Psych Central Professional For mental health, psychiatric and psychological professionals.2015-10-09T16:41:41Z Deepan Chatterjee, Ph.D. <![CDATA[Physician, Heal Thyself]]> 2015-10-09T16:41:41Z 2015-10-09T12:04:50Z I was just casually talking to a physician friend of mine around Christmas Eve last year when he remarked, “Maybe I should come in to see you sometime. I am really stressed out, especially at this time of year.” What he said has haunted me for some days thereafter, and I got to thinking about Jesus’ famous admonition to Luke in the Bible, “Physician, heal thyself.”

Physician burnout is a very common phenomenon in the healthcare profession. There are studies that show that compared to the general U.S. population, physicians are more likely to have symptoms of burnout and are more dissatisfied with work-life balance issues.1

Although we do not talk often about this issue because it is not “sexy” enough, physicians are human beings too. They deal with the same human crises and challenges. One of the major challenges is keeping sane in a world that is largely driven by sickness and disease and where physicians are constantly asked to be supermen and superwomen fighting the wrath of these twin monsters.

Feeling Burnout Pangs?

I have encountered periods of fatigue and burnout too, especially after long, challenging days of multiple patient suicide attempts, crises interventions and needing to send someone to the hospital when they become too agitated and violent for the nursing staff to handle.

Those days can be painful reminders of the constant burden that we carry on our backs always as healthcare professionals, patient safety first and foremost.

I would advise any physician that has felt the pangs of burnout – and I suspect there will be a large audience to fill a stadium if I asked for a show of hands- to do the following:

  • Accept that you are no superman or superwoman. You are human and like all humans, you are prone to making mistakes.
  • You do not have to be the “savior” for all your patients. You should obviously try to do your best at every step, but realize that you are not solely responsible for every life and death situation that every patient of yours goes through in the course of their recovery and rehabilitation.
  • Take time out for yourself. Give yourself plenty of opportunities to enjoy multiple fun activities with family, friends and colleagues. Schedule time if you must, but do it for your sake and that of your patients and loved ones.
  • Talk to a competent professional if you feel that you cannot manage your stress on your own. Remember, there is no shame in asking for help from a physician colleague who specializes in stress management, such as a psychologist or psychiatrist.
  • Learn to say “no.” Take on tasks that you know you can handle and refuse the extra ones, even though there might be an inclination in you to do it all.

I hope the rest of the year goes well for you.

I will tell you exactly what I told my friend on Christmas Eve last year:

“In this challenging, yet exciting endeavor of patient care, do everything that you can to minimize the risk of stress and burnout in your daily lives. And yes, I am always open to hearing from you about your life and struggles. I am only a phone call away.”


1 Shanafelt, T. D., Boone, S., Tan, L., Dyrbye, L. N., Sotile, W., Satele, D., & Oreskovich, M. R. (2012). Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population Burnout and Satisfaction With Work-Life Balance. Archives of internal medicine, 172(18), 1377-1385.

Tired doctor photo available from Shutterstock

Christine Hammond, MS, LMHC <![CDATA[Strategies for Combatting Verbal Abuse]]> http://5.352 2015-10-08T12:01:27Z 2015-10-08T12:01:27Z Sticks and StonesThe 1800’s nursery rhyme, “Sticks and stones may break my bones but words will never hurt me” is not true for most people. Some people do have the natural ability to emotionally disconnect when being insulted.  (They usually struggle with being emotionally engaged in pleasant circumstances as well.) For everyone else, words have meaning and they can hurt a person.

This is precisely what the abuser is depending on: the victim is hurt by their words. Once a person is harmed, they are easier to control and manipulate. So with one well-placed phrase, the abuser has disarmed the victim and gained dominance without ever touching the person.

How can the victim combat the abuse? If the victim retaliates with verbal insults, the abuser will point the finger back on the victim. Then the abuser will act as if they are being victimized. This causes the true victim to retreat even further and the abuser has gained even more control.

There is a better way. For each of the verbal attacks listed below, try one of these strategies instead.

  • Abusers use the volume and tone of their voice either by yelling or ignoring to establish dominance. Resist the urge to scream or give the silent treatment. Instead go to the middle ground and stay there. If the abuser yells, respond in a pleasant voice slightly quieter than normal. If they ignore, speak to them anyway. Pretend they are responding to the words and have a conversation out loud.
  • Abusers use swearing and threatening language to instill fear, intimidate, manipulate, oppress and constrain. When attacked in this manner, strong positive self-talk is essential. Say, “I am not afraid” or “They can’t make me do anything” over and over. This is not something to be said out loud, rather is repeated inside the victim’s head. Two things are accomplished. First the victim feels better and second they won’t be tempted to respond to the threat from a position of weakness.
  • The abuser’s manner of speech is argumentative, competitive, sarcastic and demanding. When they interrupt, stop speaking until they are done. Then go back to the original point instead of the point the abuser was trying to make by interrupting. When they interrogate, answer the question they should have asked instead of the question that was asked. Have a couple of quick slightly sarcastic responses ready to be used in social settings. “How silly of me. After all, you are ALWAYS right.”
  • Abusers use personal attacks such as name calling, mocking responses, defaming character, berating feelings, and judging opinions. This condemning tactic leaves the victim feeling inferior and defeated. Again, counteract this with positive self-talk and the truth. It might sound overly simplistic but it is highly effective. Do a reality check by running each personal attack through a best friend test. Would a best friend agree with the insult? No. Therefore, there is no validity to the verbal assault.
  • Abusers refuse to take responsibility, become hostile, invalidate or dismiss feelings, lie, and conveniently forget promises or commitments. Everyone is responsible for their own actions and responses. Victims tend to take on more than their own fair share thus letting the abuser get off the hook. When the abuser is faced with a real life consequence for the verbal assaults, don’t bail them out.
  • Typical abusive sayings include: “I’m critical for your own good,” “I was only joking when I said that…,” “If only you would…, then I won’t have to be this way,” “You don’t know how to take a joke,” “The problem with you is…,” and “That (verbal abuse) didn’t really happen.” These phrases are a signal that a verbal abuse rant is about to begin. Use it as a warning sign and get out of the conversation as quickly as possible. This is a great time to become distracted by something or someone outside of the conversation.

As a result of the verbal abuse, the victim feels they can’t ever win. But this is not true. Even small victories are helpful and can increase self-confidence. Use these strategies to regain self-esteem. Then make a decision about when and how to get away from the abuser.

Christine Hammond is the award winning author of The Exhausted Woman’s Handbook available on Amazon, Barnes & Noble and iBooks.

Amanda Dutton, MS, LAPC <![CDATA[Steps Taken to Individualize Obesity Treatment]]> 2015-10-06T01:51:02Z 2015-10-08T11:50:35Z Earlier this year, The Journal of Public Health (April 2015) indicated recognition of six separate subgroups of obese patients in the United States.

This finding is significant because it is a step toward individualizing obesity treatment rather than having a “one size fits all” approach to care.

The subgroups are as follows:

  • Younger healthy females
  • Young males who were heavy drinkers
  • Middle-aged individuals who were unhappy and anxious
  • Older people who despite living with physical health conditions were happy
  • Older affluent healthy adults
  • Individuals with very poor health

While there is further need to individualize care of the obese population, this approach is a step in the right direction.

Recognizing that there is more to weight management than just weight loss can help aid in the long term benefit to individuals over time.

