Category Archives: psychology

What are you waiting for?

The American Association for Marriage and Family Therapy asserts that the typical couple coming in for counseling has had difficulties for over five years…which makes me wonder, what are they waiting for?

There are a lot of seemingly perfectly sensible reasons to postpone counseling when things start to go awry:

“It’s expensive.” This is true; counseling does cost money and relationship counseling is an out-of-pocket expense. Still, most therapists are cheaper than two retainers, two divorce attorneys, a mediator, a parent coordinator, etc…

“I don’t want to be told what to do.” Well, a good therapist isn’t just going to tell you what to do. A therapist is going to be asking a lot of questions, having you fill out a lot of questionnaires, and trying to develop a very clear picture of your relationship’s specific strengths and the particular types of problems each of you identify. That way, research-recommended approaches can be matched to the problem(s) of the particular couple.

Fear. Don’t a lot of people fear that it’s going to be like that old Simpsons episode, where, after Marge vents for hours, the therapist turns to Homer and says something to the effect of, “I’ve never said this before, but it really is all your fault.” That’s not what happens in real life.

Shame. So many people suffer with shame over the difficulties they are having. Marital difficulties feel like a failure. Yet, if marital problems were some rare, shameful thing, why are there so many marital therapists? We have our own doctoral programs, professional licensure, and organizations. Beyond that, other non-specialists in the mental health professions also offer couples counseling.   Shame can be overcome by getting help and feeling less alone in the suffering.

The Ostrich. Just try to ignore it and hope it goes away: the addiction, the affair, the endless disputes about parenting or money or values and ethics. Some things, ignored, will go away: a minor cold, a pimple, a minor aggravation of the day. Other things, though, just fester and turn into a nasty emotional infection: resentment, trauma, guilt, hurt.

If your relationship is suffering from feelings of distance and disconnect, or seems to be a vortex of repetitive arguments, counseling could be very effective. Often, five or six appointments, spread out over four to six months, can make a world of difference when both parties are willing to work at changing patterns of behavior and experimenting with new ways of interacting.

It’s important to find a counselor who is a good fit. Call a few of us; talk for a few minutes; get a sense of style and see who seems like a good fit for the two of you.

Be bold. Push past shame and fear; challenge your inner ostrich. Then start to feel happy again.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Toxic Myths, revisited

A lot of people ask about toxic myths: what does that mean? Why “myths?” (I’d like to say, well, buy the book, and sometimes do).

The toxic myths are examples of lies dressed up as truths. Our culture is seething with them, but in Toxic Mythology, I only addressed a few.

For example, consider the myth that people can compartmentalize their lives. Someone can, within this myth, be an absolute scoundrel in their personal life but supposedly be capable of being completely trustworthy and honorable in their public/vocational role.   Conversely, they can (per the myth, at least) be a sociopath in their professional life but be kind, tender and good in private.

So…if you buy this myth, you have to be willing to:

Vote for someone who swears to uphold a particular principle while having a personal and/or professional life littered with betrayals and a habit of acting on expediency, not principle;

Believe your child who promises she didn’t really cheat on that exam or plagiarize on the paper (despite the software evidence) after same child was grounded for “borrowing” money out of your wallet without permission.

Keep on an employee whom you overhear lie to customers because you haven’t caught that employee lying to you.

Convince yourself that your gossipy acquaintance never, ever would talk about YOU behind your back.

Does any of that sound reasonable? Of course not; these are, however, the toxic myth in action. Our culture tells us that it’s perfectly reasonable to believe that compartmentalization of character is possible and (further) that we should be “judgmental.” That’s another myth for another day.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Mental Health, Well-Being, and Responsibility

More about personal responsibility in regards to mental health and well-being…

Have you noticed how often people talk about things they do as if they were events that happened. It’s as if “stuff happened,” and they were just hapless victims of circumstances. Note, I am talking about the things people actually DO – not things that really do happen to them.

“I got to work (or class, or church, or wherever) late.” A more accurate description would be, “I decided to do (some category of activity) rather than leave on time.” Maybe it was staying in bed, maybe it was “one more chore,” but the person decided to do something and thus the lateness.

