Psych Central Professional For mental health, psychiatric and psychological professionals.2015-09-01T12:27:46Z Sharie Stines, Psy.D <![CDATA[Treating Pedophilia]]> 2015-08-31T20:28:23Z 2015-09-01T12:27:46Z According to the DSM-5-TR, the criteria to diagnose Pedophilia is defined as recurrent experiences of intense sexual arousal, fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children, usually under the age of 14.

The person must be at least 16 years of age and five years older than the child or children with whom he has these experiences or feelings towards. A person in late adolescence involved in a long term sexual relationship with a 12 or 13 year old is not included in this category (American Psychiatric Association, 2000). The disorder of pedophilia has been found almost exclusively in males.

It is very important for practitioners who work with sex offenders to understand the facts about their illness, rather than making judgments based upon assumptions. There is still much to learn about the mental illness of pedophilia

Some of the treatment methods for persons with pedophilia include cognitive-behavior therapy – such as relapse-prevention therapy, aversion therapy, masturbatory satiation and orgasmic reorientation; group therapy; psychotherapy (which is less prevalent now than prior to 1960;) and drug therapy such as androgen deprivation therapy (Comer, 2010) or the use of serotonin reuptake inhibitors.

Evidence exists that these anti-depression medications, that are used for treating obsessive compulsive disorders (OCD,) are effective in treating pedophilia.


While physical castration is considered barbaric in this country, it has been used in Europe in the past. It is no longer used as a means of treatment for sexual deviants in Europe today. Castration involves the physical removal of the testes, which is the organ in the male which produces the sex hormone testosterone.

Testosterone is mainly responsible for the sex drive in males. With pedophiles, there is more than a sex drive at play as they believe they love these children that they molest and believe they have a close and special relationship with them.

However, studies have shown that castration is effective in removing the desire for sexual behavior from sex offenders. Studies have found that between 67% and 97% of men who are castrated become asexual (Crawford, 1981). Please note, this is not a practice that is currently used today and is merely included in this article for informational purposes.

Androgen Deprivation Therapy

Androgen Deprivation Therapy is a drug treatment that involves the reduction of the male hormones in a pedophile’s system, especially the hormone testosterone. In simpler terms, ADT is chemical castration.

Studies have shown that physical treatment (hormone therapy and castration) in all types of paraphilias have proven more successful than psychosocial therapies. Pharmacological treatments are the treatments of choice for the most serious of sexual deviances. According to Rösler and Witztum, a combination of GnRh agonists and psychotherapy has shown positive results in treating pedophilia (Rice & Harris, 2011).

Three different types of hormone inhibiting medications used for diminishing the sex drive of sexual abusers have been studied. Those are the progestogens, the gonadotropin-releasing hormone agonists, and the competitive testosterone inhibitors.

These medications can take between three to 10 months to show results, all have negative side-effects, and they can be very expensive to administer.

Gonadotropin-releasing hormone agonists have become the preferred method of hormone treatment because they have fewer adverse effects and improved efficacy over the other testosterone inhibiting treatments.

One of the good “side effects” of this type of hormone therapy that has been discovered is that once the pedophile’s sexual impulses have been reduced by hormone therapy, they are more willing to participate in psychotherapy (Hall & Hall, 2007).

Specific Serotonin ReUptake Inhibitors (SSRIs)

Some specific serotonin reuptake inhibitors that are used for treating obsessive-compulsive disorder (OCD) have been found to be effective for treating sexual disorders.

It has been suggested that paraphilias are part of the spectrum of OCD. With this consideration in mind, the OCD medication Sertraline (Zoloft) was tested on pedophiles. This treatment proved effective and subsequent studies were conducted confirming the belief that paraphilias are related to obsessive compulsive disorders and the same anti-depressant treatments are effective for both.

According to Bradford and Kaye, SSRIs have less severe side-effects than anti-androgen therapy and hormone treatment (Bradford & Kaye, n.d.) In addition, pedophiles who have received SSRI treatment have reported limited side-effects and an ability to have non-paraphilic sexual relationships (Federoff & Moran, 1997).

Research was conducted on 58 pedophiles, comparing the effectiveness of three separate SSRIs – fluvoxamine, fluoxetine, and sertraline. Results indicated that the level of paraphilic fantasies decreased with no significant differences reported regarding the efficacy between the three SSRIs tested. (Greenberg, Bradford, Curry& O’Rourke, 1996).

Cognitive Behavior Therapy

The cognitive behavior therapist is mainly concerned with redirecting the pedophile’s thinking and, as a result, his behavior by using various methods to help eliminate his erotic thoughts toward children (Berlin & Krout, 1994).

There are a variety of cognitive behavioral therapy methods, including conditioning approaches, behavior skills training, social skills, empathy training, and trying to address the underlying sexual arousal pattern (University of Wisconsin, Board of Regents, 2002).

Aversion therapy is a type of behavior therapy that attempts to associate something negative with each of a pedophile’s inappropriate sexual thoughts.  This type of therapy is accomplished using visualization techniques. One approach is to have sexual offenders fantasize about a deviant reaction and when they feel sexually aroused, fantasize about the consequences of being arrested, going to prison, and being raped in prison (University of Wisconsin, Board Of Regents, 2002).

Many sex-offenders are treated while in prison using group therapy where the therapist and other peers try to help other offenders confront their denial and rationalization behaviors. The groups are set up to provide a non-threatening environment where those being treated can feel relatively safe to share.

This type of treatment is called “therapeutic confrontation,” and its purpose to help offenders develop empathy for others. Having peers and therapists confront them on the irrational thinking they use to abuse children, hopefully, will help them break out of denial and change (University of Wisconsin, Board of Regents, 2002).

There is no specific conclusion on the efficacy of these treatments.

Christine Hammond, MS, LMHC <![CDATA[Ten Tips for Victims of Sociopathic Behavior]]> http://5.286 2015-09-01T12:25:38Z 2015-09-01T12:25:38Z Gas Light MovieIt is apparent that something is out of sorts. At first the person who was extremely charming, almost too good to be real has now become intimidating, demanding and even threatening.  The pathological lying over trivial matters, even when caught, can no longer be ignored.  They are unreliable, unrelenting, irresponsible, disruptive, outrageous, traumatizing, insincere, unrepentant, lawless, and shameless. It appears they are sociopathic.

What can be done? Here are ten tips for the victims of sociopathic behavior.

  1. Name the type of abuse. All sociopaths use some form of abuse to manipulate victims. Abuse can be emotional, physical, mental, verbal, financial, sexual and spiritual. Begin by reviewing examples of each to identify the abuse. For instance, gaslighting is a popular form of mental abuse where the abuser, through a series of lies and deceptions, gets the victim to believe they (the victim) are going crazy.
  2. Diagnosis the behavior. Search the web for descriptions on sociopaths and read blogs written by them. Most sociopaths are unashamed of their behavior and willingly admit to harming others emotionally, physically, or financially. Some even justify criminal behavior by blaming the victim for being too naïve. This will further assist in understanding the disorder and its’ impact on victims.
  3. Recognize their patterns. Now is the time to put the first and second tip together. Even sociopaths are creatures of habit. When they find an abusive pattern that works in one environment, they tend to repeat it over and over. Because they tend to be master seducers, they might use sex as a distraction whenever they are caught in a lie. Or they might seduce superiors at work to advance their career.
  4. Think of this as a game of chess. In order to be successful, defensive and offensive maneuvers must be well thought out. Sociopaths love to place a person on the defensive; it is a way to avoid responsibility. Decide in advance that when cornered by a verbal assault, use a non-emotional response such as, “I’m sorry you feel that way.” Plan ahead of time several short responses that can be utilized instead of responding protectively.
  5. Set boundaries. These boundaries are not for the sociopath because they won’t follow them. Rather the boundaries are for the victim. Know in advance the limits of tolerance for each area of abuse mentioned. For instance, aggressive shoving, secret bank accounts, theft, adulterous relationships, or forced sexual contact may all be a boundary. Once this is crossed, it is time to move on.
  6. Have an exit plan. Sociopaths are very cunning and can smell fear. So the exit plan might have to be done in secret. This should not be a momentary decision, rather a well-thought out scheme to escape. Stash money, passport, clothes, keys, and any other important documents aside before departure. Carefully plan the time to leave and have a safe location to go to in advance.
  7. Tell a close friend or relative. Sociopaths isolate their prey from family and friends to create a dependency on them. It might take some effort to re-establish a safe relationship but it is essential for accountability and healing. Having a perspective outside of the relationship helps to see things more clearly.
  8. Move away if possible. Sometimes the best way to get a sociopath out of a victim’s life is to suggest they move away. Sociopaths tend to take the path of least resistance so the effort to follow a person and continue the abusive behavior requires too much work. In addition, the fresh start for the victim can be transforming as they have a chance to shed the trauma.
  9. Be reflective. Once the victim is safe, it is time to be more reflective about the experience. More than likely, they ignored several warning signs and didn’t follow their own instincts. Now having gone through this experience, the instincts have a chance to grow stronger with greater knowledge and understanding.
  10. New relationships need to be checked. Anxiety over future relationships is a common feeling after being with a sociopath. This is very understandable given the past. Have a close friend who knows of the sociopathic behavior check new relationships. This double check provides some security that the same mistake will not be made in the future.

Victims can recover from the abuse of a sociopath and go on to live very full lives.


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 Science-Based Techniques to Change Behavior…with Videos]]> http://3.485 2015-09-01T02:04:58Z 2015-09-01T02:04:58Z

Following are some very useful and informative videos that discuss scientifically based methods for changing human behavior. These applied behavior analysis principles are relevant to anyone. Of course, some techniques work better for some people and for some behaviors compared to others, but generally speaking ABA principles are related to all people. The examples provided below can be effective for all kids and adults with or without a diagnosis or disability.