As noted in the above subgroups, there are multiple factors to be considered when reviewing supports that may need to be in place for subjects as they work on achieving a stable weight: addiction management, mental health support, physical health management, etc.

Without having the appropriate supports in place, and without following up with recommended after care to ensure ongoing mental, physical and psychosocial wellness long term, the probability of ongoing success decrease significantly.

Multiple Factors Affect Obesity

At the 22nd European Congress on Obesity this year (May 2015), the importance of addressing multiple factors that affect the likelihood of obesity was addressed even more in depth.

There, it was theorized that obesity could be a “whole brain” disease, meaning that various chemicals and reactions happening within and to the brain interacted in a specific way for a particular individual that predisposed him or her to be more likely to become obese.

As an explanation, not only does the brain provide psychological reasons for concern (e.g. addictive traits, propensity for depression, anxiety, etc.), but also the brain is the source of managing endocrine hormones (such as those that determine hypothyroidism), the receptors that recognize fluctuation of the satiety hormones gherlin and leptin and receives signals from the vagus nerve when the gut indicates that it is full.

Perhaps there will be a time that pharmaceuticals can be personalized to the individual, as hypothesized at the conference.

In this way, medication could be adjusted to the particular phenotype of the person so that the specific causative could be addressed without leading to unnecessary side effects or concerns.

In a recent study published in the European Journal of Clinical Nutrition (July 2015), the relevance of the need for such personalized medications was made clear.

Evidence was found to indicate that there may be long term psychological effects for gastric bypass patients once they reach 10 years post-op.

According to the study, findings indicated a significant increase in quality of life as it relates to physical health; however, mental health symptoms such as neuroticism, fear of intimacy and locus of control deteriorated.

Long Term Effects of Bariatric Surgery

Results remained parallel regardless of the amount of successful long term weight loss the participant maintained during this time period. Study participants that were in a control group that undertook a monitored dietary program did not show the same level of mental health decline, indicating further evaluation may be needed regarding the long term effects of possible nutrient deficiencies experienced with bariatric surgery.

It is quite promising to see that the scientific community is recognizing the need for continuity of care amongst all aspects of healthcare as it relates to the obese community, particularly as it relates to those that chose bariatric surgery, as the effects appear to continue appearing long term.

Ongoing care for this population is necessary to manage the multiple changes that happen in a short period of time, from physical changes, to psychological, to potential social and psychosocial changes as well.


22nd European Congress on Obesity (May 2015)
The Journal of Public Health (April 2015)
European Journal of Clinical Nutrition (July 2015)

Obese family photo available from Shutterstock

Margaret Altman, LCSW, MSW <![CDATA[The Genetic Footprint]]> 2015-10-06T01:50:02Z 2015-10-07T11:49:11Z Clinical practice within the profession of psychology has been in the news of late as the debate on the efficacy of drug-based treatment vs. psychotherapy becomes more heated.

Recent reports on the problems with drug research, the lack of information given to clients on drug effects and the use of medication of children have projected psychotherapy into the spotlight as a safe and effective method of helping individuals in emotional distress.

Epigenetic Research

This focus puts the spotlight on clinicians who are on the front lines in treating clients and reforming the mental health system.

The field of Epigenetic research connects genetics with environment in a molecular, lasting way and it makes what clinicians do on a daily more relevant, enduring and exciting.

Epigenetics applies to the domain of the genome as well as psychology and the practice of therapy.

The field of Epigenetic research is looking at external modifications to DNA that turn genes “on” or “off.”

These modifications do not change the DNA sequence but they alter the genetic expression.

On-going experiences can become embedded in our DNA and in our long term memory and will affect our thinking, feeling and behavior in current and future situations.

Clinicians need to be aware of the significance of these findings because what clinicians do with clients in practice may well become part of the client’s molecular genetic template. The emotional interaction with clients will have long lasting impact.

For clinicians and their clients, this news, which points to the embedding of strong negative and positive client experiences in DNA and long term memory is a call for more targeted assessments and treatment.

In addition, molecular changes in our DNA may be passed down through the years and through generations as well so that the children of clients may be influenced by the changes in the DNA imprint.

Impact of Long Term Memory

Memory is a complicated and multi-faceted concept and involves various brain systems that are engaged in working memory (known as short term memory), autobiographical memory episodic memory and long term memory.

When we speak of experiences that become part of our DNA and long term memory, we refer to strong positive and negative (traumatic) memories of abuse, of birthday parties, of divorces, births, deaths and transformative therapy interactions that have an emotional impact.

These powerful experiences are most likely to be processed into long term memory and genes and therefore have an impact upon our behavior, thinking and feeling.

What our clients have experienced in their past and present and what clinicians do during the therapeutic interaction leaves a lasting footprint.

In the case of early child abuse and other traumas, we now know why experiences and memories are never lost in memory and can be reconstructed and triggered by a variety of cues that may seem imperceptible to some.

This issue is a cautionary one because the repeated triggering reinforces the memory and becomes a disabling factor. Fear cues may appear within the therapeutic context as well and this knowledge may make the clinician more observant and a better listener.

PTSD and Threatening Cues

The cycle of repeated fear arousal is PTSD and many clinicians are learning and practicing methods of treating this painful disorder.

Traumatic memories can be brought up and reconsolidated in therapy, over-written with positive or neutral information but they are never completely lost.

Research shows that certain chemicals such as valprolic acid can strengthen reconsolidation of the original fear memory or enhance long-term memory for extinction such that it becomes independent of context.

These findings have important implications for the use of medications as adjuncts to behavior therapy in the treatment of phobia and related anxiety disorders.

Some individuals are more vulnerable to PTSD because of early abuse followed by what they perceive as threatening cues during their lifetimes.

Others, who have not been sensitized, are less vulnerable but with this information clinicians need to take certain steps in treatment with sensitized clients that will be noted below.

Beyond becoming a better listener and observer, there needs to be carefully targeted evaluation of the client’s early history. Their “lived experiences” need to be done as early as possible so that sensitive clients can be identified.

Within the therapeutic relationship and within the environment that the therapy takes place, there may be fear cues that are not readily apparent. These cues may involve the receptionist’s attitude towards the client, the number of people in the waiting room, the physical dimensions of the office and of the therapist themselves.

Kelly Higdon, LMFT <![CDATA[Why Social Media Matters]]> http://4.619 2015-10-06T18:37:07Z 2015-10-06T18:37:07Z Social Media Private PracticeI believe we are here to make a difference in the world. As therapists we often do this through our relationships with clients. I call it changing the family tree. Work that can impact not just the individual but will ripple into generations beyond.

Today we have another opportunity to influence our communities and culture, all because of technology, all because of social media.

As a private practice coach, I do refer to using social media to build your practice by offering something of value to people. With every tweet and post, you can inspire and help someone that you would otherwise never see in your office.

For this blog, I am writing about a different way of using social media as therapists. Beyond our couches, we can reach into the hearts of others, educate, dialogue and influence common cultural issues that impact the lives of our clients and that keep people from getting our kind of help.

For example, during the first full week of October, NAMI and participants across the country are bringing awareness to mental illness. #Iamstigmafree is the campaign that seeks to break down the stigma around mental illness. One hashtag is making an impact on the world. You can participate by sharing the hashtags on your social media accounts. Start giving voice to an all to common issue.

