Psych Central Professional For mental health, psychiatric and psychological professionals. 2016-05-04T13:44:55Z Christine Hammond, MS, LMHC <![CDATA[Difference between Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder]]> http://5.665 2016-05-04T13:44:55Z 2016-05-04T13:44:55Z OCPD and OCDIt is amazing the difference one word can make. Add the word “Personality” to Obsessive Compulsive Disorder (OCD) and it changes the definition and classification. There are some similarities such as obsessive and compulsive traits, thoughts and actions. However the underlying disorder is extremely different.

Here is the DSM-V definition of both:

Obsessive Compulsive Personality Disorder (OCPD) is classified as a type of personality disorder:

  • A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
  • Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met)
  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)
  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
  • Is unable to discard worn-out or worthless objects even when they have no sentimental value
  • Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes
  • Shows significant rigidity and stubbornness

Obsessive Compulsive Disorder (OCD) is classified as a type of obsessive compulsive related disorder:

  • Presence of obsessions, compulsions, or both:
    • Obsessions are defined by:
      • Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
      • The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action.
    • Compulsions are defined by:
      • Repetitive behaviors (hand washing) or mental acts (counting) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
      • The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.
    • The obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The similarities are:

  • Both can create significant relational issues and make it difficult to interact with others.
  • Both have intense, obsessive, and racing thoughts that are difficult to manage or prevent.
  • Both develop internal rules to be strictly followed in an effort to reduce stress or anxiety.
  • Both do compulsive behaviors to self-sooth such as hording or excessive cleaning.
  • Both have extremely high expectations of self to the point of requiring perfectionism.
  • Both can have “meltdowns” if a compulsion is not followed or their image is tarnished.

The big differences are:

  • OCPD can be seen in every environment and is pervasive whereas OCD is usually isolated to a few specific things or locations.
  • OCD is a learned behavior usually done as a way of coping with extreme stress whereas OCPD is part biological and part environmental beginning in early childhood and continuing through out adulthood.
  • A person may change OCD behaviors as they age whereas OCPD behaviors cannot be changed without significant effort and therapy.
  • OCD behaviors can cause significant impairment at work whereas OCPD behaviors are usually praised at work because of their strong devotion to it.
  • OCD behaviors are frequently done out of fear to avoid an undesirable outcome whereas OCPD behaviors are done out of fear of not living up to internal perfectionist expectations.
  • By outward appearance alone, it is difficult to identify an OCD person whereas OCPD persons are usually extremely well groomed, dress impeccably, and are very aware of the perfectionist image they portray.
  • OCD people know their behaviors or fears tend to be irrational whereas OCPD people believe their thinking is more correct than others and have a difficult time accepting the idea that their reasoning might be inaccurate.

The good news about both disorders is that they tend to do very well with therapy and the prognosis can be quite good.

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

Susan Gonsalves <![CDATA[Recovery Programs: Empathy as a Necessary Tool]]> 2016-05-02T20:09:30Z 2016-05-04T10:57:45Z recovery programs and empathyRecovery can be defined as a return to a normal state of mind, strength or health[i], which indicates that the focus of recovery programs should be on a return to the normal, or original state, prior to the onset of a mental illness.  With the recent popularization of neuroplastic change[ii] recovery has become more feasible, and realistic.

Michael Kirby declares that: “recovery requires appropriate patient support, including peer-to-peer support, family or caregiver support, community interventions and supportive housing programs [iii],” and should be focused on assisting patients solve their problems on their own, instead of solving the problems for them iii.

This concept mirrors Rogers’ client-centered approach, whereby, clients are drawn to the conclusions on their own, with the support of the therapist. This is done through empathy and unconditional positive regard, two components that play a major role in recovery programs.

Empathy is one of the strongest emotions a client can be offered. It demonstrates to them that we are truly listening to, and hearing what they are saying, and that we are trying our best to understand their situation. It is an admission that we will never know fully what they are going through, but that we acknowledge the difficulty they are facing, and that we are there for them in times of need.