You can use shaping to gradually change a person’s behavior. Shaping is reinforcing successive approximations of the target behavior. This means that you reinforce small steps toward the larger behavior goal that you would like to see. Watch the video for more information.

Shaping can be an effective technique for many purposes. In addition to the examples provided in the video, another example of shaping is getting a toddler to sleep in her own bed. If a toddler has been used to co-sleeping with her parent (or parents), it can be difficult to get her to sleep on her own in her own bed. Using shaping can help to get her to sleep by herself without too much crying or too much distress.

Another example could be shaping the behavior of throwing a ball. See the following cute video, especially the first half, which provides a natural example of shaping this behavior. Particularly look at how the child does not throw well at all at first and then, with Mom’s prompts and praise, he ends up continuously throwing the ball across the table to her.

Extinction and redirection are additional behavioral techniques that can be used to change behavior. When working with a child or parenting a child, extinction can be used, for instance, by ignoring whining. Using redirection can help to change the child’s focus to another activity and re-establish motivation for the child to participate in adaptive behaviors. These techniques can be tricky to use together, though. It’s important not to reinforce the whining by giving the child a new toy or allowing them to participate in a new activity contingent on the whining. Instead, the new toy or activity should be contingent on desired/adaptive behavior, such as sitting quietly or following through with a demand.

[Consult a BCBA if you would like more information or if you are in need of professional services. Providing ABA services should be completed by a trained behavior analyst (a BCBA) or someone pursuing their BCBA credential who works under a BCBA.]

[Image Credit: mickyso via Fotalia]

Allison Puryear, LCSW, CEDS <![CDATA[10 Ways to be Patient When the Phone Isn’t Ringing]]> 2015-08-31T13:19:55Z 2015-08-31T13:19:55Z For most of us, there’s lag time between networking our buns off and getting that first client.

By lag time, I mean a scary, panic-inducing, freak out span of time where you have to keep reminding yourself to chill out.

If you’re working full time still, you’re wondering if you’re ever going to be able to quit this agency job.

If you quit to devote all your time to your private practice, you may be raking yourself over the coals for this decision. I know, this part isn’t inspiring, but I’m laying it out there because 1) most of us go through it so you should expect it and use these tips to ease the fear, and 2) to validate those of you currently in this space. I promise it’s okay.

When we moved to Seattle, where I was a total unknown, I networked like crazy. I met 90 people in my first 90 days in the city. We moved there June 8, which was a Wednesday. My networking started the following Monday and two- or three-a-days weren’t uncommon.

I didn’t get my first call from a client until August 20. The only reason I remember that date is because it’s my birthday and I decided to take it as a sign that I was on the right path (I’m really good at finding signs that mean what I want them to). And, a couple of months later, I was full. See, my sign was real.

So we’re talking two and a half months of figuring out how to not lose it.

When we moved to Asheville, I had a harder time hitting the ground running. We had a toddler and the day cares had long waiting lists. Because I’d learned a lot from my Seattle experience, I started getting referrals within a few weeks and they trickled in, but not at the pace I would’ve liked. I was full about four months after I started networking, but because it was a trickle, rather than the flood I got in Seattle, I still had that scary feeling.

Manage Expectations

I give you these timelines to manage expectations. Very few people get referrals their first week. Very few people fill up in four months; I have a lot of experience, knew all the steps to take and I have a lot of joy in building, so please be easy on yourself if it takes more time.

Also, please be clear that I was on insurance panels as well. Getting full with private pay can take an average of two years and because of extenuating circumstances, we needed money faster than that.

So, here are some tips that worked for me during both start-ups:

1. Get the foundation of your practice settled. Have your paperwork exactly how you want it. Get to know your systems well. If you’re using an Electronic Health Record, play with the test clients until you know it backwards and forwards. Test out your credit card processor, online scheduler, learn how to bill insurance if you’re taking it.

2. Make sure your website is awesome. You don’t have to hire a pro, but you can if you’re paralyzed. While you have time, tweak your copy (the writing on your site). Make sure it’s speaking to your ideal clients. Here are some concrete steps to making sure your website 
stands out.

3. Make sure it’s easy to get in touch with you. No matter what system you’re using (phone, online scheduler, HIPAA compliant email, business cards) make sure someone in the throes of misery can easily figure out how to make an appointment.

4. Have fun. Some people will tell you to be in the office during all the hours you plan to work. There’s only so much website and paperwork tweaking a therapist can do before losing his or her mind. You have downtime! Go to the park, take a mid-day yoga class, go to a movie solo. I used to take these epic walks down to the beach with our dog. We’d walk for three or four hours sometimes just breathing in the salty air and practicing being present. Well, I was; he was just trying to pee on everything. If you’ve been in a 8 a.m. to 5 p.m. job, it’s going to feel like playing hooky. Good! Way to rebel, you wild child.

5. Meditate. Y’all know I can get a little woo woo, right? What, the signs thing didn’t give it away? I swear to you that meditation is what skyrocketed my practice in Seattle. As soon as I was consistent with meditation, the phone started to ring. And ring. Which reminds me…

Heather Gilmore, LLMSW <![CDATA[Social Skills for Children with Autism: Reference List for BCBA’s (Applied Behavior Analysis)]]> http://3.478 2015-08-31T00:36:58Z 2015-08-31T00:36:58Z

This blog post will consist of a reference list of peer-reviewed journal articles that relate to the topic of social skills and children with autism spectrum disorders. It is an ethical responsibility for BCBA’s to make regular and thorough contact with the scientific literature. Being aware of the evidence behind potential interventions for ABA services provided to children with autism is a necessity for BCBA’s and others providing applied behavior analysis services.

Most of us providing ABA services are busy with many valuable activities such as providing supervision and other necessary tasks. Many of us may have difficulty finding as much time as we would like to or need in order to sufficiently browse the scientific literature.

I will make a series of posts that continue reference lists related to specific topics. I hope these posts will be of value to you and your clients. Please let me know if there are specific topics that you would like me to explore. I also always appreciate feedback and would love if you could share any other references you have to add to this list. You can contact me directly or just provide the reference in the comments.

REFERENCE LIST FOR: Social Skills and Children with Autism Spectrum Disorders

  • Berler, E. S., Gross, A. M., & Drabman, R. S. (1982), Social skills training with children: Proceed with caution. Journal of Applied Behavior Analysis.  15, 41–53. doi: 10.1901/jaba.1982.15-41
  • Caballero, A. & Connell, J. E. (2010). Evaluation of the effects of social cue cards for preschool age children with autism spectrum disorders (ASD). Journal of Behavior Assessment and Intervention in Children, 1(1), 25-42.
  • Fenstermacher, K., Olympia, D., & Sheridan, S. M. (2006). Effectiveness of a computer-facilitated interactive social skills training program for boys with attention deficit hyperactivity disorder. School Psychology Quarterly, 21(2), 197-224.
  • Gaylord-Ross, R. J., Haring, T. G., Breen, C., & Pitts-Conway, V. (1984), The training and generalization of social interaction skills with autistic youth. Journal of Applied Behavior Analysis, 17, 229–247. doi: 10.1901/jaba.1984.17-229
  • Gillis, J. M., & Butler, R. C. (2007). Social skills interventions for preschoolers with autism spectrum disorder: A description of single-subject design studies. Journal of Early and Intensive Behavior Intervention, 4(3), 532-547.
  • Guglielmo, H. M., & Tryon, G. S. (2001). Social skill training in an integrated preschool program. School Psychology Quarterly, 16(2), 158-175.
  • Hughes, C., Lorden, S. W., Scott, S. V., Hwang, B., Derer, K. R., Rodi, M. S., Pitkin, S. E., & Godshall, J. C. (1998). Identification and validation of critical conversational social skills. Journal of Applied Behavior Analysis, 31, 431–446. doi: 10.1901/jaba.1998.31-431
  • Kamps, D. M., Leonard, B. R., Vernon, S., Dugan, E. P., Delquadri, J. C., Gershon, B., Wade, L., & Folk, L. (1992). Teaching social skills to students with autism to increase peer interactions in an integrated first-grade classroom. Journal of Applied Behavior Analysis, 25, 281–288. doi: 10.1901/jaba.1992.25-281
  • Leaf, J. B., Oppenheim-Leaf, M. L., Call, N. A., Sheldon, J. B., Sherman, J. A., Taubman, M., McEachin, J., Dayharsh, J., & Leaf, R. (2012). Comparing the teaching interaction procedure to social stories for people with autism. Journal of Applied Behavior Analysis, 45, 281–298. doi: 10.1901/jaba.2012.45-281
  • Lindblad, R. (2007). Review of StorymoviesTM STANDARD: Social concepts and skills at school, volume 1 (DVD) and StorymoviesTM PROFESSIONAL: Social concepts and skills at school, volume 1 (DVD). The Journal of Speech and Language Pathology – Applied Behavior Analysis, 2(1), 139-143.
  • Lovett, S., & Rehfeldt, R. A. (2014). An evaluation of multiple exemplar instruction to teach perspective-taking skills to adolescents with Asperger Syndrome. Behavioral Development Bulletin, 19(2), 22-36.
  • Nikopoulous, C. K. (2007). Use of video modeling to increase generalization of social play by children with autism. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 2(2), 195-212.
  • Nikopoulos, C. K., & Nikopoulou-Smyrni, P. (2008). Teaching complex social skills to children with autism; advances of video modeling. Journal of Early and Intensive Behavior Intervention, 5(2), 30-43.
  • Oberman, L. M., & Ramachandran, V. S. (2007). The simulating social mind: The role of the mirror neuron system and simulation in the social and communicative deficits of autism spectrum disorders. Psychological Bulletin, 133(2), 310-327.
  • Ostmeyer, K., and Scarpa, A. (2012). Examining school-based social skills program needs and barriers for students with high-functioning autism spectrum disorders using participatory action research. Psychology in the Schools, 49, 932–941. doi: 10.1002/pits.21646
  • Peters, L. C., & Thompson, R. H. (2015). Teaching children with autism to respond to conversation partners’ interest. Journal of Applied Behavior Analysis. doi: 10.1002/jaba.235
  • Pfiffner, L. J. & McBurnett, K. (1997). Social skills training with parent generalization: Treatment effects for children with attention deficit disorder. Journal of Consulting and Clinical Psychology, 65(5), 749-757.
  • Reichow, B., Steiner, A. M., & Volkmar, F. (2013). Cochrane Review: Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evidence-Based Child Health, 8, 266–315. doi: 10.1002/ebch.1903
  • Romanczyk, R.. G., White, S., & Gillis, J. M. (2005). Social skills versus skilled social behavior: A problematic distinction in autism spectrum disorders. Journal of Early and Intensive Behavior Intervention, 2(3), 177-193.
  • Sansosti, F. J. (2009). Teaching social behavior to children with autism spectrum disorders using Social StoriesTM: Implications for school-based practice. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 4(1), 170-179.
  • Thiemann, K. S., & Goldstein, H. (2001). Social stories, written text cues, and video feedback: Effects on social communication of children with autism. Journal of Applied Behavior Analysis, 34, 425–446. doi: 10.1901/jaba.2001.34-425
  • Quinn, J. M., Sherman, J. A., Sheldon, J. B., Quinn, L. M., & Harchik, A. E. (1992). Social validation of component behaviors of following instructions, accepting criticism, and negotiating. Journal of Applied Behavior Analysis, 25, 401–413. doi: 10.1901/jaba.1992.25-401