Does that really work? The more we shine light into the dark recesses of our culture, the more we can normalize experiences, find strengths and positives and allow space for a dialogue and a rewriting of our stories. When you identify with a cause, you are saying you take a stand along side others who are hurting. The reach of our messages expands with social media. Tweet a community leader enough times from enough people and you will probably get a response.

Social media is a tool to leverage social justice issues into the forefront of our society. We can complain that our phones aren’t ringing or that our culture doesn’t support psychotherapy as a valid tool – but we can also reach out to educate and empower others.

Mercedes Samudio, Parent CoachMercedes Samudio, LCSW at The Parenting Skill is working to end parenting shaming with her campaign. Too often parents feel isolated and judged by others which decreases their willingness to reach out for help and so she created the #endparentshaming project. You can learn more about it here.  With a simple hashtag, people across the country are sharing why they want to end parent shaming by tweets and posting videos on their social media sites. A simple hashtage is evoking a response in parenting communities and bringing awareness to all too common issue that is hurting families.

Before you cringe and shy away from social media, listing all of its potential hazards, just consider what others are doing to change the world. Yes there are boundary issues that need to be addressed and should be addressed through your social media policy, however, your potential for influence is worth so much more.

So join with us and take a stand. Share #Iamstigmafree. Bring mental health awareness to light with your friends, family, and contacts. Stigma stops with us.

Allison Puryear, LCSW, CEDS <![CDATA[Failing in Slow Motion]]> 2015-10-06T01:48:36Z 2015-10-06T11:48:07Z I’ve always heard this notion that failure is a part of business. That you can’t succeed without failing. I always found it unsettling to read and, having had plenty of successes without failures, hoped it was meant for OTHER people in OTHER industries.

I saw these Pinterest pins about it and read these quotes and decided they were there to normalize it for those who struggled rather than take it like a harbinger of future failure for those who were succeeding.

Until last week.

I talk to my therapy clients about “slowing down time” in moments where they want to react impulsively. Today I want to teach you how to slow down time in your own business so you can catch failures before they negatively impact your business and I’m going to use my own failure as a case study.

Case Study

Here’s what happened: I worked for months on this three video series where I teach you guys some of what we talk about in the Abundance Practice-Building Groups. The script was solid, the content was valuable and I was excited but daunted to try a new format.

I figured out the tech end, I had a video editor lined up. I got my lights set up, took a few deep breaths, and hit record. It took five hours to record the first 10 minute video.

Film, not edit. I tried using a teleprompter for the script: too scripted. I tried putting key words in the teleprompter: I forgot important content. Somewhere in hour four, I had it down and recorded a few takes.

Videos 2 and 3 went faster, but I never felt alive doing it. In the nine hours of filming, I never felt connected to what I was teaching. It was more about hitting the points of the script. I’d tried the techniques of pretending my best friend or ideal clients were sitting with me. I tried pretending one of my groups was in the room. I tried, but I kept forgetting to maintain it in my effort to hit points A, B, & C.

Then I pretended the videos didn’t exist for a little while. My video editor didn’t need them yet so I didn’t rush into the process where I needed to watch the videos and say what time each slide needed to be put in. Honestly, I was avoiding it. I’m not usually big on avoidance but deep down I knew I was going to be displeased and I guess I wanted to hang out in denial for a while longer.

When it came time to get the editing info to the video editor, I was a week from launch. I sat at my favorite coffee shop with my ear buds, gritted my teeth and made it happen.

It was bad. Not train wreck bad but definitely not something I wanted to represent how I normally work with people. I happened to have my Mastermind Group the next day and played them a clip. I was met with initial silence and then, these wonderful women said what they knew I didn’t want to hear— I wasn’t me on video, I was totally wooden, it wasn’t usable. Honest entrepreneurial friends are such lifesavers.

Let me back up and talk about launches and time lines and why this was a big deal.

The type of launch sequence I’m using is a series of free offerings that are intended to help build my audience by providing information that is going to help move them towards their goals. Ideally it’s a win/win: it helps you build your practice while also building your trust in me.

The day after the third video, people are able to sign up for the Abundance Practice-Building Group. Sign up lasts about a week from August 14-20th and the first groups starts September 1st. Normally it would be an option to just push everything back a week or a month, but because I’m pregnant, I have to have the groups end when they’re slated to in February and don’t have that flexibility.

So after another great conversation with Joe Sanok from The Practice of the Practice and further processing and planning with my brilliant husband, Joel, I came up with a new plan to pivot and make something new work

. I’m clear that I am a people-person. Trying to connect with a red camera light isn’t going to work. So I sent an email to the local folks who have been in my group, therapists who plan to be in the next round of groups, and a few friends in private practice. I told them what happened and invited them to come to my office so I could teach this to them while recording it all.

Within a few hours, I had an office-full lined up for each of the three video recordings.

So, I filmed the videos which then got cleaned up and plopped into my website by Wednesday morning and though I “um’ed and “like”d and stumbled, I was talking like I normally do when you add a dose of nervousness to my teaching.

It’s a thousand times better than the one I toiled over for months. Each recording had a different group of practice-builders in the room, which was so awesome and for which I’m so grateful. Last minute is so not my style but all those years of working on flexibility is finally impacting something other than my relationships.

So, what can you learn from this?

Christine Hammond, MS, LMHC <![CDATA[Understanding Paranoid Personality Disorder]]> http://5.346 2015-10-06T13:50:42Z 2015-10-06T09:56:55Z Paranoid Personality DisorderSome people truly believe that everyone is out to get them.  They have baseless suspicions of family, friends, co-workers, the trash man, the police, or even the cashier at the grocery store intentionally harming them. They imagine hostile conversations and project their irrational fears as real motives of others. When confronting the accusations, they insist the problem is everyone else. They are paranoid.

So what is Paranoid Personality Disorder?  Here is the technical definition according to the DSM-V:

  • Global mistrust and suspicion of others motives after 18 years old.
    • suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
    • is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
    • is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
    • reads hidden demeaning or threatening meanings into benign remarks or events
    • persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
    • perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
    • has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
  • Does not occur exclusively during the course of Schizophrenia, a Mood Disorderwith Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.

The practical definition looks more like this:

  • Believes others are using or taking advantage of them
  • Reluctant to confide in others out of fear
  • Unforgiving and holds grudges for unusually long periods of time
  • Reacts negatively to criticism and refuses to let go
  • Reacts with anger, retaliates against anyone they perceive is causing harm
  • Cold, distant, controlling, and jealous
  • Believes they are always right
  • May utilize recording devices in order to prove the infidelity of others
  • Suspicious without any justification
  • Frequently believes they are in danger and scans environment for proof
  • Sensitive to slights of others

Mel Gibson in his portrayal of Jerry in “Conspiracy Theory” did a wonderful job showing what paranoids look like in real life.  The constant looking over his shoulder, reading more meaning into seemingly meaningless things, the hypervigilant behavior, and intense anger are all characteristics of PPD.

So how do you deal with a person who might be PPD?  Here are a few suggestions:

  • Although they are highly logical, don’t attempt to logically reason the paranoid thoughts away. It won’t work because their thoughts are rooted in deep emotional fear.
  • Paranoid beliefs begin in childhood and have little to do with present circumstances. There are no magic ingredients of affirmation that will stop the paranoia. They must decide to abandon the belief on their own.
  • They record as many things as possible by video or audio including people or family in their own home, so expect it. This may seem a bit strange and weird, but to them this is normal.
  • Choose words carefully when speaking as they frequently read far more meaning into them than intended.
  • All it takes is one comment they don’t like and they will shut a person out of their life forever. Use past slights of others as indication of their potential triggers.
  • Their ability to assess risk in an environment is very high. Sometimes, they are right about potential dangers, listen and don’t immediately discount.
  • Sometimes they are right about the ill motives of others. Validate these times.
  • They are highly perceptive which can be quite useful in a variety of vocations. Appreciate their ability.