Unconditional positive regard [iv] acts as a way to build confidence in the client; it says that we accept them as a positive and good person, no matter the circumstance. This does not mean that we accept negative behavior as positive or that we encourage it, but that we accept the person as a wholly positive being, whose behavior may be negative from time to time – just like everyone else.

I have found that these two components play a significant role in a clients understanding of their self within a therapeutic setting, and translate well into their lives outside of therapy, counseling, etc.

Unconditional Positive Regard

By employing both empathy and unconditional positive regard, we are actually building the clients confidence so that outside of therapy sessions, they will be more able to cope, and deal with new negative and stressful situations they may face.

In my experience, when I have offered clients my empathy, and unconditional positive regard, they have reacted in a much more positive way, and have ended up recovering from the emotional crisis much quicker than they otherwise would have.

Further, empathy and unconditional positive regard work together in strengthening the client-therapist relationship, or therapeutic alliance (therapist, confidant, counselor etc), which only has positive effects on the client receiving care. This too, builds the client’s confidence, and ability to cope because it demonstrates to them that they are able to confide in someone without being judged – even their deepest, darkest secrets.

How does all of this translate to recovery programs? Recovery programs are similar to traditional therapy in that they are meant to assist clients in facing and coping with their issues or crises.

These programs may be more structured than traditional therapy (for instance, psychoanalytic therapy does not focus, necessarily, on re-framing a persons mind, whereas cognitive behavioral therapy, or CBT, does).

If we are following from Kirby’s iii understanding of recovery, then most programs use CBT’s methodology. For instance, WRAP[v] is a self-maintenance program that focuses on dealing with issues (for the sake of this article we will focus solely on mental health issues). The 5 key recovery concepts that are listed are: hope, personal responsibility, education, self-advocacy and support.


As you can see, empathy is not mentioned as a key recovery concept. Although it could be argued that empathy is included in one of the 5 key concepts, it should be its own, and should be a major focus area in any recovery program – whether it be peer or self led.

Rogers has shown us that empathy proves very powerful when assisting a client iv so we should be employing it in every therapy-based situation we find ourselves in, including recovery programs. In recovery programs the focus is, of course, the client, (the focus should always be the client) and empathy can only encourage and support the client even more.

Patricia Deegan conceptualizes recovery perfectly in her article “Recovery: The Lived Experience of Rehabilitation.”

She says: “they experience themselves as recovering a new sense of self and of purpose within and beyond the limits of the disability[vi].” This can be achieved through finding support, and encouragement in your peers, mental health professionals, and community – which will undoubtedly translate into your personal understanding and conceptualization of your self.

The encouragement and support given to you by your peers, for example, is empathetic. They attempt to understand your troubles and acknowledge that you are important enough that they do not meddle. Although we are there to assist clients, and we are there to aid in their recovery, we acknowledge that we are powerless in these situations, and the reason for this is because our power is relinquished, and given to our clients. Because in recovery, the only power we have is through our empathy and understanding.

[i] Recovery. (n.d). In Oxford Dictionaries online. Retrieved from

[ii] Doidge, Norman. (2007). The Brain that Changes Itself. New York, NY: Viking Press.

Doidge, Norman. (2015). The Brain’s Way of Healing. New York: NY: Viking Press.

[iii] Kirby, M. (2008). Mental Health in Canada: out of the shadows forever. CMAJ, 178 (10) pp. 1320-1322.

[iv] Rogers, Carl. (1951). Client-Centered Therapy: Its Current Practice, Implications and Theory. London: Constable. ISBN 1-84119-840-4.

Rogers, Carl. (1959). A Theory of Therapy, Personality and Interpersonal Relationships as Developed in the Client-centered Framework. In (ed.) S. Koch,Psychology: A Study of a Science. Vol. 3: Formulations of the Person and the Social Context. New York: McGraw Hill

[v] Copeland, M. E. (1995). WRAP is…Retrieved from

[vi] Deegan, P. E. (1988). Recovery: The Lived Experience of Rehabilitation. Psychosocial Rehabilitation Journal 11 (4), 1119.