Someone complains, “I woke up with a hangover,” when, of course, the reality is, “I decided to drink to a point where I knew I would feel lousy today but last night it seemed like a really good idea.”

“The (whatever task – homework, a chore, etc.) didn’t get done.” What really happened? The person decided to do something else, or a whole bunch of something elses, rather than that pesky task.

So, one way to improve one’s well-being is to simply start taking responsibility for choices. I might decide to have a brownie ice cream sundae for breakfast, and if so, I should say I am deciding to have this instead of scrambled egg whites with cheese. The brownie sundae, in all its wonderful deliciousness, will not just happen to me by accident, without warning.

I can decide to sit and stew about something that bothers me or I can decide to try to focus on some other activity and decide that I will figure out what to do about a particular problem when I’m in a better frame of mind. I get to decide; an hour spent stewing is something I can choose, or maybe I can choose to do something else instead.

You can decide to be in a relationship with someone who is toxic and mean, or not.

You can decide whether to seek help in parenting strategies, or throw up your hands in despair, or try the consequence-of-the-week approach except for when you’re too tired to argue.

You can decide whether to join a grief support group or suffer in silence and loneliness.

The act of owning a decision gives a greater sense of control, because if you decided one thing today, you might decide something else in five minutes, or tomorrow, or next week. If stuff just happens to you, you have no control, and thus must sit around being helpless, hoping for better luck next time.

Luck is an iffy plan.

It would be better to decide.

 

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Personal Responsibility and Mental Health

This is another reflection on the Florida Adlerian Society’s annual conference last Friday. One of the primary speakers emphasized the role of personal responsibility in mental health. I can imagine, taken out of context, how brutal that might sound. “Are we now blaming victims and ill people for their woes?” the person exposed to just that sound bite might wonder. “Is that what mental health professionals believe?”

The short answer is no, that’s not what we believe.

Embracing free will and the dignity of each person, however, ineluctably leads one to emphasize the role of personal responsibility in how one deals with what happens in life. This isn’t something new: it is ancient philosophy dressed up in psychotherapy clothes. So, while someone may suffer terrible misfortunes outside of their control, the impetus to decide what to do about it is within them. Seek help, or sink into despair? Reach up to grasp a hand, or reach out for a bottle, or needle, or some other vial of trouble?

Sometimes people do have some personal responsibility for what happens, and indulge in magical thinking in which bad things just randomly happen to them. I recall a person I met many years ago who got into trouble for buying drugs. He complained about the injustice of the level of trouble; he didn’t mean to do it. It just happened. (I’m pretty much quoting here.) I asked, how do you buy drugs by accident? How do you take a peaceful stroll around your neighborhood and accidentally end up lurking behind a shopping center chatting with the type of entrepreneurs who set up shop near dumpsters and concrete walls? Acting like there is no personal responsibility means that there is no effort to make things better. It’s just a lot of bad luck, from his perspective; no reason to change because you can’t change “luck.”

Often, though, human suffering is due to others’ actions. Just the same, an adult has some power to effect change. The responsibility is not for others’ bad actions, but to take some sort of action to help oneself. Sometimes people evade taking responsibility to make change because it will be uncomfortable, or embarrassing, or mean that they have to admit that at some earlier point they were wrong. Breaking off a destructive friendship or leaving a toxic work environment can be very challenging for a host of reasons, and leaving an abusive relationship can be dangerous. Reach out and get help. If the first, or second, or third person you go to for help is clueless – keep looking for the right help.