Living with PPD can be exhausting, exciting, and challenging.  They have the ability to fake social interaction in front of others despite their strong dislike of others. Often, they will leave saying shocking things about the very people they seemed to be enjoying.  Their paranoia is pervasive in nearly every close conversation.  They say things like, “I was just trying to keep you safe” or “I can see things that you don’t” as a way of softening the paranoia.  Frequently their intentions are good as they are very protective of those they love.

Christine Hammond is the award winning author of The Exhausted Woman’s Handbook available on Amazon, Barnes & Noble and iBooks.

Heather Gilmore, LLMSW <![CDATA[11 Tips for Parenting a Child with ADHD]]> http://3.530 2015-10-04T14:19:57Z 2015-10-04T14:19:57Z

It can be exhausting and confusing to have a child with ADHD (or ADHD-like symptoms). However, if you’re reading this, I know that you also love your child whole-heartedly. Your child is probably creative, adventourous, fun, unique, or any combination of these characteristics.

Because it can be difficult to know what parenting tactics work best for kids with ADHD, I will provide a quick list of some parenting strategies that are based on evidence-based treatment models for kids with ADHD as well as from the behaviorism literature (which is based on the science of behavior and learning).

Pelham and Fabiano (2008) reviewed the scientific literature and concluded that behavioral parent training and classroom management strategies were the approaches to treating ADHD which had the most support. They had the most studies which showed the effectiveness of their procedures.

These two approaches were in comparison to behavioral peer interventions and social skills training which both had smaller effects on ADHD symptoms.

All treatments that produced positive outcomes for kids with ADHD included a behavioral approach.

Pelham and Fabiano (2008) discuss the positive effects of the following interventions:

  • Behavioral contingency strategies, such as token or point systems
  • Daily Report (Behavior) Cards from school to home with rewards provided at home for meeting certain criteria (i.e. good behavior)
  • Parent training: To learn about and implement behavior management plans

Other suggestions for parenting a child with ADHD include:

  • Establishing rules and consequences and maintain consistency with both the rules and consequences
  • Remain calm when your child “misbehaves”
  • Reinforce positive behaviors (Ex: give praise or rewards for maintaining longer periods of attention or following multiple step instructions, etc.)
  • Have your child implement a self-management plan (help him to set personal goals and work toward those goals)
  • Help your child to become more aware of his “problem behaviors” (in a loving, nurturing way)
  • Help your child identify his strengths and interests
  • Allow your child time to participate in hobbies and build on his strengths
  • Break challenging tasks into smaller pieces and give breaks in between completion of the pieces


Pelham Jr, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 37(1), 184-214.
[image credit: Christin Lola via Fotalia]
Staci Lee Schnell, M.S., C.S.,LMFT <![CDATA[Breast Cancer’s Emotional Impact]]> 2015-10-03T22:21:27Z 2015-10-04T11:21:01Z October is Breast Cancer Awareness Month. It is important to understand the emotional impact breast cancer may have. Many women with breast cancer face significant emotional issues during and after their treatments.

Anxiety, depression and fear are often evident. One may worry that their cancer will return, be concerned about their physical change, or they may be concerned about the impact of their diagnosis on their family, social or work life. The physical, emotional, and social effects of the disease can seem overwhelming.

The Cancer Experience

Fear of recurrence is extremely common and normal. Some women become hyper-vigilant in looking for any sign that the cancer may have returned. They may second-guess and worry about every symptom. Discussing the fears with their physician or therapist can be very helpful.

Breast cancer survivors typically report some level of emotional distress during their treatment. If the physical side effects are life altering, it is normal to feel extreme sadness or even anger. Grieving the loss of a breast or breasts is an important part of the emotional healing process.

The cancer experience can greatly impact one’s self-esteem and body image. Physical changes such as hair and weight loss or the loss of one or both breasts can leave one feeling like they have lost themselves.

Family support can be critical in emotional healing. Individual as well as couple and family therapy is highly recommended and extremely beneficial for all those impacted. Medical Family Therapy significantly enhances treatment for major and chronic illness such as breast cancer.

Breast cancer has been known to cause some women to feel isolated and to withdraw from many of their normal social interactions. Sometimes, typical social supports are unable to provide the kind of help one may need or want. A breast cancer support group can be extremely beneficial to most.

Some breast cancer patients develop a sense of helplessness or hopelessness when their stress becomes overwhelming or they are physically feeling bad. Those able to utilize some of the strategies and techniques listed below have lowered their anxiety and depression levels, leading them to feel less overwhelmed.

  • Relaxation
  • Stress Management
  • Psychotherapy
  • Cancer Education
  • Support Groups
  • Medication
  • Exercise
  • Healthy Diet


American Cancer Society:
National Cancer Institute:

Ribbon and sneakers photo available from Shutterstock

Heather Gilmore, LLMSW <![CDATA[5 Habits to Improve Healthy Eating: Improve Your Health and Your Life]]> http://3.526 2015-10-03T14:19:37Z 2015-10-03T14:19:37Z

It can be difficult to maintain healthy eating habits especially with the way in which American society supports fast food restaurants, impulsiveness, and quick fixes.

In our society (I can’t speak to other countries since I’ve never been anywhere else), it is so easy to succumb to the pressures of immediate gratification such as by getting fast food for lunch or ordering pizza for dinner.

It is also the nature of our society (in general) that we do things quickly, we can’t slow down and relax and still feel content and at peace. For some reason, we are pressured into thinking we need to be busy and fill our time with as much stuff as we can.

This is a hindrance on our health, though, as we aren’t able to take the path that might take more effort (at least at first). We aren’t as likely to enjoy the process of cooking homemade healthy meals. Additionally, we are so pressed for time that we feel the need to take the path that will get us the results as quickly as possible (in this case, get us food).

Additionally, the food industries of our society encourage us to eat as much as we can (instead of eating just enough). We are also encouraged to eat high calorie foods, such as carbs and coffee-based drinks with lots of added sugar and cream.

Changing just a few things in your day to day living can help you to improve your eating habits. Adopting the following habits can greatly increase your health as well as improve the way you feel and raise your energy levels. These may even help you to lose weight, as well.


1. Make your lunches for the week on Sunday

This habit can make it easier to grab a healthy lunch for the week.

2. Say “no” to yourself once a week (Then, more often)

When you get the urge to eat a bag of Dorito chips or to eat 5 slices of pizza in one sitting (or any other really unhealthy choice), tell yourself “no” just once. Then, once you get the hang of moving past that urge, try telling yourself no twice in a week. Eventually, it will become easier to say no to yourself.

3. Eat something healthy before you eat something high in calories

When you get hungry, try eating something healthy and then go for the higher calorie food. For example, eat a salad before you eat your pizza.

4. Cook healthy foods with unhealthy foods

My 7 year old daughter thought of this idea but it makes a lot of sense. If you still want the cheese or pasta, adding in healthy foods, such as broccoli, lentils, or beans, can make the meal not only healthier but more delicious, as well.