[image credit: Daria Filiminova via Fotalia]

Heather Gilmore, LLMSW <![CDATA[3 Ways to Improve the Back-to-School Transition for Yourself and Your Kids]]> http://3.474 2015-08-30T22:34:02Z 2015-08-30T22:34:02Z

Back to school is already here for some families and others will experience this transition within the next couple of weeks. Any parent knows that the transition can bring some challenges although it is often an exciting time.

Following are a few ways that you, as a parent, can help to improve the back to school transition for your kids. Following these suggestions will likely make the transition go much more smoothly for you, as well. If your kids are already in school, committing to these tips can make the beginning of the school year at least somewhat more manageable.

1. Begin sticking to a set bedtime and wake up time.

  • It is important for kids to get enough sleep. Sleep impacts the brain’s functioning, attention, behavior, and learning.
  • Decide on an appropriate bedtime and wake up time and just keep trying to stick with those selected times (which should be the times that your child will need to go to sleep and wake up during school).
  • Try working on this habit beginning at least two weeks prior to the start of school or beginning right now if that time has already passed.

Is Your Child Getting Enough Sleep Infographic

Image Credit: National Jewish Health

2. Begin a more structured evening routine

  • Routines help children (and adults) in many ways. Scientific research supports the use of visual schedules for children. You can create a schedule that includes words and/or pictures of the activities that are included in your child’s evening routine. The routine should include all of the activities that you would like your child to do before bed including new habits you would like the child to build.
  • Here is a sample bedtime routine although you can modify the routine and should make it individualized to suit your child’s needs, interests, and your family lifestyle.

Bedtime Routine

[Image credit: PopSugar]

3. Read, Read, Read

  • I know that I have made this suggestion (to “read, read, read”) in a previous post some time ago, but I strongly encourage parents to help their kids get into the habit of reading. Without accurate and fluency in reading, many academic and life activities will be challenging. Plus, so many benefits could arise from your child being a competent reader. For instance, your child is able to learn so much more from books than simply what he encounters on a day to day basis. Your child can increase in self-confidence and once he feels like reading is not too difficult, he may start reading willingly more and more. This has lots of benefits for his future.

[Image Credit: A. Greer]

[Image Credit: Back to School: © maglara via Fotalia]

Heather Gilmore, LLMSW <![CDATA[3 Antecedent Strategies to Increase Good Behavior in Kids]]> http://3.469 2015-08-30T20:13:27Z 2015-08-30T20:13:27Z

There are many strategies that you can do to help your own children or the children you work with increase the likelihood that they will engage in more “good” behavior and less “bad” behavior. Whether the child has a diagnosis of autism spectrum disorder, ADHD, another diagnosis, or does not have a diagnosis at all, the following antecedent strategies are likely to be beneficial in improving your child’s overall behavior.

Antecedent strategies are strategies that can be implemented before any problem behavior occurs. This is my favorite way of addressing problem behavior. It is basically being proactive instead of waiting for problems to arise and then having to be more reactive to the situation. Of course, there are strategies for what to do during or after a problem behavior occurs, but this article will focus on a few helpful antecedent strategies.

    • Providing choices to your kids prior to any maladaptive behavior occurring can decrease the likelihood that they will participate in problematic behavior and increase the likelihood that they will engage in the behaviors that you would like to see.
    • Providing choices allows kids to make decisions about the activities of their day to day life rather than having to abide by someone else’s commands all the time. Kids have to do a lot, such as go to school, do homework, clean up after themselves, and many other tasks, so providing kids some opportunity to have a say in their own activities will likely increase their ability to comply when you do provide a command without displaying as much problem behavior.
    • Examples of providing choices includes asking your child if they want to clean their room on their own or with your help, asking your child if he wants green beans or broccoli with dinner, and asking your child if he wants to do math or reading homework first. There are lots of ways to provide your child with choices.
    • Kids are more likely to learn appropriate and desired behavior if they regularly observe others modeling that behavior.
    • To model desired behavior, keep in mind the behaviors that you would like to see in your child, such as taking care of items when they are done being used, maintaining an organized bedroom, or saying kind words about others. Then, participate in these behaviors often.
    • Making choices in any given moment is based on the likelihood of reinforcement that is associated with the possible options at that time. This is part of what is known as the matching law (Reed & Kaplan, 2011), which basically states that, at any point in time, a person’s behavior is actually correlated with the amount of reinforcement that particular behavior has received in the past as compared to the other possible behaviors (“choices”) in that moment.
    • To reinforce good behavior, provide praise, attention, and other forms of reinforcement, such as preferred items like electronics or edibles, immediately after the occurence of desired behaviors which are the behaviors you want your chid to continue doing or behaviors you would like them to do more of.
    • Reinforcement doesn’t have to include material items all of the time, but when material items are used as reinforcement, provide praise and attention simultaneously, so that praise and attention will become even more reinforcing to the child. This occurs by pairing social interaction with the child’s preferred items.
    • You also don’t have to reinforce EVERY SINGLE instance of behavior. Intermittent reinforcement, particularly variable ratio schedules of reinforcement, actually creates stronger rates of responding. This means that it is beneficial to reinforce your child for the behaviors you want them to continue on variable rates, such as every 1st, 3rd, or 5th time that the behavior occurs.



Reed, D. D., & Kaplan, B. A. (2011). The Matching Law: A Tutorial for Practitioners. Behavior Analysis in Practice, 4(2), 15–24. Retrieved from:; Schedules of Reinforcement; Retrieved from:

Image Credit: Syda Productions via Fotalia

Cheryl Fisher, PhD.,NCC, LCPC <![CDATA[Mini-Mindfulness Moments]]> 2015-08-28T18:58:07Z 2015-08-29T12:00:19Z I wake up in the morning to the sound of birds chirping delightfully outside my window. I quietly make my way in the early morning hour to my yoga room where the gentle flow of the table top waterfall cascades rhythmically, inviting me to my morning meditation.

I inhale deeply, letting the stream of thoughts flowing in my mind pass gracefully in and out of consciousness and I exhale any tension or tightness my body may be holding as I sit in my deep meditation for a delicious 40 minutes.

BEEP BEEP BEEP! The sound of my alarm wakes me from my dream. I roll out of bed, grab my robe, fumble to let the dogs out, stubbing my toe along the way. Following a few expletives, I scoop the dog food into the metal bowls, toss them to the floor and make my way to the hot, steaming shower that must quickly wash away the foggy brain of sleep still lingering.

I jump into my clothes, paint on some semblence of a face, and pull up my hair. I grab a glass of juice and a packet of instant oatmeal and yogurt which will serve as my breakfast and lunch when I make it to the office.

I secure the dogs, and (as I exit my house) I take a deep breath (holding it for the required four seconds), offer a blessing for the day on the exhale, and haul it to my Jeep because I am now five minutes late for work!

Research continues to remind us of the role of mindfulness in our experience of overall wellness.

Jon Kabat-Zinn in his groundbreaking book “Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness,” writes “…there is something about the cultivation of mindfulness that is healing, that is transformative and that can serve to give our lives back to us…” (pg. xxvii).

A practice of mindfulness extends beyond the individual practitioner and benefits those who surround her or him. Thich Nhat Hanh, Buddhist monk and author of many books including “Planting Seeds: Practicing Mindfulness with Children,” offers “When you are solid, happy and full of compassion, you will naturally know how to create a happy family or school environmen, and how to water the positive qualities in your children, other family members, students, and colleagues at work” (p. 41).

While most of us would agree that this sounds divine and long to attain a lifestyle that promotes full presence, many of us struggle with the basic logistics of beginning a practice.

To devote the suggested 40 minutes a day to meditation would require many of us to eliminate sleep, and while I am a huge advocate for daily meditation, I find that a 20 minute practice following my hour at the gym is about all I can devote daily.

Mindfulness Moments

However, there are numerous ways that we can create moments of mindfulness throughout our day.