Typically, people do things that undercut happiness and health in some way and evade responsibility. People have habits that cause insomnia, for example, and complain, as if poor sleep side-tackled them in the hallway due to no fault of their own. We take on extra activities and complain about being too busy. People fail to set limits with their kids and then yell and throw consequences around when their children are irresponsible, disrespectful and unpleasant to be around. People make choices all day, often on auto-pilot, and a great many of us are prone to griping about all sorts of situations that result, as if stuff just happens without cause. Yes, of course, sometimes, stuff does happen…but, if you’re always five minutes late…that’s you. Not the traffic, not the cat, not the dog…it’s you. If your friends are inconsiderate, that’s not your fault, but it is your problem if you keep tolerating it. If you do tolerate it, then take responsibility for it and stop complaining. “Yes, good old Joe is always late but that’s just him; it’s not personal.” You’ve decided to accept it. Stop griping. If you can’t stop griping, you haven’t accepted it. If you can’t accept it, then do something: leave when he’s late. Put your foot down. Tell him off. Lie about what time you’re meeting and get there late yourself (it might work, once). Whatever; if you’re not prepared to do something about it then face that you have decided to let Joe be chronically late without regard for your preferences or schedule because you have decided tolerating it beats the alternatives you’ve identified of annoying Joe or losing his friendship.

Narrowing it down to mental health, whatever a person is suffering, help is available. How one lives is always part of healing. Proper amounts of exercise, sleep and nutrition are part of it, and things for which most people can take some responsibility. Seeking right guidance requires making choices. Unless you belong to a professional mental health association, your friends might not be the best source of professional advice on the specific strategies, to, for example, use mindfulness training, exercise and specific cognitive therapy techniques to rewire your brain and reduce obsessive-compulsive symptoms. You get to choose. That’s not blaming you for your suffering, but it is saying that you have the freedom, responsibility, and capacity to move towards healing.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Well…something’s crazy (but it’s probably not us)

Yesterday I attended the Florida Adlerian Society’s annual conference; it runs for three days but I was only able to commit to one. It was a great day: wonderful speakers, challenging information, and, of course, the warm and friendly Adlerians in attendance.

Adler is one of the great founders of psychotherapy, but often is relegated to a corner with a few remarks about birth order and maybe credit for starting the child guidance movement. He’s much more than that, and if you’re curious, visit www.alfredadler.org.

An interesting point made during yesterday’s talks was the evolution of bereavement in psychiatry over the past few decades.   The Diagnostic and Statistical Manual of Mental Disorders is the American Psychiatric Association’s published list of descriptions of various patterns of symptoms. The intention, back in the early 1980s and DSM-III, was to provide a structure for shared dialogue and research for the identified hypothesized mental disorders. No one was pretending these were all clearly identifiable and diagnosable, discrete brain diseases. In the DSM-III days, bereavement, as a category, covered up to a two year long period. If a grieving person was still sad more often than not, still struggling with aspects of grief and getting back to a (new) normal life, mental health professionals figured, depending on the relationship, two years was a reasonable time frame. Of course, some losses never heal – but people somehow figure out how to go on, just the same. The point is, no sensible person thought it was pathological to still have some regular bouts of tearfulness a year or more after your most beloved person died.

In 1994, the next edition of the DSM came along, DSM-IV. It gave people two months – not two years – to get over it and move on. If not – if the person was still crying, or numb, or having appetite and/or sleep disturbances, or otherwise met the minimum criteria for depression…well, that meant that bereavement was over and the person was now diagnosable with a major mental disorder – depression – which was now sometimes described as a permanent brain disease.

In 2013, the DSM-5 was published (note that the change from Roman numerals to integers was done by the APA – it’s not a typo on my part). The DSM-5 got rid of the bereavement issue entirely: now you get two weeks of being sad more days than not, plus the other possible symptoms, and you’re mentally ill with depression (according to the APA). There is no exception for bereavement, although it ought to be noted on the chart. One rationale provided, about which I’ve written in the past, is that this way people can get their health insurer to cover their grief counseling. Whether this makes it worthwhile to pathologize normal grief, I leave each reader to consider.

Are you mentally ill if you have trouble eating or sleeping, or burst into tears almost daily, two weeks after someone you dearly love passes away? I don’t know anyone who thinks so, but the manual that has become the healthcare provider’s and insurer’s standard frames it so.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Cognitive Behavioral Therapy: So Much More than Positive Thinking

It’s more than just positive thinking

A smart, thoughtful person mentioned the other day, in conversation, that Cognitive Behavioral Therapy (CBT) seems to be just “the power of positive thinking.” That’s probably what it sounds like when it gets boiled down to a sound bite…but in reality, it’s so much more. There are many excellent resources out there, so I won’t attempt to tackle the whole topic here. A brief example, though, on the difference between CBT and simple positive thinking, might help.