5. Be sure to buy lots of healthy foods when you go grocery shopping

When you go grocery shopping, make sure that you put lots of produce and other healthy foods into your cart. If the healthy foods aren’t in your house at all, you will not be able to eat healthier foods as easily.

Feel free to let me know in the comments if you have any other healthy eating habits ideas.

[image credit: bokan via Fotalia]

Odelya Gertel Kraybill, Ph.D. <![CDATA[After Trauma II: Basic Info for Trauma Survivors]]> 2015-10-01T03:43:29Z 2015-10-03T11:43:00Z In my last post, I presented reasons why trauma survivors often fail to get the support they need, what it feels like after trauma, how easy it is to misdiagnose trauma and how valuable psychoeducation can be. In this post, I suggest important reminders and a list of things you can do after trauma that will lead you towards trauma integration.

Reminder Number One: Trauma Also Brings Emergence of New Life

The moment that you experienced trauma, your survival system called upon unused personal resources to help you survive and it continues to do so. If you are like most trauma survivors, odds are you barely conscious of the strengths you have already displayed in coping with trauma. These are innate survival instincts that have helped you to hold on to life even at is most challenging and they are an important source of energy in your trauma integration process.

Reminder Number Two: There are Neither Shortcuts nor Miracle Cures

The journey towards trauma integration may take a long time. Therapy requires more than a few sessions. You can often get immediate assistance in managing some of your symptoms, but there are no instant cures. If a therapist promises you quick healing, 100% cure,or full reversal of your traumatic experience, I suggest you find another therapist.

Trauma takes things away from us and some can’t be returned, ever. These are sometimes physically, tangible – people we loved, a body that once functioned perfectly.

Other times, they are emotional, intangible – a sense of uncomplicated wholeness, pristine memories of beloved times and places.

Either way, coming to terms with irreversible loss is an essential part of trauma reintegration. Anyone who implies otherwise makes the journey ultimately harder for survivors.

Good things and meaningful life can and usually do return after the occurrence of trauma, to be sure. But the goal of therapy cannot be return to some state of wholeness imagined to exist in the past, it must be finding a path to deep meaning and inner rest in the post-trauma present, which includes both trauma-related losses and meaningful things that followed trauma.

Reminder Number Three: Therapy Should Make You Feel Better, Not Worse

If you find yourself going to therapy and over and over again, feeling worse rather than better after your sessions or more emotionally flooded after a session than before, something may be off track in your therapy.

Of course, it to be expected that you may often feel flooded during the session. Your therapist can and should accompany you in these difficult moments. It is important, however, that something else happen as well: you should feel reconnected to resources for coping before you leave the session.

Part of a therapist’s responsibility is to make realistic decisions about managing sessions in such a way that you leave feeling supported and more able to manage what is happening than when you walked in.

This response might include a ritual that you create together that connects you to your inner resources or the use of grounding tools, mindful expansion exercises, sensory integration tools, reset exercise*, or breathing techniques.

It might also include scheduling a follow up session or phone call, committing to a contact via email, text, or Skype call, or in really difficult times, referring you for further assistance.

The bottom line — if something is not right for you about the way others are guiding you to work with your experience of trauma, listen to yourself.

You are the only authority on your body and health. Part of the damage of trauma is that it tends to reduce survivors’ ability to trust themselves.

Odelya Gertel Kraybill, Ph.D. <![CDATA[After Trauma I: Basic Info for Trauma Survivors]]> 2015-10-01T03:42:34Z 2015-10-02T11:41:58Z A lot of trauma survivors fail to get the support they so much deserve, simply because the symptoms of trauma are often mistaken for other disorders. In this post, I want to share with you basic information for trauma survivors and a practical list of things you can do after trauma.

What it is Like After Trauma

Trauma affects the nervous system at deep, pre-conscious levels. Traumatic memories are not stored in a place where thought and talk-based mechanisms are managed in the human brain. Trauma seems to be processed when it is happening mainly by the instinctual part of the brain – the part that makes you yell and jump a foot into the air when something startles you – and it also seems to take up long-term residence there.

The instinctual brain is a sort of pre-conscious data management and control network. It is responsible, among other things, for basic sensory integration.

Think of an advanced robot with lots of sensors and wiring for detecting sound, motion, light and temperature, balance, etc.

Now imagine that robot exposed to something highly damaging. like a fire. After such a trauma, the robot’s high-level central computer might still work. But its autonomic systems for gathering and interpreting data about the world now malfunction. It frequently interprets and reports incoming data to be extremely threatening, even when there is no danger at hand.

The human sensory integration mechanism (of sound, sight, motion and temperature etc.) takes a severe hit from trauma and chronic, high-level stress.

The impact of cumulative stress is less immediate but eventually similar in its brain responses to that of trauma. Survivors consume far more energy coping with unusual or uncomfortable sensory experiences than previously and if they are severely traumatized, they may react in ways that are unpredictable, to themselves and others.

After trauma, one of the most common responses is a lingering sense that things are “out of control,” accompanied by a deep longing or drive to re-assert control. This response is predictable from a nervous system that once – in a time of past trauma – correctly perceived that things were out of control and danger imminent. But now it is reporting constant alarms, mostly false.

As the key monitor, interpreter and coordinator of the body’s systems for communication with the external world, the nervous system of a traumatized person frequently misreads the data coming in from the senses. Any unexpected or unusual inputs are likely to trigger emergency responses to threat, which most of the time doesn’t exist in the current reality.

Wrong Diagnosis

It’s hard to live and maintain routines when inner alarm bells keep going off. An ordinary day can be full of them. Tiredness and chronic fatigue are a common result. And so are depression, hyper-activity and deep anxieties about all kinds of things.

When therapists are not well-informed about trauma, they can easily miss its presence as a root cause entirely. Frequently, they misdiagnose trauma as depression, ADHD or anxiety and personality disorders.

Speaking From Experience

I am a trauma survivor myself. As a young adul,t I spent almost 10 years in therapy with two different therapists, in which time the word trauma was not once mentioned. I often left the therapy room emotionally flooded, feeling like this terrible time would never end.

Life brings difficult experiences to everyone, so of course I had plenty of things to work on in therapy. But today, I know that the core of my struggle was not the psychodynamics of childhood I was discussing with my therapists, but the unrecognized and untreated traumatic experiences that I carried all those years.

Christine Hammond, MS, LMHC <![CDATA[Understanding Dependent Personality Disorder]]> http://5.341 2015-10-01T14:51:33Z 2015-10-01T14:51:33Z DPDThe word “dependent” is the perfect descriptive word to summarize Dependent Personality Disorder (DPD).  DPDs need other people for all areas of emotional support and affirmation. Frequently, they are reliant on one particular person such as a spouse, parent, or adult child.  Often, their dependence is in direct contrast to the other person who is usually very independent.

So what is DPD?  Here is the technical definition according to the DSM-V:

  • A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contests.
    • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
    • Needs others to assume responsibilities for most areas of his or her life.
    • Has difficulty expressing disagreement with others because of fear of loss of support or approval.
    • Has difficulty initiating projects or doing things on his or her own.
    • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
    • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
    • Urgently seeks another relationship as a source of care and support when a close relationship ends.
    • Is unrealistic preoccupied with fears of being left to take care of himself or herself.