1. Add intention to routine activities.

Routine activities can take on contemplative practice when we se t our intention on being fully present in that moment. Putting the distraction of our phones away, walking the dogs, making the bed, even emptying the dishwasher can become moments of mindfulness. For example, a morning shower is filled with sensory experiences, if we allow ourselves to be present to the sensations of the water cascading down the body. We can use that time to do a body scan and note tension being held and allow the warm water to release the tightness and relax our muscles.

2. Breathe through the mundane

Traffic lights are notorious stressors. However, we can repurpose those few minutes by taking deep breaths, setting aside the agenda for the day, turning off the radio and becoming fully present in our bodies.

3. Color consciousness

Adult coloring books have become the latest craze as it allows the individual to focus on a single task. It incorporates creativity and color and allows a few moments of relaxed consciousness. Grab a book and color during breaks at work.

4. Jigsaw meditation

Jigsaw puzzles are another way to promote a focused meditation. Dollar stores carry small puzzles that can be placed in work break rooms, promoting collective consciousness with colleagues. Again, taking a few quiet moments focusing on this task may be just what the doctor ordered to relieve stress during the day.

5. Devotion moments

Opening a book with inspirational quotes offers just moments of reflection and contemplation.
While I have many, my recent favorite book, “The Meaning of Life” by Bradley Trevor Greive, provides brief reflections captured in precious pictures of animals.

6. Teatime

Taking a break for` a cuppa’ tea has long been a favorite of mine. Tea has been a staple in China for centuries, at first used for medicinal reasons and later for more social consumption. British afternoon tea was offered to break up the extremely long time between breakfast and the fashionably late dinner which were the only two meals served. Still a good cup of tea in the afternoon can provide a soothing, fragrant, mini-escape from a stressful day.

7. The Zen of Nature

Years ago, I purchased a mini Zen garden for my office. Filled with sand and miniature rocks, I use a small rake and create swirls and twirls in the sand as I release the tension of the day. I know other colleagues who enjoy the art of Bonsai and trim their tiny trees during breaks. Nature is a sacred space that connects with us in prophetic ways. Gardening, nature walks, watching a sun rise or set, just being present to the outdoors for moments can provide us with significant stress reduction.

8. Blow Bubbles

Bubble therapy is a personal favorite and requires one to take a deep breath only to skillfully exhale in a way that will not burst the bubble. After a particularly stressful day, I like to take my huge bubble bottle outside and blow to my heart’s content.

9. Gratitude List

Counting our blessings appears to offer not only a moment of mindfulness but a shift in brain chemistry. Taking time to reflect on that which we are grateful can promote an immediate reduction in the experience of external stressors that lingers long after the moment has dissipated.

10. Connect with others.

Animals can provide a connection and comfort in the most primal way. Watching goldfish pop to the surface during feeding and swim gracefully among the miniatures in the bowl is therapeutic. However, nothing beats a cuddle with two 65 pound dogs. We all just huddle together rubbing each other’s tummies and enjoying the connection between human and animal. While I love my canine cuddles, my ultimate is sitting quietly for a few moments hugging my spouse.

Armed with a handful (or two) of ways to incorporate moments of mindfulness take a deep breath, exhale and enjoy being present in your day.

Bird at the window photo available from Shutterstock

Bret Moore, Psy.D. <![CDATA[Interpersonal Psychotherapy Shows Promise as PTSD Treatment]]> 2015-08-26T19:11:06Z 2015-08-28T12:10:38Z Developing effective and efficient interventions for service members and veterans battling post traumatic stress disorder is a primary focus for many psychiatric researchers within governmental and civilian institutions.

Hundreds of millions of dollars have been funneled into these programs for the purpose of developing, refining and delivering a variety of psychosocial and pharmacological treatments.

However, to date, results have been modest at best. And based on new studies looking specifically at treatments like Cognitive Processing Therapy and Prolonged Exposure, results are arguably disappointing.

These results are discouraging considering the financial resources infused into research centers and the increasing number of military personnel diagnosed each year with PTSD.

The trauma-focused talk therapies touted as the “gold standard” treatments for PTSD provide relief for many veterans, but countless others continue to struggle with nightmares, intrusive thoughts and hyperarousal.

Although studies support the effectiveness of exposure therapy, this several decades old approach requires the patient to recount the most distressing aspect of their traumatic event in order to “desensitize” to it.

For many, this process is too difficult and leads to high dropout rates. In some cases, dropout rates may be as high as 50 percent.

Exposure Therapy Pitfalls

The problems with exposure therapy are not unique. The homework assignments associated with cognitive therapy is often viewed as unwieldy. This approach is problematic considering compliance rates with psychotherapy homework assignments is lacking in general. And if the assignments that are a core component of cognitive therapy are not completed outside of therapy, improvement is slow if it occurs at all.

Medications have not fared much better. In fact, they’re probably worse. Psychiatrist Richard Friedman eloquently made this point in a recent New York Times OP-ED piece titled, “Psychiatry’s Identity Crisis.”

Friedman pointed out the fact that psychiatric medications today are no more effective than their pharmacological brothers and sisters of the 1950s and 1960s.

Granted, the side effects of today’s medications are less severe, but they are still numerous and result in poor compliance.

Sexual dysfunction, sleep disturbances and gastrointestinal distress plague a significant minority of those who take them. And as highlighted by Dr. Friedman, most people would rather participate in psychotherapy than take a pill. This point is important as compliance, which is related to patient preference, is directly related to outcomes.

The good news is that researchers are studying other forms of therapy for PTSD.

One receiving recent attention is Interpersonal Psychotherapy. Interpersonal Psychotherapy, commonly referred to simply as IPT, is a talk therapy that has historically focused on depression.

Its core therapeutic component is the improvement of relationship conflicts. Preliminary results for Interpersonal Psychotherapy with trauma patients are promising, although supporting its use with service members and veterans are lacking.

Treatment Comparisons

Recently, researchers compared Interpersonal Psychotherapy, Prolonged Exposure and relaxation therapy in 110 unmedicated patients; results were reported in the May 2015 volume of  The American Journal of Psychiatry.

Overall, fewer patients dropped out of the Interpersonal Psychotherapy group indicating greater tolerance of the treatment. Furthermore, a greater percentage of patients showed improvement from Interpersonal Psychotherapy compared to the other therapies.

Results were even more impressive when depression was a factor. Depressed patients were nine times more likely to drop out of exposure therapy compared to Interpersonal Psychotherapy. The effectiveness of Interpersonal Psychotherapy in depression is not surprising considering the data overwhelmingly supports its use for the depressive disorders.

As we continue to fund medication and psychotherapy research for PTSD, a portion of these monies should be funneled to researchers studying Interpersonal Psychotherapy. So far it has shown that is as effective as other mainstream talk therapies and medication.

And since it is better tolerated by those receiving it, fewer people will drop out of treatment and more people will get better.

For more information on Interpersonal Psychotherapy visit this website.

* This article was adapted from a previous article written by Dr. Moore for his column “Kevlar for the Mind.”

Soldier photo available from Shutterstock

Christine Hammond, MS, LMHC <![CDATA[7 Ways a Person Can Be Abused]]> http://5.281 2015-08-27T21:14:15Z 2015-08-27T21:14:15Z AbuseA bruise is not a requirement for proof of abusive behavior. There are many other ways a person can be abused. Abuse can be manipulation, exploitation, maltreatment, neglect, violence, cruelty, harm, hurt, ill-treatment, and exploitive. The seven ways it is manifested is through physical, mental, verbal, emotional, financial, sexual and spiritual. The following list is not inclusive but rather provides an opportunity to explore, evaluate and discuss any potential destructive behavior.

Physical Abuse. Has the victim experienced:

  • Intimidation – Bullying by standing over, looking down, or getting “in your face” and then refusing to back off.
  • Isolation – Limiting ability to escape from or abandoning in dangerous situations.
  • Restraint – Confines by blocking a doorway, grabbing when trying to leave, locking doors with no key, or tying up.
  • Aggression – Hitting, kicking, punching, arm twisting, pushing, beating, shoving, biting, slapping, striking with an object, shaking, pinching, choking, hair pulling, dragging, burning, cutting, stabbing, strangling, and force feeding (including overdose or misuse of drugs).
  • Endangerment – Verbal threats of killing mixed with physical violence and use of weapons.

Mental Abuse. Has the victim experienced:

  • Rage – An intense, furious anger that comes out of nowhere, usually over nothing, startling and shocking a person into compliance or silence.
  • Gaslighting – Lying about the past making a person doubt their memory, perception, and sanity. They claim and give evidence of past wrong behavior further causing doubt.
  • The Stare – An intense stare with no feeling behind it frequently mixed with the silent treatment.
  • Silent Treatment – Punish by ignoring. They also have a history of cutting others out of their life permanently over small things.
  • Projection – They dump their issues onto others as if the other person did it.
  • Twisting – When confronted, they will twist it around to blame others for their actions. They will not accept responsibility for their behavior and instead insist on an apology.
  • Manipulation – Make others fear the worst such as abandonment, infidelity, or rejection.
  • Victim Card – When all else fails, they resorts to playing the victim card to gain sympathy and further control behavior.

Verbal Abuse. Has the victim experienced:

  • Extremes in Volume and Tone Voice – One way is to increase the volume by yelling, screaming, and raging. The second is complete silence, ignoring, and refusing to respond.
  • Intimidating Words – Swearing and threatening language come easily when a person refuses to do what they want.
  • Intense Manner of Speech – It is argumentative, competitive, sarcastic and demanding. They frequently interrupt, talk over, withhold key information, bully and interrogate.
  • Personal Attacks – Common examples include criticizing, name calling, mocking responses, defaming character, berating feelings, and judging opinions.
  • No Apology – They refuse to take responsibility, become hostile, invalidate or dismiss feelings of others, lie, and conveniently forget promises or commitments.
  • Blame Game – Anything that goes wrong is someone else’s fault. Accuses others of being too sensitive, is overly critical of reactions, one-up feelings and oppose opinions.
  • Browbeating – Typical sayings include: “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.”