Nikki Zalewski/Bigstock

Susan Gonsalves <![CDATA[After the Death of Dr. Rose Polge: Who has a Duty of Care to Doctors?]]> 2016-05-02T17:43:02Z 2016-05-03T10:41:46Z the death of Dr. Rose PolgeThe UK media are reporting that a body found at the seaside in Dorset has been formally identified as that of missing junior doctor Rose Polge. The press had stated that when she first went missing she may have written a note that mentioned Health Secretary Jeremy Hunt.

Jeremy Hunt, the UK Minister for Health is currently locked in a battle with the British Medical Association – the ‘doctors’ union’ – over proposed changes to the doctors’ contract with the National Health Service.

Among many reasons the medical profession is resisting these proposals is doctors argue these changes will make their lives even more stressful just as working conditions for physicians in the UK become ever more impossible.

The family Of Dr. Rose Polge has requested their privacy at this very difficult time.

Speculation as to what happened would be inappropriate. But it is inevitable that this kind of tragedy draws attention to the stress junior doctors are under and their campaign over working conditions.

A study published in the Journal of Epidemiology and Community Health entitled, “Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995,” found that the suicide rate in female doctors was higher than in the general population, whereas the rate in male doctors was less than that of the general population.

This investigation, by a team led by Professor Keith Hawton, from the University of Oxford found the difference between the mortality ratios of the female and male doctors was statistically significant. There were also significant differences between specialty with community health doctors, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine.

Keith Hawton, Aslog Malmberg and Sue Simkin from the Centre for Suicide Research, Department of Psychiatry, University of Oxford, published a study in 2004 that remains one of the largest psychological investigations into suicide in doctors.

Psychological Autopsy

The authors describe their research as a “psychological autopsy study,” of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. Most of the deaths appeared to have been planned and two thirds of doctors had left a suicide note, while a third were known to have spoken of suicide before their deaths, most within the week beforehand.

Twenty-five of the doctors had significant problems related to work, 14 had relationship predicaments and 10 had financial difficulties.

Given the current working atmosphere in the NHS, it is particularly interesting that the study found most doctors had significant problems at work. Seven were facing complaints, which in five cases appeared to have been a key factor leading to suicide. Most of these doctors were also facing other difficulties at work or home.

Other common professional problems included feeling overloaded by the volume of work, long hours and struggling with the responsibility of the job.

The study, “Suicide in doctors: a psychological autopsy study,” was published in the Journal of Psychosomatic Research’. It investigated 28 men and 10 women.  44% were under 35. 47% were married, 29% single and 10% divorced or separated. Of 25 who worked for the NHS, 15 were consultants or principals in general practice and 10 were junior staff. Twelve worked in general practice.

The pattern of diagnoses was similar to other studies, but with lower rates of psychotic illness and personality disorder, as would be expected, the authors of the study contend, in such a professional group.

The authors argue that physicians, in general, tend to minimize their own health problems, often fail to seek suitable help, do not take time off work and distrust occupational health services.

The doctors in this sample, the authors explain, reflected this pattern. They were less likely to have consulted their GPs shortly before death than people in other population-based studies of suicide.

A surprisingly high proportion, the authors say, had received treatment for depression compared with subjects in other studies. However, their probable ability to conceal the profundity of their hopelessness and suicidal drive from others might explain why so few had been admitted to hospital or seen by their GPs before death.

The authors of the study conclude that the impact of complaints, overwork and burden of administration on some of the doctors studied is of great concern. Given the study was done in 2004, David Casey and Kartina Choong from the University of Central Lancashire, in their more recent investigation of doctor’s suicides, quote a report issued by the Royal College of Physicians in 2012.

This demonstrated that there were one-third fewer acute trust beds than 25 years ago yet a 37% increase in hospital admissions over the last 10 years.

Under More Pressure?

David Casey and Kartina Choong’s study cites evidence that 75% of medical consultants reported being under more pressure than three years ago and 25% of medical registrars reported their workload as unmanageable.

Robyn Brickel, MA, LMFT <![CDATA[Substance Use and the Teenage Mind: A New Look at Treating Adolescents in Therapy]]> 2016-05-02T17:37:14Z 2016-05-02T05:40:16Z substance abuse and the teenage mindAdolescence arrives with a surge of emotional energy.  It can empower youth to expand their capabilities, make new friends, depend less on parents, and live more passionately.  The influence of parents remains important in a child’s life, and is necessary to support teens in making good choices.