The practical definition looks more like this:

  • Indecisiveness in small and large matters
  • Constantly checking to see what others would do before making any decision
  • Acts passive and helpless even though they might be fully capable of handling a situation
  • Oversensitivity to criticism especially from the person they are most dependent on
  • Avoids disagreeing with others out of fear of losing support or approval
  • Fears of abandonment are intense and pervasive
  • Tolerates mistreatment and abuse especially from the person they are dependent on
  • Places needs of caretakers above their own
  • Naïve, often lacks common sense in relationships

DPDs are not Co-dependent and visa versa. Co-dependents are addicted to the other person needed them. They can get a “high” of sorts from knowing that the other person is dependent on them. DPDs by contrast don’t get excited by others needing them. Many DPDs are resent to any form of dependency on them even though they are dependent on others.

So how do you deal with a person who might be DPD?  Here are a few suggestions:

  • Because they are approval seeking, expect it even for the little things. It is almost as if they can’t make a decision without running it by another person(s). Frequent quick phone calls or text messages can reduce the frustration.
  • Be reassuring with DPDs and don’t push them away. They are very sensitive to criticism and pushing away is the same thing as rejection or abandonment. Because they tend to be passive, they might not express their frustration easily, so become a good student of their body language instead.
  • “You are doing the right thing” is very comforting to say to a dependent especially if they have to confront someone else or stand up for themselves.
  • Since small decisions require approval, give it without anger, resentment, bitterness, sarcasm, or minimizing. This might take some practice at first, but it is worth the effort. DPDs are extremely loyal and faithful so once you have their attention, treasure it.
  • If you take the time to validate their feelings, they will be on your side for life. If you minimize their feelings, they will see that as rejection.
  • Give them time to make a decision. Be patient with their process.
  • Don’t ever belittle them in front of others and always refrain from sarcasm when speaking with them. They are very sensitive.

Dependents are great at relationships because they are so giving and willing to put up with all kinds of nonsense.  But don’t take them for granted or they will be lost for good.  Instead, understand the nature of a dependent and set more realistic expectations consistent with their personality.

Christine Hammond is the award winning author of The Exhausted Woman’s Handbook available on Amazon, Barnes & Noble and iBooks.

Cheryl Fisher, PhD.,NCC, LCPC <![CDATA[Summer Ratatouille: Savoring the Season]]> 2015-09-29T17:45:48Z 2015-10-01T11:45:15Z As I sit in the Labor Day beach traffic anxiously awaiting my arrival at my sandy destination as a final attempt to catch that last wave of summer fun, I reflect on this summer’s adventures.

Family BBQs, beach vacations, crab feasts, long bike rides, hiking with my fur-family, leisurely weekends laying on the hammock and engulfing light reading and the succulence of my summer garden.

This year, my garden was filled with the expansive array of colors and textures of tomatoes, carrots, beets, zucchini, squash, green beans, peppers, peas and strawberries. Little compares to sinking your teeth into a freshly plucked tomato straight from the vine, or the smell of aromatic herbs of oregano, thyme, basil and rosemary as they rise from the wet, warm earth during a summer shower.

As the season comes to an end, the vines begin to wither and summer quickly becomes a memory fading green to yellow to brown in the autumn breeze. The sunflowers once bursting yellow and bobbing in the breeze now brown and wilted bow gently following a stellar performance as the summer curtain closes.

I am not ready to release the sweet surrender of summer and I decide that when I return home, I will take the remnants of summer and create a ratatouille filled with the harvest that remains so that I might savor the season for a bit longer.

Savoring and Connecting Fully

According to Webster’s dictionary, to savor is to “taste or smell with pleasure; to delight in; to relish; to like; to favor.”

Princeton’s Wordnet invites that one “taste appreciatively” when savoring. Therefore, savoring appears to require active engagement in the relationship between a person and her object of appreciation. Thus, savoring is about connecting fully.

Jon Kabat-Zinn, in his book, “Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, wrote “at its core, mindfulness is about relationality.”

It is about connecting with the experience at hand be it a conversation with a friend, sharing a meal with family or appreciating the end of a beautiful summer. Further, it is in this connectedness that we experience the moment long after it has faded away.

Ways to Savor the Season

1. Travel Journals and Scrapbooks

I like to capture the moment by providing mini-narratives of my excursion. A picture or postcard further allows the visual context of the story. For example, during a trip to Scotland, I narrated our bus ride to the countryside of Dumgoyne which boasts the delightful Glengoyne distillery and where I first acquired my taste for single malt scotch. I embellished this narrative with pictures and labels from the samplings.

2. Long walks experiencing the seasonal changes.

While I am reluctant to release summer, I thoroughly enjoy early morning walks when the sun is still pondering her arrival under the blanket of dawn. With the exception of the birds and crickets, the Earth is still. The musty smell of dew on the fading lawns permeates the mist of the pretense to summer’s humidity.

But there is a change. A cool breeze gently rustles the trees, leaves withered and gold, giving pause in anticipation of autumn.

3. Keepsakes

What a wonderful way to relish the beauty of summer by creating keepsakes. Collected sea glass and sea shells, (treasures from the ocean) make a nice display. Drying herbs in the freezer allows them to be used in stews and soups throughout the long winter. Drying flowers from the garden and creating arrangements can be a wonderful way to stay connected to the bouquets of summer. Better yet, preserve those wonderful flavors by sealing in cans and storing for the season.

4. Share the memories

Have an end-of-the-summer party inviting friends to come with vacation pictures in hand. Over drinks and potluck meal, linger over stories of summer adventures.

5. Be in gratitude

I am a groupie of gratitude. It is a practice that I enjoy each night as I climb into my comfy bed next to a man who tolerates my form of crazy, and two 65-lb.. fur-family members who greet me as if I were “all that” and a peanut-butter bone. I mentally list everything that I am truly grateful for in my life…in my work…in my family…in the season …and I savor each nugget as I fall blissfully asleep.

How do you savor the season?

Beach photo available from Shutterstock

Heather Gilmore, LLMSW <![CDATA[FREE Autism Downloads]]> http://3.520 2015-10-01T02:15:20Z 2015-10-01T02:15:20Z

Following is a list of links which offer free downloads related to autism.

Educate Autism

This site offers a variety of free downloads for individuals with autism. Examples of some of the available downloads include: body parts identification worksheets, colors, hand-writing, fine motor skill activities, schedules, token economy materials, and more.

Practical Autism Resources

Practical Autism Resources offers 100s of pages of free downloads.

Autism Teaching Strategies

The creator of this site, Joel Shaul, LCSW, provides dozens of downloads specifically related to social skills and children with higher functioning autism (or asperger’s).

Autism West Midlands

This site provides downloads for topics, such as autism and sleep, play and social skills, and much more. They also have a lot of interesting visual resources (or hand-outs), such as schedules, prompting tools, and hand-outs.

Autism Buddy

Autism Buddy provides a variety of resources including printable schedules, worksheets, and flash cards.


If you know of any other great resources with free downloads related to autism, feel free to let me know.

[image credit: kreizihorse via Fotalia]

Heather Gilmore, LLMSW <![CDATA[Benefits of Music Therapy & ABA (Applied Behavior Analysis) for Young Kids with Autism]]> http://3.516 2015-10-01T00:42:50Z 2015-10-01T00:42:50Z

As a Behavior Analyst in training, I have witnessed the incredible benefits that many children with Autism can experience by use of applied behavior analysis (ABA). However, I also notice that many children with ASD also receive services, such as speech therapy and occupational therapy. Occassionally, various professionals also recommend mental health therapy for particular issues experienced by higher functioning children. Of course there are many other options out there for different types of “interventions” for autism as well as other conditions (some of these with little to no research evidence to support their effectiveness and others with more support).

