these behaviors are dangerous under any circumstances. However, the concern level is higher when certain conditions are met. For instance, if an entire football team gets a brand on their arms, this would not call for a heightened level of concern. If the teen is doing it simply to fit in, then it is a totally different problem than one who is doing it for emotional expression

   This is what I presume is the case with your “Goth” daughter.Most chronic self-mutilators have a hard time expressing themselves. They do not know how to cope with certain stressors and they do not know how to tell the world that they don’t know how to cope! This causes severe emotional distress and tension. When most people feel tension, they attempt to deal with it usually by releasing it. Some people may exercise to release the tension. If the exercise is successful in releasing the tension, then it will be used again. A self-mutilator who cuts on herself does so because it releases tension and stress. It worked as a coping mechanism so she does it the next time she feels tension. When she cuts on herself, she can actually see the release in the form of blood. Watching the blood gives her tremendous relief. It’s like a tea pot that has boiled but is still sitting on the stove. The pressure continues to build until either someone lifts it off or it comes out on its own.

   Other self-mutilators will harm themselves because they want to feel something. They have become so numb to the world and to their own feelings that they would rather feel pain than feel nothing. Feeling pain reminds them that they are still alive. It reminds them that they are someone who can feel. These types usually have low self-esteems and are probably depressed.

Self-mutilators need to be listened to above all else. Most self-mutilators have learned that “no one listens” and therefore they assume that “no one cares”. Loved ones need to allow self-mutilators to open up with them about their feelings. Frequently self-mutilators have a lot of rage and anger deep inside but have never been able to let it out effectively. They will also tend to be very apprehensive when it comes to trusting others. They have been “burned” too many times from others in their lives to trust so easily. This makes it very difficult for others (school counselors, friends, and parents) to be able to be trusted. They feel like their Goth friends are the only ones who understand because they are going through the same exact thing. It’s like being told “You wouldn’t understand addicts, because you’re not one yourself”. Well, this is what the self-mutilator is telling you by… not telling you anything. Your daughter trusts the Goth friends more than she trusts you because she feels like she can open up to them about her problems. Self-mutilators need to know that it is ok and safe to open up about what they are going through. Most self-mutilators hide the places they are cutting. For instance, females will often cut on their legs so that it is hidden by their pants. Also, they do not advertise that they are about to cut themselves. They may just go to their room, or go to the bathroom.   The teenage years are a time of change and uncertainty. This makes it ripe for a teen who is already depressed. Loved ones would do well to be there in a consistent manner. Loved ones, especially parents, can be role models for effective ways to cope with life. Finally, a mental health professional should be consulted to evaluate the severity, suicide risk, and the possible need for medication.

   There are other outside sources that could prove valuable. For instance Self-Mutilators Anonymous publishes literature on this topic. Maybe, if you feel uncomfortable approaching this with your teenager, you could leave some material around the house or in her room. That way she could read it in a non-threatening manner. Or if the two of you are watching TV together, and this topic comes up, simply make a comment on it, about how misunderstood it is and how people need to just listen. This may show your daughter a point of view that she did not think you had. She may then feel more comfortable to approach you with it.

 RC

 

 

 

Misbehavior in Public

Always have a plan for misbehavior, especially in public! And make sure that little Johnny knows the plan too. Tell him in advance what will happen if he throws a fit. Even better would be to define what a “fit” is. To some, it may be screaming, to others a fit is not a fit until someone’s little body is on the ground writhing and kicking. Johnny’s father may not agree with the definition, but as long as you and little Johnny do, you are off to a good start.

   So what does little Johnny get out of throwing fits? Well, what do you do in response to his fit throwing? Do you play along? Playing along would consist of giving him what he is demanding, trying to soothe him, trying to placate him, and threatening him with things that will never happen. Sending him to his room for the rest of his life is not something that you are prepared to follow through with. Simply tell him in advance what will happen if he does not comply with your expectations for the grocery store. One good time to do this is when you are sitting in the car in the parking lot of the store. You say to Johnny, “We are going into the store. In the store we use our inside voice and keep our hands to ourselves.” You then proceed to tell him the consequences of not complying with this. These consequences have to be reasonable… for your sake! Only threaten if you are actually going to go through with it! If he throws a fit and you attempt to ignore it but it gets too bad, then by all means leave the store. Deal with little Johnny exactly how you said you were going to. You try the shopping another time. This may sound unreasonable to try the shopping another time when you are telling yourself “I have to get this done tonight”. What you have to do is raise good children to become great adults. You don’t have to do your shopping that day. By sticking with this whole parent thing, you are raising your children to become great adults.