Adolescence is also a time when some teens look to experience alcohol or drugs (such as heroine, cocaine, marijuana and prescription medicine, among other substances). All too often, tragic results follow.

As therapists, how can we help more teens and families avoid or repair the damage and danger of substance abuse?  What can we know about adolescent development to better understand the needs, risk factors and vulnerabilities at this life stage, and respond effectively?

Adolescence Spans More Years Than Most People Realize

Adolescence starts at about age 11 in girls, 12 1/2 in boys, and continues into a person’s mid-twenties. Neuroscience tells us that the brain changes dramatically during this time and does not fully develop until age 27.

Brain remodeling refers to the process of physical and neurological transformation. Excess neurons that formed during childhood die off naturally — a process of synaptic pruning.  A performance-enhancing sheath (myelin) grows along the remaining active neurons — a change called myelination. The myelin sheath allows impulses to flow up to 3000 times faster along the brain’s circuits. The brain becomes more specialized, efficient and more integrated.

New Thoughts, Feelings and Vulnerabilities Emerge

We also know that new ways of thinking, feeling and behaving appear — sometimes dramatically — during this time. Four qualities emerge with adolescence: “Novelty seeking, social engagement, increased emotional intensity and creative exploration,” says Daniel Siegel in his book Brainstorm: The Power and Purpose of the Teenage Brain.

These qualities inspire many young people to do amazing and wonderful things. However, without the benefit of healthy attachments, these drives can also misguide others toward dangerous, high-risk, even deadly behavior.

How vulnerable are adolescents to risky and dangerous substance use behaviors?  The numbers are staggering.  While they do not predict the risk for any one person, they reveal unmet needs for education and appropriate guidance for adolescents:

  • One in five youth between the ages of 12 and 17 in the US have an abusive/dependent or problematic use of illicit drugs or alcohol
  • Alcohol poisoning and related incidents cause 4,358 deaths each year for youth under age 21, and lead to emergency-room injuries for another 190,000 people in this age group each year (NIAA, Underage Drinking)
  • Over 27% of 8th, 10th and 12th graders in the US report past-year use of an illicit drug other than alcohol (NIDA DrugFacts, December 2014)
  • After marijuana, prescription and over the counter medications account for most illegal drug use by 12th graders in 2013
  • Underage drinking accounts for 11% of all alcohol consumed in the US, 90% of which is consumed in binge drinking (CDC Fact Sheets – Underage Drinking)
  • Youth who drink or use drugs are more likely to become victims of sexual or physical assault
  • The average onset of first use of drugs or alcohol for boys is 12, for girls it is 12 1/2
  • For those who began consuming alcohol by age 15, 47% experienced alcohol dependence later in life, compared to 9% who began at age 21 or older (NCADD FAQ)

Adolescents make decisions, choose behavior and experience consequences differently than adults do. It can be very perplexing for adults to look on and try to make sense of a young person’s journey.

Heather Gilmore, MSW, LLMSW, BCBA <![CDATA[Natural Teaching or DTT in ABA (Applied Behavior Analysis)?]]> http://3.636 2016-04-30T18:20:20Z 2016-04-30T18:20:20Z

When providing applied behavior analysis services to children with autism spectrum disorder, it is so important to provide intervention that is based on scientific research, intervention that is the most likely to be effective and that is also least intrusive to the individual client.

In practice, applied behavior analysis can look different based upon of course the child, but also based upon the behavior analyst’s preferences, training, clinical judgment, and ability to modify their approach based upon research findings.

Applied behavior analysis is often perceived as only representing “discrete trial training” (DTT). DTT is an intervention that incorporates fast-paced learning trials most often occurring at a desk or table. The idea is that with the frequent repetition and practice (with the use of behavioral principles such as positive reinforcement) that the child will learn new skills.

Another ABA approach is natural teaching. This approach relates more to teaching during the activities that the child would “naturally” participate in, such as while playing with toys. In particular, one specific form of natural teaching is called Pivotal Response Treatment.