In general, I notice that there may be a lack of acknowledgement in the field of ABA in regards to the possible benefits that other fields might provide. It is certainly the case that ABA has an enormous research base for its effectiveness with children with Autism. However, some research indicates the possible benefits of considering the use of tools that are utilized in other treatment approaches, as well.

For instance, Lim and Draper (2011), discuss the benefits of adding a music therapy component to ABA treatment. In their article, “The Effects of Music Therapy Incorporated with Applied Behavior Analysis Verbal Behavior Approach for Children with Autism Spectrum Disorders,” they discuss their experiment in which they had 3 groups of children with autism from the ages of  3 to 5. The three groups were 1. music incorporated with ABA VB (verbal behavior), 2. ABA VB, and 3. no treatment.

Results in the Lim and Draper (2011) study indicated that the music-incorporated group and the speech (ABA VB) only group increased skill acquisition in all 4 verbal operants. The difference was that the music/ABA group showed higher levels of echoic production while the speech (ABA VB) only group showed higher levels of tacting skills.

This study suggests that including musical stimuli in applied behavior analysis treatment may enhance certain skill areas for children with autism.

FOOD FOR THOUGHT: This study makes me wonder what other “outside the box” (or creative) ideas would be beneficial for improving skill acqusition for children with autism (while also maintaining a behavioral approach, of course).

If you have any thoughts or ideas, feel free to comment below.

Reference: Lim, H. A., & Draper, E. (2011). The effects of music therapy incorporated with applied behavior analysis verbal behavior approach for children with autism spectrum disorders. Journal of music therapy, 48(4), 532.
[image credit: sges via Fotalia]
Steve Greenman, MA, LPC, NCC <![CDATA[A Postmodernist Vision of Counseling]]> 2015-09-29T17:44:44Z 2015-09-30T11:44:18Z

“If the patient doesn’t fit the book, throw away the book, and listen to the patient”
Betty Friedan

James T. Hansen’s (2010) abstract entitled “Consequences of the Postmodernist Vision: Diversity as the Guiding Value for the Counseling Profession” shares that many realms of the counseling profession are still guided by modernistic thought and could be significantly enriched by a foundational shift to post modernistic concepts.

Hansen uses the example of how strongly the counseling profession has identified with the multicultural movement with its deep ideological roots within postmodernism theory and how multicultural diversity has had a positive influence on how we see and treat clients.

Hansen shares in his abstract two specific areas in the counseling field that could be positively affected by a paradigm shift from modernism to post modernism and they are professional identity and the helping relationship with clients.

Critical Analysis

Hansen describes modernism as a paradigm that presumes that the singular essences of objects in the material universe can be either accurately or inaccurately represented by immaterial human minds (Rorty, 1979).

Hansen uses the example of birds to describe the differences between modern and postmodern thought. Modernist perception of birds might be inaccurately describing birds as Gods, use scientific methods to discover bird’s essence and mentally represent birds as flying organisms (Anderson, 1990; Hansen, 2007). In a nut shell, modernism is looking for singular truth to reality.

Postmodernism defines thought as being in the eye of the beholder. To postmodernists, there is no correct essence; each one’s perception as in the example of birds may be justifiable, depending on the needs of a particular community of perceivers.

Examples of postmodern thought include:

  • Multiple perspectives without labeling one right or wrong.
  • No singular truth.
  • No culture closer to the truth than they other.
  • All species including humans are to be appreciated rather than judged. Diversity is the key even to the point of one being able to construct multiple realties (Hansen, 2004).

Professional Identity

One of the issues profoundly affecting the counseling profession is lack of a professional identity.

The diverse aspects of counseling have made it extremely difficult to pinpoint what the nature of the counseling profession exactly is and in so being, it is difficult for counselors to agree on what precise identity factors are there that distinguish counselors from other helping professionals.

Postmodernist influence on professional identity for counselors would allow:

  • Freedom rather than being fixed and congruent.
  • Identity would be fluid and diverse.
  • Individually determined versus socially constructed.
  • Local and pragmatic versus universal.

Hansen uses the example of professional identity as analogous to national citizenship. Citizens of democratic countries are not usually defined by a particular identity. Rather, citizens are defined by the fact that they are part of a particular country and usually have some knowledge about the history and values of that country.

Under the postmodern structure, counselors can be conceived of as citizens of the counseling profession who have been exposed to the literature and values of the profession but an identity is created by local demands not by influential members of the profession (Hansen, 2010).

]]> 0 Allison Puryear, LCSW, CEDS <![CDATA[Can Introverted Non-Go-Getters Succeed in Private Practice?]]> 2015-09-28T17:06:31Z 2015-09-29T12:06:06Z I’m going to answer a question I get at least once per month. It usually goes something like this: “I’m really introverted and not a go-getter; do I have any chance at succeeding in private practice?”

My answer is “Absolutely!”

Sometimes, people read my story and think I’m going to preach my personal (outgoing, extroverted) avenue towards building. Here’s the thing: my personal way works for the people it works for–people who can’t get enough of people.

I have other tricks up my sleeve for folks who get burned out by people. I want you to be good at your job and good at life and burning yourself out will not work.

Not Better, Just Different

Let me clarify that “go-getter” is not better, just different. Yes, we may get more done faster, but possibly too hastily. On an average day, my decision making takes about five minutes tops. Trying to decide stresses me out. Quick decision + action + figure it out if it tanks isn’t always the best strategy. Getting lost in decision making isn’t helpful either, but there’s a lovely middle ground in there, I bet.

So, not a go-getter? No problem. Sometimes there’s a bit of making yourself do things that are scary or putting yourself out there in a way that is not your norm. As a competent therapist who made it through grad school and has the uncomfortable conversations that come up in life, you already have this down. You don’t have to hustle if hustling isn’t in your nature.

In fact, I will argue that trying to do things that are of someone else’s nature and not your own is a sure fire way to fail.

Here’s why you may even be better suited to private practice than an extroverted Type A like me:

  • You know how to pace yourself. I hope you know how much of a strength this is. It’s like burn-out prevention is built into your DNA as long as you build your practice in a way that’s true to you.
  • The loneliness I used to feel in private practice doesn’t feel like loneliness to you; it feels comfortable.
  • You don’t talk your partner’s/roommate’s ear off when you get off of work because you haven’t been able to talk about what you want to talk about all day.
  • You don’t overwhelm people with your energy.
  • You don’t have to hyper-regulate around your anxious clients to keep from activating them more.
  • You naturally take more time to self-reflect, re-evaluate and check in.
  • Your identity doesn’t hinge on achievement in the same way. Of course you want to succeed and you will, but you’re less attached to each little sign that that success is on it’s way.
  • With the advent of social media and websites, you can “be seen” in ways that are more permanent and less fleeting. And you will probably think about what to write instead of hastily responding like I might.

Are you feeling like it’s more doable? I really, really hope so.
For those of you who don’t fit in to the introverted, non-go-getter category, don’t worry. You’re going to be great, too. I just wanted to take some time to reassure the folks who tend to reach out with the most self-doubt.

This article was adapted from a post originally published on the Abundance Practice Building blog.