   Part of the consequence can also be not receiving a reward. At first this may seem like bribery, but bribery is usually reserved for use when one person is trying to get another to do something wrong. What you as a parent are doing is trying to get your child to act appropriate. When you are sitting in the car in the parking lot before hand, you may say something to the effect of “At the end of shopping, when you have done as mommy has said, then you may_________”. A word of caution: Do not use excessive amounts of candy or anything with significant monetary value. This could be very expensive. Maybe little Johnny can be rewarded by helping you put the groceries on the conveyor belt. Or maybe you could go to the deli at the end and pick up a free cookie. Whatever it is, as the reward is given, say “This is for doing as mommy said to do. I like it when you__________”. If Johnny likes to run away from you and the cart, simply tell him that he must keep one arm on the cart at all times. As soon as Johnny lifts his hand off the cart, remind him about the reward and tell him to put it back on the cart. This is a lot more concrete than simply telling him to stay close to mommy. As he behaves better, maybe he will be allowed to let go of the cart.

   Part of a good parenting plan is to know when and where the fit may come out. Is it in the same aisle everytime? Or is it after an hour of shopping has gone by? Bring a book or something for little Johnny to keep busy. It may simply be that he gets bored. Bring a snack for little Johnny as kids usually say they are “starving”. Encourage him to help you find the items on the list. Give him a couple of items to keep his eyes open for. You are no longer reinforcing his bad behavior, but encouraging good behavior. This way the two of you are interacting in a positive and healthy way. And that is a great way to earn respect.

-RC

ADD & ADHD: What’s the Difference?

An important thing to remember when discussing mental health issues is the lingo, the psychobabble, the terminology, or simply put, the words people use. Depending on what your mental health professional means, your daughter and your friend’s son may have similar issues. Whatever you want to call it, either ADD or ADHD, it has been given several nasty labels throughout history (“Defect of Moral Control”, “Post-Encephalitic Behavior Disorder”, “Minimal Brain Dysfunction”, “Hyperkinetic Disorder of Childhood”). For a long time, ADD and ADHD were separate disorders. There was Attention Deficit Disorder +/-, and Attention Deficit Hyperactivity Disorder. Finally, the two were combined to the more encompassing ADHD. The wording evolved into what is currently called Attention Deficit Hyperactivity Disorder. Some may still be used to using the old way of referring to the disorder. This evolution of terminology happens frequently. Just think, “moron” and “imbecile” were at one time actual clinical terms! “Neurotic” is another example of a once-used term that no longer has any real significance.

   ADD and ADHD generally refer to the same problem. ADD stands for Attention Deficit Disorder while ADHD stands for Attention Deficit Hyperactivity Disorder. The only difference here is that the latter has “Hyperactivity” in it. The technical, and therefore correct term, is ADHD. The term “Attention Deficit Disorder” is actually not even a real disorder anymore! Where some of the confusion sometimes comes is that there are three types of ADHD that specify which behavior is more dominant. There is the inattentive type (where inattention is the major problem), the hyperactive type (where hyperactivity is the predominant problem), and the combined type (where both inattentiveness and hyperactivity are equally present). The child with the inattentive type is the one who “can’t” pay attention while the child with the hyperactive type is the one who “can’t” sit still. Sometimes, for ease, if a child has the inattentive type, instead of saying Attention Deficit Hyperactive Disorder, inattentive type, a professional may simply say “ADD”.

   Usually if a child is diagnosed with the hyperactive type, then ADHD will be used. Either way, “Attention Deficit Hyperactivity Disorder” is the technical term. Just imagine, back in the day your daughter could have been given a diagnosis of “Minimal Brain Dysfunction”! Who knows what ADHD will be called in 20 years?

-RC

How Does That Make You Feel?

“How does that make you feel?”  That is one of the most common questions a therapist will ask someone in therapy.  Unfortunatly it is overused, and often not entirely necessary. 

What I tell my clients all the time is to make decisions not based on how you feel but based on what you think.  Our emotions lie to us on a regular basis.  What may feel good may not acutally be good.  People who abuse drugs say that it feels good.  But we all know that drugs are not good for you.  Sexual acting out may feel good, but may not be good. 

Emotions are created by how and what we think.  Change your thinking and you will change your emotions.  An example that I prefer goes like this: I am walking down the hallway and someone bumps into me.  I can decide to go on walking and not worry about be bumped into or I can obsess about the person and how I think they have “disprespected me” etc.  The emotions that I have are dependent on the thought that I have.  If I believe I am hurt (in this example disrepected) then I will feel hurt. 

Think of children with terminal illnesses.  How often are they complaining and crying etc.? Why are they not more depressed?  Their situation is pretty bad?  They choose not to be depressed.  They choose to see the best in their world and situation.  They choose to have gratitude.  They choose the way they think.