Emotional Abuse. Has the victim experienced:

  • Nitpicking – Whatever is important to others is minimized in comparison to their own agenda. They belittle accomplishments, aspirations, or personality in front of others. Teasing or sarcasm is commonly used to degrade and mock.
  • Embarrassment/Shame – They share private information without consent, treat other people like a child, or expose some shameful event. Constantly being reminding of shortcomings, often in a passive-aggressive way.
  • Increased Anxiety – It is easy to become anxious when questioned about every move, motive or aptitude. Feeling overwhelmed from the excessive responsibility being dumped, expecting others to drop everything to “cheer them up”.
  • Excessive Guilt – They claim that they should be the most important person in others life. It is selfish for others to take care of themselves.
  • Insecurity – From being held to an unrealistic, unattainable or unsustainable standard. Then when the person fails, they are treated as inferior.
  • Confusion – Being treated as an extension of the abuser, not a separate person.
  • Alienation – Belittling friends and family and making other’s social engagements a nightmare (by contrast, they will be amazingly charming at their social engagements).
  • Anger/Fear – They generate an angry response by acting immature and selfish but then accuse the other person of behaving that way. Use of intimidation, threats, frightening behavior, or destruction of treasured possessions.
  • Hostility/Rejection – Stalking in and away from the house. Refusing to acknowledge worth by withholding love or intimacy creating a threat of rejection.

Financial Abuse. Has the victim experienced:

  • Forbidden Access – To money, checking accounts, or possessions to create a dependency on them for food, clothing, shelter, and necessities. Maintains secret accounts at various financial institutions. Depletes retirement accounts without knowledge.
  • Stealing – Steals, defrauds or exploits from family and expects everyone to be ok with it.
  • Assets – Demands that all financial gifts, assets or inheritances be placed in their name. Open bank accounts in their name without giving access to records. Cancels life, health, car or house insurance without prior knowledge.
  • Paychecks – Forces paychecks to be handed over and deposited it in their account.
  • Bills/Credit – Puts all the bills or credit cards in other’s name. The assets are in their name but debt is in someone else’s name. Maxes out credit cards without knowledge and ruins other’s credit rating.
  • Taxes – Falsifies tax records to show greater reductions and expects others to sign documents without question.
  • Budget – Puts others on a strict allowance with an impossible “budget” thereby setting them up for failure. Punishes spending with verbal, physical, sexual or emotional abuse.
  • Career – Forbids others from earning money, attending school, or advancing careers.
  • Work – Interferes in work environment by calling the boss. Insists on having access to work emails and calendar knowing details about the job that is excessive, unprofessional, and violates confidentiality. Harasses while at work through unannounced visits, excessive phone calls or texting to negatively impact the job.

Sexual Abuse. Has the victim experienced:

  • Grooming – Doing an unwanted or embarrassing sexual act designed to catch others off-guard, create a feeling of trepidation, and see if others comply.
  • Jealousy Rages – Demands to be told everything about previous sexual partners. Then they use information to call them a slut. Frequent accusations of being attracted to others, flirting, flaunting your body, and cheating.
  • Coercion Tactics – Use of harassment, guilt, shame, blame, or rage to coerce others into having sex. They nag, insult, become disruptive, and refuse to allow sleep until they concede.
  • Threatens Infidelity – Dangles the possibility of another person in order to bully into doing uncomfortable sexual acts.
  • Inciting Fear – Others submit to unwanted sexual acts out of fear that they will hit, leave, humiliate, punish, betray, or withhold money.
  • Selfish Appeals – A classic example of selfish sex is unprotected sex. Because intercourse is all about how they feel, they refuse to use condoms and insist others take full responsibility for birth control or STD/STI protection.
  • Sexual Withdraw – Some completely withdraw all sex from the relationship. Any requests for sex are met with ridicule, rants about performance, and excessive excuses for abstinence.
  • Ultimatums – For them, others body is theirs and their body is theirs. Ultimatums include demands to lose weight, groom a certain way, forced pregnancy or an abortion, and forbidding breast feeding.
  • Destroying Principles – Previous sexual standards are obliterated. For instance, participating in pornography, prostitution, having multiple partners at one time, or sex with animals was completely out of the question but now are common.
  • Rape – The FBI defines rape as “Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”
  • Degrading Acts – Degradation is in the eye of the beholder. They will not view these acts as degrading but others might. Here are a couple of examples: urinating on a person, having sex while on the toilet, or forced sex in public places.
  • Sadistic Sex – There are two forms of sadistic sexual acts: mild (also known as S&M) and severe which can lead to death. Mild examples include: master-slave role playing, immobilizing others through drugs or alcohol, administering pain (whipping) during sex, confining others to a cage, typing up, blindfolding, or clamping sexual organs. The severe examples include: physical beatings, choking, psychological torture, burning, cutting, stabbing, vampirism, and murder before, during or after sex.

Spiritual Abuse. Has the victim experienced:

  • Dichotomous Thinking – Dividing people into two parts. Those who agree with them and those who don’t. They make fun of, belittle, and show prejudice towards other beliefs.
  • Elitists – Refusing to associate with people or groups they consider impure or unholy.
  • Submission – Requires that others completely adopt their point of view. There is no room for differing opinions or questioning their authority. Name calling, chastising, and the silent treatment are common maneuvers into compliance.
  • Labeling – People who don’t comply with their beliefs are seen as disobedient, rebellious, lacking faith, demons, or enemies of the faith.
  • Public Performance – Demand perfection and happiness at all times. Religious activities such as attending church have extreme demands, excessive expectations, and rigidity.
  • Legalistic – Strict adherence to their rules and regulations are commanded with absolute statements about insignificant issues such as hair color or style. Non-compliance is met with severe discipline and even excommunication.
  • Segregation – Use secrecy or withholds information to a few select worthy individuals. Estrangement from extended family members and friends outside of the religion. This includes shunning, alienation, or persecution.
  • Blind Obedience – Is expected. They have replaced religion with themselves and people are expected to worship them.
  • Abuse of Authority – Use position or authority to connive for their personal benefit which is often financial. They justify the behavior by saying they deserve it.
  • Fraud – Engaging in criminal misconduct or cover up the transgressions of others in the name of their religion. This includes covering up sexual abuse, physical abuse, financial felonies, and misdemeanors.

Reminder: This list is a starting point to bring about discussion. There are many more ways a person can be abused.


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

Kelly Higdon, LMFT <![CDATA[How to Have Fun Getting your CEUs]]> http://4.596 2015-08-27T19:22:56Z 2015-08-27T19:22:56Z CEUs for CounselorsAs a mental health professional, the learning never stops. While I love continuing education, I also know that it can feel hard to fit in when you are seeing clients and running a business. Recently I have decided to make this process a whole lot more enjoyable. Want to join me? Here is what I have learned so far.

– Be curious. Recently, I signed up for a songwriting course. Is this because I am going to be a songwriter?  I am simply curious about the process and would love to play with writing some songs for my daughter. Not all of your learning as therapist has to set you on the path to a specialization or a certificate. Have some fun and choose to learn something you know nothing about!

-Flex a muscle. Adventure into developing a new expertise or focus. Building upon learning to become an expert is an awesome goal for your CEUs. Maybe you want to become Gottman certified or specialize in Trauma Sensitive Yoga. Jumping off of the knowledge you already have can be equally as fun.

-Look at the benefit. Beyond checking off those CEU hours, how is what you are learning going to benefit your skill set as a therapist, your relationship with the client, the impact on the client and your business? If you are in private practice, CEU hours will direct impact your business as you learn new skills. When you know your “why” of choosing the CEU, it can be motivating.

-Get a community. Get your CEU hours with a friend or group of colleagues. Some CEU courses like ours offer a community online where you can build relationships. Doing CEUs with others can be more fun with support and shared ideas.

-Make it accessible. Online CEUs work well for people that can’t travel and need more flexibility in when they obtain their hours. Others turn their CEU time into a vacation (speak to your accountant about tax write offs) choosing CEU hours at a destination. This is the best if you can do it. Go to Hawaii, learn something new and bring your family. If you do online hours, go somewhere for the day that is relaxing and still make time to clear your mind and focus on learning.

Stop just checking CEUs off of your to-do list and start enjoying the process.

Our bootcamp is now offering 14 hours of CEUs through NBCC. If you have been wanting to work on your business but are frustrated that you aren’t going to get education credit for all of your effort, then check out more information at

What have you learned lately in your CEUs?

Sharie Stines, Psy.D <![CDATA[Why Couples Counseling Doesn’t Work in Abusive Relationships]]> 2015-08-26T18:58:49Z 2015-08-27T12:00:20Z It is imperative that therapists be educated about the dynamics of interpersonal violence in order to provide competent treatment to batterers and their victims.

In general, couples counseling is an ineffective means of treatment, at best, for this population, and in fact, may cause more harm than good.

Couples counseling tends to be counter-productive in an abusive relationship for many reasons. One is that this type of therapy assumes the concept of mutuality in the relationship and that the problems are based on a systemic problem between the two parties.

Couples counseling helps people with conflict resolution, communication problems, childhood issues brought to the relationship and struggles with intimacy.

In an abusive relationship, mutual goals cannot be attained because the abusive member is not interested in equality.