In CBT, we are indeed looking for patterns of negative thinking. These are identified, and then we dig down to the underlying thoughts. From there, the challenging and reforming of particular thoughts begins. Then comes the hard work of rehearsing those new thoughts.

Consider, for example, an adult who is very anxious about grades in college. This student is up late studying, preoccupied with grades, and anxious to the point of headaches and nausea before tests. The student feels terrible, of course. The top layer of thinking probably includes themes such as, “I have to do well,” or, “This is too important to fail.” The level of distress the client feels, though, seems out of proportion; the client is sick and nauseated over A- or B+ grades. Digging deeper, the client turns out to have buried beliefs such as, “Perfect or failure – no in-between,” or, “Hero or zero,” or, “No one loves a loser.” Thus, the A- feels like a failure and even a threat to love and security. Those aren’t conscious thoughts: no reasonable grownup thinks, “Oh, no one can love me because I got an A-!” It’s more of a personal belief, often acquired early in life, which became the background to many experiences.

You can see that trying to be “positive” about the top layer thoughts might seem silly: “Oh, it’s fine to fail,” or, “It’s OK for me to not do well.” The client cannot buy into that. However, a deeply held belief – that one is either perfect or a complete and utter failure – merits serious attention, and probably underlies many difficulties for this client. Thus CBT starts it work – which is much more complex than presented here – by seeking the foundational troubling beliefs that are leading to the negative thinking.

As I noted – this is a cursory glance at one aspect of CBT. It is a well-researched method of treating anxiety, OCD, depression, and other difficulties. If it seems as if it might be helpful for you, please see appropriate professional guidance.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Letting Children be Children

Is having a healthy, happy childhood a good thing? Is it important to have that foundation in order to be a productive, healthy and happy adult? All of us would agree that, “Well, duh. Of course.” Well, of course…yet, around the world, it seems that the short-lived glorification of childhood as a separate, sacred stage of life (in many ways a 20th century movement) is crumbling away.

In some European nations, 14 year olds have attained the age of consent to sexual activity with adults. Here in the US, they aren’t expected to remember their homework and thus teachers must dutifully post assignments on a school website so parents can check. For the record: 14 year olds can remember homework. Try breaking a promise about a privilege and see how good their memory actually is. The same child, however, is not capable of informed consent. They are not equipped to really understand long-term consequences due to brain development.

In the Netherlands, a 12 year old who is seriously ill – and consider that here, an awful lot of parents don’t expect 12 year old children to do chores or remember their own shin guards for soccer – can petition a judge to be euthanized due to illness. Their parents get to choose whether to grant permission up until age 16. That means that a 17 year old can petition to be medically killed. The same child might not be able to follow through on a college admission essay, or otherwise exhibit normal responsibility, but somehow their request to die ought to be treated as a perfectly normal legal procedure.

In our own country, about 9% of children have been diagnosed with ADHD and are being treated with medications, most often powerful stimulant medications – a rate that dwarfs much of Europe’s less-than-1% rate for medicating children.

Psychologically and physically, children aren’t miniature adults, as was so often the view in the past, due to the physically challenging, dangerous life most humans lived over much of history. They need love, secure boundaries, and guidance in learning to make good choices as they mature. Where these needs are unmet, adult dysfunction, emotional distress and physical illnesses are apt to follow.

They definitely don’t need to make life-or-death decisions, or be exploited by bad adults, or otherwise be treated with an expectation that they are fully rational, insightful grownups.

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Review: The Collapse of Parenting: How We Hurt Our Kids When We Treat Them Like Grownups, by Leonard Sax, M.D., Ph.D.

A friend recommended this book and this past weekend I read a large portion of it. It’s aimed at parents and others who are directly involved in raising children, and cites some pretty striking research about the negative outcomes of giving children more freedom and flexibility than they can handle. Children being given the control over their lives that ought to be reserved for responsible adults are far more likely to develop anxiety, depression and obesity; they have less attachment to their families and adults in general, and are more likely to turn to peers for advice. Their peers, of course, are not apt to know any more than them about making wise choices about life.