Shy businesswoman photo available from Shutterstock

Christine Hammond, MS, LMHC <![CDATA[Understanding Avoidant Personality Disorder]]> http://5.337 2015-09-29T10:11:44Z 2015-09-29T10:11:44Z Avoidant Personality DisorderIn a social media rich environment where a person is frequently overexposed, those with Avoidant Personality Disorder (APD) are a welcome change. APD pretty much sums up the disorder in one name.  In nearly every environment of family, work, or community involvement, APDs avoid social interaction.  Think of a recluse, hermit, outsider, lone wolf, or loner who likes being that way and in fact prefers to live that way and that is your APD. This person would not be on social media and does not understand the need for it.

Here is the technical DSM-V definition:

  • Identity: Low self-esteem, excessive feelings of shame or inadequacy
  • Self-direction: Reluctance to pursue goals or take risks
  • Empathy: Preoccupation with criticism or rejection
  • Intimacy: Reluctance to get involved with people unless certain of being liked
  • Withdrawal: Avoidance of social activity or contact
  • Intimacy avoidance: Avoidance of close or romantic relationship and sexual relationships
  • Anhedonia: Lack of enjoyment from life’s experiences or unable to take pleasure in things
  • Anxiousness: Intense feelings of nervousness or panic often in reaction to social situations

The practical definition for clients looks more like this:

  • Hypersensitive to rejection, often inferring it from subtle cues
  • Prefers social isolation and dislikes large crowds
  • Appears to like being alone but secretly prefers the presence of one person
  • Extreme shyness in nearly every situation
  • Avoids physical contact, sees this as an indication of intimacy
  • Is self-loathing but few would suspect this
  • Mistrusts others but is not paranoid
  • Others perceive distance in intimacy but they believe they are being intimate
  • Self-critical about their problems and circumstances
  • Problems in occupational functioning due to lack of communication

Remember reading “Catcher in the Rye” written in 1952 by J.D. Salinger?  It was one of those readings that some schools required and other schools banned the book because it was believed to instigate teenage rebellion.  Well, the book sold over 65 million copies but J.D. Salinger disappeared.  Most authors would love such recognition but he hid and died in 2010.  It is unknown if J.D. Salinger might be APD however, his behavior is similar to someone with this disorder. Generally, APDs are very uncomfortable with any type of public recognition.

So how does a person respond to someone who might have APD?  Here are a few suggestions:

  • Be careful in conversations, they shut down easily and become self-loathing. Don’t be anxious around them, it is easily sensed and misinterpreted.
  • Find an area of common interest to establish a bond of reassurance. They can and will trust a person over a long period time and given enough patience.
  • Don’t minimize their feelings or self-doubt, they feel very intensely. Their social distance is often mistaken for a lack of feeling, but in reality they are very sensitive.
  • Don’t try to make it better by saying something. Listening is the most effective tool. Listen to the words said and not said. Note changes in body language to gauge important points.
  • They don’t like conflict, so make the environment as non-confrontational as possible.
  • Pay attention to all of what they are saying as they frequently don’t say all of what they mean. Ask questions, don’t jump to conclusions or make assumptions. Many times they will think they have said something when they have not.
  • They are awkward in social settings so expect it. Don’t intentionally put them in uncomfortable environments without prior permission. This is not a person who likes surprise parties.
  • They already know they are different so don’t bother telling them. Rather, learn to appreciate their independence.
  • They have a tendency to believe that they are more intimate with a person than what might actually be the case. Those married to an APD should be very careful with words and body language as APDs tend to take offense easily to the slightest infraction. They truly see their relationships as having more intimacy than it might actually have.

Because APDs prefer to be in the background, they have a unique perspective on the world around them and can be very philosophical. Often, they have amazing insights into people and circumstances that others frequently miss. Seeing the bigger picture is not difficult for APDs as their sensitivity is constantly feeding them input from a variety of senses. Once they are comfortable with a person, they will share their thoughts and perceptions. Treasure these moments, they are sacred.

Christine Hammond is the award winning author of The Exhausted Woman’s Handbook available on Amazon, Barnes & Noble and iBooks.

Heather Gilmore, LLMSW <![CDATA[3 Tips for the Working Mom: Work-Life Balance]]> http://3.512 2015-09-28T03:10:00Z 2015-09-28T03:10:00Z Work Life Balance Concept

Almost any mom can tell you about the challenges of balancing the many roles and responsibilities she has to manage in her day to day life. Whether you work from home or outside the home, I bet you can relate to the struggle of trying to figure out how to balance work with the rest of your life (your family, personal time, household responsiblities, etc.).

Wouldn’t it be great to have a way to live life with more peace and to feel like things were more manageable and to not feel like everything was so chaotic or that you’re always scrambling to fit everything in?

I will present some effective tools for you to use that will help you achieve a better work-life balance. The tips that I discuss are based on the principles of behavior and learning and are founded in the science of applied behavior analysis. That means that these tips are based on scientific evidence that supports their effectiveness for changing the way people behave and live their lives.


First things first…First, you need to evaluate your own time. How do you spend your time on a day to day basis. Any type of intervention (or change that you want to make) should be preceded by taking accurate information on what is already happening.

This information needs to be as accurate as possible to provide the best results. It is common for our memory to make errors in identifying what actually happened, which is why you should do your time study in the moment.

A time study is basically a list of how you spent your time across a certain number of days. The “intervals” (the chunks of time that you will divide your days into) can vary, but generally, having a data sheet broken into half hour increments will work to start with.

To see a sample time study developed by Hope Family Resources, LLC (my business), download personal time study…or…

Click here to visit Hope Family Resources and then click on “personal time study” to download the file.


Any effective behavior change procedure includes specific goals.

“If you don’t know where you are going, any road will get you there.” –Lewis Carroll


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Be specific in what you mean when you are thinking about wanting better work-life balance.

For instance, does that mean

  • that you want to work less (how much less?) or
  • that you want to spend more time with your kids (how much time? do you have an idea of what kinds of activities?) or
  • do you want more “me time” (does that mean a few minutes here and there or days away from the house that don’t include errands or work?)

Think about and clarify what you really mean by work-life balance and write it down.


Before beginning to make a bunch of changes and trying to start developing new habits, doing this task will have a big impact on helping you to succeed at the work-life balance……..

Decide on 3 specific time slots in your day which will be used for developing habits for enhancing work-life balance.

Don’t decide what will go in those time slots quite yet. That will be addressed a little later on. Simply decide what times of day will work best to create “routines.” What time of day seems like it would make most sense to develop a series of tasks that will help you manage your life? Usually some sort of morning routine and evening routine are established. The evening routine might be framed as beginning after dinner and ending when the kids go to bed or maybe it begins an hour before you go to bed (and yes, adults should have bedtimes, too). Another time slot could be the half hour after you get home from work or, if you stay home, maybe it’s from 2:00-3:00 in the afternoon.

My daily routine time slots are: 5:30-7:00 am (before I go to work), 6:00-6:30 pm (right after I get home from work), and 8:00-9:30 pm (beginning after my toddler goes to bed).


  1. Create your time study for 1 week.
  2. Write down 3 specific goals.
  3. Write down the 3 time slots you have decided to use for your daily routines.

More action steps to be discussed in future posts.


I will provide additional information on the work-life balance for working moms in upcoming posts.

Feel free to comment below on any specific challenges that you face as a working mom or any particular topics you would like me to address.

I appreciate your thoughts and your feedback and will definitely consider them as I develop future content.

[image credit: Work-Life Balance Concept © Krasimira Nevenova via Fotalia]