Couples counseling sends the message to both the batterer (batterer can be physical, emotional, and/or psychological in nature) and his partner that the problem is mutual and that somehow the partner is responsible (at least in part) for the abuser’s behaviors.

This type of “provocation causing the abuse” was a common theory in the 1960s and 70s for couples counseling practices. Terms like, “she pushed my buttons” get credibility and both the perpetrator and the victim believe she is somehow culpable for instigating the abuse.

Both members of the partnership are taught to focus on their feelings when in couples counseling. This approach is counterproductive in an abusive relationship because the abuser spends too much time already focusing on his feelings and not enough time focusing on other people’s feelings (particularly his partner’s).

Different Approach Needed

What needs to be done in the abusive relationship is very different from the systemic approach or psychodynamic approach to therapy.

The abuser needs to learn how to stop focusing on his feelings, and must instead focus on his behaviors, attitudes and beliefs. He must learn how to not focus on his feelings, but rather to focus on changing his damaging thoughts because it is his belief system that leads to his damaging actions (or omissions).

It is important for therapists to understand that abuse is not caused by bad relationship dynamics. The partner cannot ever change an abuser’s behavior by changing herself.

In fact, this type of counseling encourages the abuser’s faulty thinking that, “if she stops doing the things that upset me and takes better care of my needs, then I will become a better partner.”

This type of counseling intervention will never work; and, if it did, how healthy is this pattern, where one partner is responsible for the other’s poor behavior? The abused partner ends up feeling even further invalidated and powerless because now the abusive partner has used the counselor as another weapon in his arsenal to attack – “remember, the counselor told you to…”

Couples counseling can be detrimental to the emotional health of the victim in a variety of other ways as well. For instance, compromises are often made in couples counseling between the two parties. This leads to the assumption that the victim’s behaviors and the abuser’s behaviors are morally equivalent with respect to damage caused in the relationship.

Dangers to Victim

In effect, the abuser can use the therapist as a coercive means of controlling his partner by “compromising” with her. “If she agrees to stop seeing her family so much, then I’ll agree to stop ___________________” (yelling, giving the silent treatment, other emotionally coercive action he uses to control her).

Not only has the abuser used the therapist to further control his partner, the partner experiences complete cognitive dissonance, once again, after compromising away her rights in order to not be hurt, as if these two contributions to the relationship are equally destructive (her family visits and his abuse).

With respect to the topic of conflict resolution, many therapists try to help couples learn how to resolve conflicts. They use cognitive behavioral and psycho-education approaches to teach the couples new ways of interacting. What they fail to realize, is that in an abusive relationship, this approach completely misses the problem.

The problem is not that the couple has a conflict resolution issue; the problem is that the abuser caused the conflict in the first place. The conflict was caused because an abusive partner communicates abusively, by displaying abusive attitudes and acting out on abusive beliefs, such as attitudes of entitlement, superiority, condescension, or joking at his partner’s expense.

He may display behaviors of projection, defensiveness, verbal attacks, gas-lighting, pouting, the silent treatment and a myriad of other damaging modes of communication.

The bottom line is, his behavior damages any hope for a healthy interpersonal interaction; resulting in an irresolvable conflict. The root cause is the abuse, not the conflict. This same mindset applies to “communication” problem resolution as well.

Another situation that can occur in couples counseling is that the more the victim claims she is being abused, and states that the primary problem is that her partner is abusive, a therapist not familiar with the dynamics of abuse, may start to question the victim, assuming that she is not taking ownership of her side of the problems in the relationship.

This can cause the therapist and the abuser to form an alliance of sorts, serving as a united front as they both focus attention on the victim’s problems, thus resulting in further trauma for the victim. Once again, the therapy sessions themselves and the therapist become further means of manipulation for an abuser.

One of the most serious repercussions of couples counseling is that if the victim starts to believe she is safe enough to share the truth about what is happening in the relationship, she may open up and be quite frank with the therapist while her partner is present.

This situation could prove to be very dangerous for the victim, however, because the abuser may retaliate later when no one else is around. The purpose of this abuse is to control the victim, ensuring that she never “betray” him in the therapist’s office again.

Note: This same advice also applies to the narcissistic or psychopathic spouse as well. Therapists need to be aware of the types of emotional manipulation that is involved with those client’s (or their spouses) with characterological issues.

The best known treatment for abusers is within the context of a group, with other abusers, where the focus is on promoting personal responsibility and accountability. There are four basic requirements for changing an abuser: (1) consequences; (2) accountability; (3) confrontation; and (4) education.

Abusers are difficult to treat and require long term accountability with others before any real change can occur. Many abuser programs require their members to have at least nine months of non-abusive behavior after joining an abuser recovery group, prior to entering couples counseling.

Dr. Julie Hanks, LCSW <![CDATA[4 Common Marketing Mistakes of New Private Practitioners]]> http://2.7311 2015-08-27T06:55:54Z 2015-08-27T06:55:54Z Marketing Mistakes

Creating a private practice is an ambitious and brave endeavor, particularly because our training as clinicians more than likely didn’t include any business education. When beginning a practice, new therapists sometimes struggle with how exactly to “market themselves” (read here for my suggestion on rethinking marketing as instead creating relationships, educating and serving the public, and building trust). What strategies work…and what ones don’t? James Joyce wrote that “mistakes are the portal of discovery,” so we opened up a discussion on this topic to see where some of our Facebook community went wrong in the specific aspect of marketing. Here are 4 common marketing mishaps to avoid:

money down the drain1) Wasting Time and Money on Advertisements  

By far, the most common response we heard from those who chimed in had to do with the waste and inefficiency of paid advertisements, particularly Google Adwords and pay-per-click marketing. Unless you’re an expert, navigating the technicalities of these campaigns can be confusing, time-consuming, and expensive. Also, it seems that (at least in the experience of those in our conversation) therapy is not something that individuals seek out through browsing ads, either online or print, and there is simply not a good enough return on investment for you to pay a newspaper or site to promote your services. Not to worry, though; there are much more efficient ways for you to create a thriving practice.

2) Not Having a Functioning, Optimized Website  

While paid advertisements are generally not a successful strategy for attracting clients, an informative and frequently updated website is a proven way to build a flourishing practice. Neglecting to have a website or blog that is aesthetically pleasing, well-kept, and optimized toward one’s ideal client can cost you business. A clinician in our Facebook group explained that she made the mistake of promoting her practice before she had even finished putting together her website. You do not want potential clients to come across a 404 Error Page or “Coming Soon!” reading when they view your site, so make sure it is complete! Remember that your website is your storefront and should clearly and confidently declare your message, expertise, and how you can help your clientele.

One therapist recalls how she initially wanted to be as cost-efficient as possible, so she built a website that was free but was not particularly attractive or professional-looking. Fortunately, she was able to recreate her site into something better with the help of a web specialist (unlike paying someone to create and maintain an ad campaign, hiring an expert to help with your site is a valuable investment).

3) Seeing Anyone as a Client    

This is something that comes up over and over again. Working with “mismatched clients” doesn’t benefit anyone. While it may be initially tempting to agree to see any individual who inquires about your services, you will be much happier and successful in your work if you first identify your ideal client (and create an “elevator speech” that you can use to communicate who he/she is), then graciously refer out to colleagues those who are a better fit for someone else.

4) Not Seeking Out the Right Mentor or Community of Support

Many therapists responded that they wish they had found a community of like-minded, experienced professionals to help them on their journey. Remember that others have been in your shoes, just starting out in private practice, learning by trial-and-error, and having to navigate new responsibilities and challenges (related to marketing and business),  and you don’t have to go it alone!

One clinician described how she did frequently talk with others in the field, but they were negative and discouraging. Finding the right support, individuals who energize, inspire, and educate you, will be critical to your success.

Rock the Media School for Therapists

If you’re looking for ways to increase the number of clients you see, check out my Rock the Media School to learn more about attracting individuals through social media.

What marketing mistakes have YOU made?

Join my Private Practice Toolbox Facebook group and connect with 3100 therapists around the globe in 2 simple steps: 1) Click request to join the group and 2) Fill out this brief questionnaire before you’ll be added to the group.Get practice tips and blog updates in your inbox.

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Allison Puryear, LCSW, CEDS <![CDATA[Fear-Mongering, Bullies and Jealousy]]> 2015-08-26T18:57:49Z 2015-08-26T18:57:49Z If I had a dollar for every time one of my practice-builders was discouraged by someone feeling stuck in their own agency job, I’d have a lot of dollars. Maybe we should start fining those naysayers a negativity tax.

I’ve had people announce that they were going to private practice and be flat out told they’re going to fail by someone who has never gone into private practice; someone who had no idea what he was talking about. We have to be so careful about these messages, especially early on when we’re particularly vulnerable.

These people who are saying you can’t do it are scared. They have no idea what it takes to build a private practice. Maybe they tried in the past and failed. A lot of people declare themselves private practitioners and then don’t do a minute of research on business and marketing. They just expect the clients to magically find them and then say private practice is a losing game when it doesn’t go their way.

It’s like a client going to one therapy session and saying that therapy doesn’t work. You have to invest your energy, you have to be serious and you have to want it enough to be pushed out of your comfort zone.

What’s sad is that these fear-mongerers reinforce that little voice in our heads that say we can’t do it. They give power to the part of you that feels the most insecure. We all have that part; the fact that it exists in you is just a sign that you’re human and definitely not a sign that you won’t succeed.


When I was a kid, if one of my friends was mean to me, my mom would say my friend was just jealous. I thought she was ridiculous for saying this since I didn’t really have anything to be jealous of. I didn’t have the coolest toys and the coolest clothes. I did, however, have front teeth that closely resembled Dale’s of Chip & Dale, really confusing hair, a tender hear, and really awesome parents.