It’s a conundrum for some: after all, kids have to learn how to make choices, but they can’t handle the full variety of options that many parents want to give them. Learning how to present a narrow, fair range of choices is, apparently, a challenge for parents who are desperate to be liked. This craving for their children’s approval underlies a lot of dysfunctional, but seemingly well-intended, parenting. I described a parent’s style as a “democracy” (the children are school age) and the parent took it as a compliment…as if being democratic with children, where no one is really in charge and knows best, was a good plan.

Do kids need choices? Absolutely. Do they need – or can they even handle – the full range of options that an adult might handle? Absolutely not.

For parents, teachers, grandparents and others who work with children, this book is a friendly, accessible but thoroughly footnoted guide.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

…and still more decisions!

Decisions, decisions!

Our nephew and his wife are considering relocating. Given their jobs, they are employable just about anywhere – so the choices are as vast as these United States. They’ve created a spreadsheet to rate the places they are considering on a variety of factors: climate, culture, length of commute, ease of accessing travel to family back home…we’re looking forward to seeing how they narrow their choices as they visit cities and rate them across variables.

It’s a useful way of making difficult choices where there isn’t an obvious “right” or “wrong” choice to make. Take the job that makes less money but is more satisfying and allows for more flexibility, or take the higher-paying job that provides better long-term financial security? Take a second job or scale back on expenses? Move far from family or stay close? The problem, of course, is even ranking how important the factors are, really, in the first place.

Maybe deciding on a job isn’t the right example for you. Perhaps you have to decide on whether to downsize or stay put, or which school to attend. Whenever there are multiple factors to compare, weighing the factors in importance to you can help narrow the choice. Writing it all down – in a chart, or listing – can help, because then it’s in front of you, not rattling around in your head, where it keeps butting into whatever else you’re trying to manage in life.

Then, too, sometimes making decisions is complicated by stress and fatigue. If you’ve ever felt overwhelmed and too hungry to pick something to eat, you’ve been in this state. Likewise, trying to figure out what task to handle first, when everything seems overwhelming. Just doing something – even if you change your mind and revert to a different task – is better than paralysis.

Some people are able to make decisions quickly and easily; for others, the fear of making the wrong decision impacts even minor choices where “wrong” would be, at best, a minor disappointment. If you’re the kind of person who gets stuck in decision making, experiment with some other ways to organize the choices: a spreadsheet or simple paper and pencil chart or list, or focus on what is most important to you as a factor, or, for minor issues, take action and see if that is the better option or if starting in the wrong direction helped you discern, quickly, the right path to take.

Of course, if anxiety is interfering with basic decision-making, please consult a professional.

 

 

 

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Decisions, decisions!

Choices are good, right? Until they’re bad.

Too many choices becomes overwhelming. We can see the results of seemingly endless choices and information when we, or someone we know, gets lost in hours/days/weeks-long process of sorting through online reviews and information in the attempt to make a decision that might have been made over a dinner conversation twenty years ago. Grownups have problems with this, and yet so many parents inflict too many choices on their children.

It’s important for children to learn to make choices and endure the consequences in small, safe, age-appropriate doses. It’s also important for children to feel like the grownups are running the show. Offering opportunities to make choices – within defined parameters – and then sticking with those choices, are great learning experiences for children.

Consider asking a five-year-old:

“Would you like applesauce or yogurt for a snack?” versus, “What would you like for snack?”

What are the odds the child isn’t going to go for fruit or low-fat dairy and will instead choose something the parent wasn’t planning to provide? With so many modern parents afraid of upsetting their children and overly eager to have their children’s approval, children are left without anyone big and safe to place limits around their world. Temper tantrums, anxiety, and entitlement are often the results.

Children benefit from parameters and calm grownups being in charge. A calm, in-charge grownup can offer safe, appropriate opportunities to learn decision-making skills and learn to live with the consequences.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.