Here’s a summary of a research study that was conducted to compare the two approaches in ABA.

Title of Study: Pivotal response treatment for children with autism spectrum disorders: A systematic review.


Accumulating studies are documenting specific motivational variables that, when combined into a naturalistic teaching paradigm, can positively influence the effectiveness of interventions for children with autism spectrum disorder (ASD). The purpose of this study was to compare two applied behavior analysis (ABA) intervention procedures, a naturalistic approach, pivotal response treatment (PRT) with a structured ABA approach in a school setting. A randomized clinical trial design using two groups of children, matched according to age, sex and mean length of utterance was used to compare the interventions. The data showed that the PRT approach was significantly more effective in improving targeted and untargeted areas after 3 months of intervention. The results are discussed in terms of variables that produce more rapid improvements in communication for children with ASD.

This is one of the many studies that support the use of natural teaching strategies. DTT can also be effective. However, as Mohammadzaheri, et. al. note, there can be side effects that come with the use of DTT (or more highly structured interventions). For instance, these approaches may have the following issues:

“(a) gains are extremely slow (often requiring many thousands of trials to teach a single word);

(b) when gains occur they often do not generalize; and

(c) the children typically are often unmotivated to be involved in the teaching sessions, frequently exhibiting escape-motivated disruptive behaviors (Koegel, et al. 1998)”

One of the highlights of this study was the higher rates of improvements in social communication skills that occurred in the PRT group. Since communication deficits are a defining characteristic of autism spectrum disorder, this study provides support for the use of natural teaching strategies, especially Pivotal Response Treatment (PRT), to improve this skill area.


Koegel, R. L., Camarata, S., Koegel, L. K., Ben-Tall, A., & Smith, A. E. (1998). Increasing speech intelligibility in children with autism. Journal of Autism and Developmental Disorders, 28(3), 241–251.

Mohammadzaheri, F., Koegel, L. K., Rezaee, M., & Rafiee, S. M. (2014). A randomized clinical trial comparison between pivotal response treatment (PRT) and structured applied behavior analysis (ABA) intervention for children with autism. Journal of Autism and Developmental Disorders, 44(11), 2769-77. doi:

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Steve Greenman, MA, LPC, NCC <![CDATA[More Research Than Practice in Problem Solving Consultation?]]> 2016-04-30T17:48:41Z 2016-04-30T17:46:29Z more research than practice in problem solving consultation?

“Man is a game playing animal and a computer is another way to play games” -Scott Adams  

Markeda Newell (2010) in his article entitled “Exploring the Use of Computer Simulation to Evaluate the Implementation of Problem-Solving Consultation”  brings up the concern that problem solving consultation research has proliferated over the last 20 years but there is a severe lack of evidence in the use of this research by front line school psychologists.

Kratochwill, Sladeczek and Plunge (1995) in their article entitled, “The Evolution of Behavior Consultation” state that there are “more advances in research and theory than in actual implementation of consultation in practice.

One is left to wonder what questions are being used in consultation and even more importantly if the questions are the right ones” (p. 146).

Newell (2010) shares that three themes emerged from data analysis and interviews from the school psychologists that participated in this qualitative case study:

  • use of behavioral approach to problem conceptualization
  • individualized approach to intervention design
  • minimal attention to plan evaluation.

The Divide

Newell found the latter three points disturbing and shares that the divide between current research data and practice techniques used in the field may be to blame.

Gutkin (2002) shares that there is an inability to make comparative or summative analyses about consultation outcomes because different people are doing different things, which fosters uncertainty about whether consultants implement the process effectively.

Newell (2010) shares Gutkin’s premise and believes answers may come from inventive new ways to collect data (computer simulation) and that “qualitative inquiry into the consultation process can lead to better understanding of the implementation and outcomes of problem solving consultation” (p. 229).

Critical Analysis

Newell (2010) states that one of the major challenges in conducting a qualitative consultation research study in current practice settings is not being able to get a picture of the whole process that school psychologists use in creating an evaluation and implementing a support plan for their clients.