So if you are seeing a therapist, and he/she continues to focus on your emotions but never delves into your thinking, he/she is doing you a disservice.  Talking about emotions is fine.  But if it never leads to talking about your thoughts, then there probably won’t be sustained change. 

So, what do you think about that?

-RC

Bipolar Disorder: The Mood Swinger

Bipolar Disorder is extremely popular now.  Just as ADHD is diagnosed frequently, Bipolar Disoder is just as diagnosed.  In fact, I had a patient once who told me that she was “both Biploar and Manic Depressive”.  Biploar Disorder is essentially Manic Depressive. 

Within Bipolar Disoder, one generally has mood swings.  These are sometimes described as a “roller coaster of emotions”.  Whereas the person with Depression is “down” the person with Bipolar Disorder is both “down” and “up”.  But here is where it is a little more confusing that most realize.  The “up” in Bipolar is not necessarily happiness as some think. It is more of an “elevated mood”.  Frequently someone with Biplor will appear to be very irritable, energetic, hyper, talkative, easily distracted and won’t seem to ever really slow down.  They may stay up for hours and then decide to paint the living room in the middle of the night.  They seem to have burts of energy.  This “mania” can at times appear to be a good thing.  Some with Biplor will become very studious, and become very hard workers. They will become very goal driven.  During the manic phase, the person will frequently do several risky activities.  They will seem to be seeking out thrills and adrenaline rushes.  Then all of the sudden…

The second key component with Bipolar is the down. This does in fact appear to be Depression at first glance.  The Bipolar person will seem to have “crashed” from an adrenaline high.  Those with Biploar Disoder are hard to get a long with.  Some may say “I never know what Susan I’m going to get”.  Or “she is so moody”.  Because of the nature of the disoder, Bipolar can look like quite a few other disoders: Depression and ADHD are frequently confused with Bipolar.

Technically, one does not have to have the “down” to receive a diagnosis of Bipolar Disorder.  If one simpyl has manic episodes, then a Bipolar Disoder may be warranted.  A good and thorough psychological interview should be conducted to determine if it is depression or Biploar Disoder. 

To make matters more complicated, there are two types of Bipolar Disoder.  Bipolar I Disoder  has big highs, and big lows.  Bipolar II Disoder has moderate highs, and big lows.  In other words, those with less “mania” may receive a diagnosis of Bipolar II Disoder.

 -RC

Pornography in Marriage

What we do in our hearts is what really matters.  Jesus stated “But I say, anyone who even looks at a woman with lust in his eye has already committed adultery with her in his heart” Mt. 5:28.

Faster growing than any other addiction, without question, is pornography addiction.  I routinely have patients who are in some way addicted to pornography.  A good majority of teenagers have seen pornography at some time in their lives.  But what about adults in marriage? 

It is, in some circles, fashionable to view pornography as a couple.  This makes absolutely no sense.  Usually, the stated intention is something to the effect of “to spice up our love life”.  Love, in this instance really means “lust”.  After all, the intention of pornography to to induce lust.  Lust has nothing to do with love.  And yet love is a key ingredient to marriage. Lust is about gratification.  Love is about much more.

When one spouse is hooked to pornography and the other isn’t this creates a lot of discomfort as well.  Amazingly a large percentage of wives are aware of their husbands’ addiction but either accept it, or give up trying to fight it.  The husband will begin to wish that his wife was the pornographic “star”.  He will ask her to perform as if she was in a pornographic movie.  This can be seriously demeaning to the wife.  Some wives have told me that they too have been aroused visually, but almost without question they wish their husbands were not viewing pornography. Men become experts at spotting the flaws in their wives’ body.  Soon the become dissatified with their wife as if she is a faulty product needing to be sent back to the assembly line.

Resentment sets in with both husband and wife when pornography is involved. 

When pornography is brought into a marriage, those “actors” and images are also brought into the marriage.  Pornography raises the sexual intensity of the viewer.  The viewer, usually the husband, begins to want the same kind of sex that he sees in the movies.  Discontent sets in when his wife does not live up to his standards.  The wife will frequently feel rejected, inadequate, and sometimes responsible.  “Maybe if I had been more sexually available…” 

Treatment may be necessary for the husband… and the wife.  The marriage has been damaged.  Marriage counseling is recommended as part of an overall healing process.  Sex addiction treatment is must for the husband as well.  This may need to start with the wife gently pushing the husband into treatment.  Do not give up on your husband.  He needs your support and unconditional love.  Forgiveness… that is a little different.  You should not be expected, nor asked, to forgive him immediately. That takes time… if it happens at all.   Don’t rush either the treatment or forgiving him.  The husband should also not demand your forgiveness. -RC