I didn’t realize until later that the only kids who were mean to me had parents who weren’t so awesome and that maybe they were jealous of the steadiness my family provided. I didn’t know how hard it was to have chaos and struggle at home, so I was free to assume that being awkward looking and shopping at Kmart meant I wasn’t worthy of jealousy. What a place of privilege.

So, not to get all maternal on you, but the people who tell you you won’t succeed are just jealous. It may not feel like you are worthy of jealousy as you teeter on the brink of the unknown, but you are.

  • They’re jealous you have the strength to take the risk.
  • They’re jealous that your work/life balance is about to get a lot better than theirs.
  • They’re jealous that you can create your own non-toxic, anti-burnout workplace that you look forward to going to everyday.
  • They’re jealous that you can pick the clients with whom you want to work.
  • They’re jealous that you won’t have to get creative when bills come in and you can just sit down and write a check.

I feel badly for the naysayers. They’re just as miserable as the kids that were mean because their own lives aren’t what they want them to be. It’s likely that they could have the private practice of their dreams if they wanted to but they make it sound like rocket science.

I know I say this a lot, but it bears repeating, especially if you’ve been faced with others’ negativity. Building a private practice isn’t difficult once you have a plan. It takes some patience and fortitude, but if you can get through grad school, you’ve got enough patience and fortitude to start your practice.

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

Business people talking photo available from Shutterstock

Dr. Julie Hanks, LCSW <![CDATA[How Media Marketing Can Build Your Practice: Podcast Interview]]> http://2.7438 2015-08-25T22:20:50Z 2015-08-25T22:20:50Z ROCK THE MEDIA podast interview with Dr. Julie Hanks One of my favorite colleagues and friends, Joe Sanok from Practice of the Practice, invited me to join him for a podcast interview on how to get media coverage for your private practice and maximize it to build your online presence, build trust with potential clients who are willing to pay your full fee. We had a great time chatting about my journey to build a media presence and how it’s directly correlated with the growth of my private practice. After intentionally doing media interviews my practice grew from a few people to 3 locations and 20 therapists!


I also give nitty-gritty details about my Rock the Media School for therapists online e-course that begins in 2 weeks. The 6 week e-course will walk you through how to identify who you want to reach, how to gain local and/or national media exposure, and how to use those interviews to build trust, boost your credibility, and attract clients who are willing to pay your full fee.
Listen to the podcast here

Are you ready to grow your media and social media presence? My first cohort of Rock the Media School for Therapists starts Sept. 7! Get details and sign up here

Christine Hammond, MS, LMHC <![CDATA[Consider This Before and After Checking the Hacked Ashley Madison List]]> http://5.275 2015-08-25T13:33:03Z 2015-08-25T13:33:03Z ashleylogoThe release of names and emails hacked from the on-line cheater’s website Ashley Madison stirs up questions of fidelity even in the best of relationships. This is especially true in light of some high profile confessions. The website promise of anonymity has been comprised and what was done in secret is now being revealed. But before checking a partner’s email address on the hacked list, consider these things.

  1. Everyone is capable of making a mistake but not everyone does. No one is perfect. Having expectations of flawless living will only lead to disappointment. Committed healthy relationships demonstrate a willingness to admit errors, change behaviors, accept adjusted boundaries, and forgive. This is something both partners need to do.
  2. “This above all: to thine own self be true.” (Polonius gives excellent advice to his son in Shakespeare’s Hamlet.) Before checking any list, take a moment to self-evaluate. Ask: “Have I ever thought of cheating on my partner?” “Have I ever acted impulsively or inappropriately with someone else?” “If my partner knew everything, would they see it as cheating?” This is the time to be honest before making accusations about anyone else.
  3. “Begin with the end in mind.” (This is habit 2 from The 7 Habits of Highly Effective People by Steven Covey) What is the goal? Is it to see if a partner is trustworthy? Faith is a belief without proof. Trust is earned over time and should not be given without some verification. Faith and trust are not the same. However, trust is not built by obsessively checking for lies or constantly believing the worst about someone. Rather, trusting someone is a decision which should be evaluated from time to time.
  4. When trust is betrayed, the only person who looks bad is the person doing the betraying. This is essential in maintaining proper perspective. Deception is reflected on the deceiver not the victim. However, there is an Italian Proverb, “He that deceives me once, it’s his fault; but twice it is my fault.” Allowing someone to continually deceive without consequence demonstrates a lack of self-respect and appropriate boundaries.

After reviewing the above, go ahead and check the list. There are several websites that allow a person to input an email address. Be willing to be honest about doing it. Demanding openness without reciprocating is unfair.  If the name is on the list, consider these points.

  1. Don’t jump to the worst possible conclusion. This is information only, not evidence. This piece needs to be evaluated in light of the whole big picture. Are there other signs of a cheating partner? Has something similar happened before? Take a step back and look at everything from an outsider’s point of view before any confrontation begins.
  2. Have a plan. Make a list of what is known and what is still a question. Knowing what needs to be asked before will keep the conversation focused. Avoid asking obvious questions designed to entrap a person. Rehearse possible answers and reactions ahead of time to prevent emotions from taking over and clouding judgement.
  3. Confront in a neutral environment. For instance, a partner’s office can be a place of confidence and give them an upper hand. Find a location and time that is dispassionate, intentional and safe. Don’t back down on asking questions, this is a time to be strong and courageous.
  4. Listen to everything. Body language is amazingly revealing especially when a person is comfortable. It is not just the words said; it is the words not said that is equally important. Pay attention to repeated vocabulary, touching around the neck, or any mannerism that is inconsistent with past behavior.
  5. Get some help. This is a good time to seek out advice from a counselor, trusted friend or mentor. Avoid speaking with family as they tend to side with their own no matter what. A partner who demands additional secrecy is a red flag.

Remember a healthy relationship requires growth on both parts. This is not one sided, no matter what has actually occurred.


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

Margaret Altman, LCSW, MSW <![CDATA[Stepping Back From the Future]]> 2015-08-23T18:42:56Z 2015-08-25T11:28:15Z If you are a Chunzi (a virtuous, noble person), you know that the ways in which Westerners cope with depression are  faulty and often ineffective. Pills and programs are the frail tools that are based upon  the Western perspective on human existence and its place in the dynamic domain of the universe.

Other cultures have a great deal to teach us about ourselves, the people close to us and the expanding universe around us. We have looked at depression through a wider lens of cultures whose traditions inform us that the Western perception of the human experience, the environment and time itself can be transformed into a view that leads to joy, hope and compassion and peace.

Ancient words of wisdom enable us to put emotional burdens aside, derive comfort from our families and constantly expand our understanding about the dynamic universe that is our home. With these teachings, we may leave depression by the side of the road.

The wonderful thing is that the modern science of psychiatry agrees with the ancient philosophers.

“Positive psychiatry” is making its entrance and embraces the therapeutic benefits of relationships and holistic principles in even the most severe states of emotional distress.

The dominating focus upon medication is weakening and comprehensive treatments are being re-invited into the office. This step is a major one in the journey towards understanding emotional pain as being part of a larger context. But there is a long way to go.

 `Depression and Prospection’

A  recent article in the British Journal of Clinical Psychology entitled “Depression and Prospection”   reports that “faulty prospection” causes and drives depression.

This view continues to locate depression as inside of the human mind and dismisses the context of human experience. It takes the position that a person’s opinion about what the future holds can shape his/her mood.

Other cultures view the future as an unknown and ever changing domain and something that we need not frantically fear.  Our negative predictions about the future sometimes lead to depression.

The Asian culture’s belief about time and the future, as we have seen from Confucius, is that changes are inevitable, time flows and that planning ahead and worrying about something that may or may not happen is futile.

In Asian and other cultures, the focus is on the present: building and strengthening close relationships, practicing humility and generosity and being honest and faithful to friends and family.

Past traditions are honored and learned from and one always hopes to continue to be vigilant and adhere to the values of the culture. Projecting oneself into future events, however, is considered an exercise in futility and often, despair.

While thinking about the future, Western cultures put great value upon setting up all kinds of plans to avoid disaster and attach a positive future to their lives.

People in this mindset try to control fate, plan for retirement and for vacations. They set goals all of the time for various things and continuously become stressed when they have to change or eliminate these goals.

It is a cycle of elation and then frustration, a roller coaster of emotions as people constantly adjust goals and plans to meet changing dynamics in themselves and their lives.

They attach emotionally to future goals and live upon future dreams and nightmares. Through this attachment, people can lose sight of the present and, often the past history of successes and failures that could re-direct their attention.

Traditionally, this cycle leads to shame and results in actions that could be driving them into deeper depression.

In the research described earlier, the authors categorized prospection into two types: faulty/negative and the less damaging–prospection gone awry. They further subdivide faulty prospection into three types: generation of possible outcomes, evaluation and negative beliefs about the future.

What Drives Depression

The faulty/negative prospection is the category that is focused upon as driving and causing depression.

The authors state that negative thoughts about the “self” are not what primarily drive and cause depression, nor do negative thoughts about the past.

A person becomes and stays depressed when he generates negative scenarios about the future and sets up the “if –then” situation that ends in disaster.

According to the article, the pessimistic predictive style can be changed with cognitive behavioral therapy and treatment that re-formats the person’s thoughts and images about future experiences.

This approach is a move away from the dominant medication model that has not made significant progress in the fight against depression. But, it is no match for our other culture’s progress through the decades of tradition.

If Confucius was present, he might quote from his scrolls from 551 B.C:

Study the past if you would define the future.”

He might point out that lived experiences and traditions are important in shaping our cognition and behavior, but he might agree that helping a person see a brighter and more satisfying future would be a positive thing to do.

A person from the Buddhist sect would agree. Most Buddhist sects believe in karma, events that occur are believed to be the result of prior events both good and bad.

“People know you for what you’ve done, not for what you plan to do.” –  Anonymous Indian

Consider the following prescription for health:

  • Build relationships, take a holistic, interconnected view of man and nature
  • Focus on the present, listen to others, use creative and expressive communications
  • Keep yourself from extremes and embrace change in a dynamic universe
  • Engage in care giving, practice humility, generosity, honesty and endurance
  • Use natural and spiritual resources and keep moving forward.

Stack of pebbles photo available from Shutterstock

Sharie Stines, Psy.D <![CDATA[Causes of Pedophilia]]> 2015-08-21T18:27:51Z 2015-08-24T12:15:06Z According the DSM-5, the criteria to diagnose Pedophilia (Pedophilic Disorder) is defined as recurrent experiences of intense sexual arousal, fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children, usually under the age of 14. The person has acted on these sexual urges or these sexual urges or fantasies cause the person distress or problems in interpersonal relationships.

In order to be classified with this disorder, the person must be at least 16 years of age and five years older than the child or children for whom he has these feelings that are possibly acted upon.

A person in late adolescence involved in a long term sexual relationship with a 12 or 13-year-old is not included in this category (American Psychiatric Association, 2014).

Different theories exist about what causes pedophilia.

Some experts propose that the causes are neurodevelopmental. Differences in the brain structure of pedophiles have been noted, such as frontocortical differences, decreased gray matter, unilateral and bilateral frontal lobe and temporal lobe and cerebellar changes.

According to research, these differences are similar to those of people with impulse control disorders, such as OCD, addictions and antisocial personality disorder.

Pedophilia could be a byproduct of other co morbid psychiatric diseases. These brain abnormalities may have been formed by abnormal brain development. However, post-traumatic stress disorder also causes these types of brain abnormalities. Traumatic experiences in the pedophiles early life could have caused this atypical development (Hall & Hall, 2007).

Neurological Differences

Other neurological differences found in pedophiles included lower intelligence levels and the lower the intelligence level, the younger the preferred victim.

A substantial number of studies have indicated that pedophiles have cerebral abnormalities found in the temporal lobes (Hucker et al., 1986). Many Serotonin agonist differences were also found in pedophiles over tested control subjects.

Also found was an increased level of pedophilia in those people who sustained serious head injuries as young children, especially prior to age six. Another finding was that more pedophiles had mothers with psychiatric illnesses than the average person (Hall & Hall, 2007).

Some pedophiles were also found to have chromosomal abnormalities. Out of 41 men studied, seven of them were found to have chromosomal abnormalities, including Klinefelter syndrome, which is a condition in which a male will have an extra X chromosome in their genetic code (Berlin & Krout, 1994).

Environmental Factors

The environmental factors involved in pedophilia must also be considered. There is much controversy over whether or not being sexually abused as a child causes that child to grow up to be a sexual abuser. Statistics do weigh out indicating, that in general, more people who abuse children as adults were abused themselves as children.

The range is anywhere between 20% and 93%.

What would the reasons be for this happening? Theorists have proposed that perhaps the pedophile either wants to identify with his abuser or conquer his feelings of powerlessness by becoming an abuser himself, or maybe the abuse itself is somehow imprinted on the psyche of the abused (Hall & Hall, 2007).
Some scientists hold to the view that pedophilia really is not that much different from other mental illnesses, other than in how its deviant behavior is manifested. Like other troubled people, most sex offenders have problems establishing satisfying intimate sexual and personal relationships with their peers (Lanyon, 1986).

Developmental Issues

Other developmental issues occurred in the lives of pedophiles more often than the general population. Sixty-one percent of pedophiles repeated a grade or were enrolled in special education classes (Hall & Hall, 2007).

As mentioned earlier, it was found that more often than not, pedophiles had lower IQs than other people. Some theorists propose that pedophiles have arrested psychosexual development, caused by early childhood stress, which has caused their development to be “fixated” or “regressed” and is manifested in their sexual preferences for children.

Perhaps these early stressors caused an incomplete maturity process in these individuals which keeps them irrationally young in mind (Lanyon, 1986). Conceivably, that is why so many pedophiles identify more with children and view their behavior as completely acceptable.

Pedophilia is similar to certain personality disorders because the individual with the disorder is very self-centered, treats children like objects for his pleasure and does not really suffer personally with emotional distress (as is the case with many mental illnesses.)

Pedophiles, on the whole, seem to really believe that their behavior is normal, yet they must hide it because conventional society does not accept it. Pedophiles are convinced that they are doing a good thing when they molest children and that the children actually enjoy the relationship.

It has been speculated that pedophiles have not developed properly and are “fixated” or “stuck” at a certain stage of development mentally, while their hormones and physical bodies matured typically. Because of this conflict, the adult-child that the pedophile has grown up to become still relates to children better than adults.

Courtney Stivers Ph.D. <![CDATA[5 Misconceptions About Marriage and Family Therapists]]> 2015-08-26T16:05:54Z 2015-08-23T13:28:32Z I have noticed over the years that there are many common misconceptions people have about marriage and family therapists. I am a Licensed Marriage and Family Therapist in Arkansas, so some of what I am saying may be influenced by my specific experiences. Here are a few of the things I wish people would understand. Can you think of any I have missed?

  1. We Only Work With Marriages and Families
    This is not true. Marriage and family therapists have unique training and conceptualize problems in a relational context or, in other words, they consider your significant relationships. Marriage and family therapists are qualified to treat individuals, couples, families, children, groups, etc. We just treat them from a family systems perspective.
  2. MFTs Only Work in Private Practices
    False! Marriage and family therapists work in many different settings including:
    • Business consulting
    • Churches
    • Community mental health centers
    • Courts
    • Employee assistance programs
    • Hospitals
    • Inpatient facilities
    • Prisons
    • Private practice
    • Research centers
    • Schools
    • Social service agencies
    • Universities
    I am sure there are even more out there. Marriage and family therapists practice in a wide range of environments.
  3. Marriage and Family Therapy is Just a Specialization
    This one is not true either. According to the American Association of Marriage and Family Therapists, the U.S. federal government considers marriage and family therapy to be one of the five core mental health professions. The others are psychiatry, psychology, social work and psychiatric nursing. Each is considered to be a separate field with a unique treatment approach.
  4. Anyone Who Works with Couples or Families is a MFT
    Wrong again. There are many different approaches to working with families and other mental health professions treat families, too. A social worker may do a wonderful job with a family in counseling, but this does not make them a marriage and family therapist.
  5. MFTs Cannot Treat Mental Illness
    Not even close. Research suggests that marriage and family therapists are effective in treating a full range of mental and emotional disorders and health problems (Sprenkle, 2003). Addiction, drug abuse, anxiety, depression, alcoholism, eating disorders and marital problems are only a few examples of problems treated by marriage and family therapists.

I am not offended when people have these misconceptions about marriage and family therapy. However, I do feel that it is a significant part of my professional identity. I am very proud of the life changing training that I have received and I want it to be acknowledged correctly as a part of who I am.

To my fellow MFTs, have you ever had a client or family member have one of these misconceptions? Did I miss any? I hope this helps and feel free to share!
Originally published on

1. Sprenkle, D. H. (2003), effectiveness research in marriage and family therapy: introduction. Journal of Marital and Family Therapy, 29, 85–96.

Therapy session photo available from Shutterstock

Imran Riaz, Psy.D <![CDATA[Will Smart Phone Use Change Our Perception of the World?]]> 2015-08-20T16:49:01Z 2015-08-23T12:00:28Z Our Smart phones demand our eyes to narrowly focus for extended periods of time on a teeny tiny rectangular hand-held object. The time on task we spend devoted to a technological instrument is unprecedented in human evolution.

Lateral peripheral vision helped our early ancestors scan the savannah for danger. Being able to sense what was around us and coming towards us helped us to survive. When our ancestors were outdoors, they were wired to look as far and as wide as the eye can see: to stretch the vision’s limit-potential.

Today, when we spend time outdoors, we find ourselves transfixed to our Smart phones. This ubiquitous reliance of technology will impact the depths of our attention.

There has been much written about the potential physical ailments that are predicted with extended Smart phone use: carpal tunnel syndrome of the hands, neck strain from how phones can keep our necks locked in position and an increase in patients reporting nearsightedness to their physicians.

We can add the tendency to miss stimuli in our peripheral vision to this growing list of costs on the costs-benefits Smart phone ledger.

Recently, to my astonishment, I saw a charter bus driver turning a busy street corner while glancing down at the phone on his lap. Routinely, as a pedestrian waiting at the stop light on K street, I can count more cars than not, with drivers looking straight ahead than I can with their visions looking down, presumably at their phones.

I wonder what the costs are of not using our peripheral vision for hours in a day– a trait that has evolved over millennium to help us survive? Perhaps our compromised awareness of danger will have fatal consequences in the forms of on-coming motor vehicles, attackers intent to do us harm that we don’t sense or natural occurrences that we don’t see with peripheral vision like falling tree branches or ledge drops.

Will agoraphobia, the fear of open spaces be diagnosed more as we grow more engrossed with our phone screens and less aware of open spaces? Are we ripening ourselves up for alien abduction because we are so distracted from what is going on around us?

The modern world has not experienced a technological upsurge like the advent of Smart phones and with such a widespread unilateral embrace. Never before  have we carried a technological instrument with us at all times. What is on our Smart phones becomes increasingly interesting day by day. The time away from being transfixed on our tiny screens seems increasingly boring and mundane.

When I was growing up, we were told to look both ways before crossing the street. Now it seems important to remind both child crossing the street and driver driving to keep their eyes ahead and off their Smart phones.

Smartphone image available from Shutterstock