Simulation to Newell represents a midpoint between “the decontextualized artificiality of the laboratory setting and the sometimes intractable and inaccessible real world setting” (Robson, 2002, p. 363).

The beauty to Newell (2010) of using computer simulation is the ability to identify how well consultants “adhered to the problem-solving model, how they conceptualized the problem, and how they selected and evaluated the intervention” (p. 231).

The methods used in this study consisted of:

  • recruitment practices used
  • research design style
  • procedures used
  • how data analysis was collected and analyzed

Criterion sampling was used to recruit participants for the study. Patton (2002) in his book Qualitative research & evaluation methods (3rd ed)” states that criterion sampling is the process of selecting cases that meet specific criteria that can illuminate the focus of the case.

With the latter in mind, recruitment consisted of three important criteria chosen school psychologists need to have to be selected:

  • work in an elementary school (case simulations were set up for elementary clients)
  • trained in problem solving consultation (and really used it!)
  • had access to a personal computer (Newell, 2010).

Research design style was a case study. What has been stated earlier  was the need for a “whole picture” snapshot of the variables that affected choices taken by the school psychologists for their clients.

Research style such as case studies specialize focus on being able to “gather comprehensive, systematic, and in depth information about each case of interest” (Patton, 2002, p. 447). Through the use of case study methodology coupled with computer simulation, stage by stage analysis could be conducted to provide data in detail to properly research the problem-solving consultation process used by the four school psychologists chosen for this study (Newell, 2010).


Sharie Stines, Psy.D <![CDATA[Breaking Free from an Abusive Relationship]]> http://7.253 2016-04-30T02:30:51Z 2016-04-30T02:30:51Z flowerFollowing are ten steps to take to break free from an exploitive, abusive, or toxic relationship.  While you may believe that your primary problem is the other person, let me emphasize, your primary prisoner is not another person, but rather, your belief system. Once you can get rid of faulty thinking and allow yourself to think differently, you can begin to heal.  Here are ten steps to take to begin your road to freedom:

  1. Find a healing partner or group of people to help you walk through this journey of healing. Make sure you have emotionally healthy friends, counselors, or some significant people who you can share your inner most thoughts and feelings with.
  2. Develop grace for yourself. You cannot heal without grace. You must eliminate self-condemnation, no matter what. It’s okay for you to see your weaknesses, but don’t criticize yourself for having them. Everyone has imperfections and no one is perfect. Don’t try to be and don’t put undue pressure on yourself to be someone you’re not. Be honest with who you are and embrace yourself.  This is necessary to do before you begin to address your repressed emotions, such as feelings of shame, fear, and rage. These feelings or emotional states need to be processed in order to heal.
  3. Begin with a relationship inventory. Take an inventory of your toxic relationship. You can start by creating a Relationship Diagram.  Draw a horizontal line on a piece of paper, on the left end of the line, put the approximate date when your toxic relationship began.  On the right end put the present date.  This horizontal line represents the duration of your toxic or abusive relationship.  The left side is the beginning and the right side is the end. Now, draw vertical lines throughout your relationship timeline. Vertical lines going above the line are positive events, and vertical lines extending below the relationship line are negative events.  Write your feelings about each event once they’ve been identified. This relationship diagram will help you begin the process of seeing and knowing what you are dealing with.  Include descriptive feelings regarding significant events in your relationship and also notice how your relationship dynamics have contributed to what is known as a trauma bond, or perhaps even, Stockholm Syndrome.
  4. Write a letter to your toxic person stating everything they mean to you and everything you want from them. Write your hopes, dreams, wants, desires, wishes, fantasies, etc.; all of the aspects of the person you appreciate. Do not give this letter to your person; this exercise is for you alone, in order to identify and process your strong emotions. It is important for you to admit to yourself that this person is significant to you and why.  Identify the hope, the promise, you have been holding on to within the relationship. Identify why you find it so hard to leave the relationship.
  5. Write another letter outlining all of the negative aspects of the relationship, including how you’ve been hurt, disrespected, devalued, ignored, and rejected. Write, without censorship, all the different ways this person has offended you and all the different ways you’ve tolerated abuse and compromised your values in order to remain in the relationship.
  6. Begin a daily journal and answer the following questions. The purpose of this exercise is to help you “know what you know” and complete the grief brought on by this relationship:
    1. What unfulfilled dreams do I have with regards to this relationship?
    2. What has been missing from my relationship and how has its absence affected my life (e.g., compassion, collaboration, empathy, concern, safety, trust, etc.)?
    3. What have I been too afraid to say out loud (either to myself or others) with regards to this relationship?
    4. What are the different types of abuse I’ve experienced in this relationship – sexual, financial, physical, emotional, spiritual, psychological, mental, other?
    5. What are my feelings today? Describe them in great detail.  Do not evaluate or judge them.
    6. What goals do I have for myself outside of my relationship?
    7. What can I begin doing today to heal? What baby steps can I take?
    8. What are my triggers? These are those things that the toxic person does that cause you to either under or over react.
    9. If possible, see if you can identify any familiar patterns or feelings in this relationship that you’ve experienced before, such as in a childhood relationship with one or both parents (or some other significant person.)
  7. In addition to writing your feelings each day, also make sure you start “rewiring your brain” by inputting new thoughts in it. Begin by developing a list of positive affirmations and repeating them to yourself each day (or each hour.)  Using Scripture is a great resource for this. Here are some examples:
    • I can do this. I will do this. I am doing this.
    • Everything is going to be okay.
    • Feelings are fleeting.
    • One day at a time.
    • I am strong and capable.
  8. Understand that healing from abuse involves developing a healthy relationship with yourself and with others. To do this, do not say anything derogatory or hurtful to yourself, ever. Resolve to be kind and compassionate to yourself. Do not continue on with a verbal dialogue inside your head that replicates the one you had with your abuser. Also, start forming healthy connections with others. Unhealthy relationship dynamics can only be broken once alternative, healthy relationships have been formed.
  9. Read books, internet sites, and any other materials you can get your hands on to inform you, keep you in reality, and break the cognitive dissonance you experience from being with an abuser.
  10. Take baby steps. Never give up. Keep moving forward. Remember, this is a process and a journey, not a destination. Enjoy something about each day and do something positive for your recovery each day. Do not beat yourself up for setbacks, and do not expect yourself to be perfect or to recover from abuse flawlessly each day.

“What we obtain too cheap, we esteem too lightly: it is dearness only that gives every thing its value. Heaven knows how to put a proper price upon its goods; and it would be strange indeed if so celestial an article as freedom should not be highly rated.”

― Thomas Paine

Heather Gilmore, MSW, LLMSW, BCBA <![CDATA[5 Great Resources for PECS materials]]> http://3.633 2016-04-30T01:41:56Z 2016-04-30T01:41:56Z

This post will provide you with some great resources for getting materials to teach and use PECS (Picture Exchange Communication System) with the kids that you work with.


  • Find the four steps of PECS
  • Use a flow chart to figure out if you should use PECS with someone
  • Sample Pictures
  • And more

National Autism Resources

  • Find lots of PECS-related products and more

PECS Youtube Videos

  • Watch informative videos about training with PECS

Indiana Resources Center for Autism

  • Learn about PECS and picture exchange

Speech and Language Kids

  • Learn about how to use PECS to encourage speech

If you have any other resources regarding PECS, please share! Thanks!

image credit: WavebreakMediaMicro via Fotalia

Christine Hammond, MS, LMHC <![CDATA[How to Live with an Anxious Person]]> http://5.660 2016-04-29T14:28:12Z 2016-04-29T14:28:12Z anxious personIt is normal to feel anxious when highway traffic goes from full speed to a screeching halt in a matter of seconds. Or when your child’s school gets placed on lockdown and all you get is a notification from the media. Or when the credit card bill statements come in larger than expected. Or when the doctor’s office leaves a message that the doctor wants to deliver test results in person. These are anxious moments and it is normal to feel apprehensive about the next course of events.

But some people are anxious about nearly everything. An ordinary conversation about where to go for dinner sparks fretfulness over who will and won’t be there. A regularly scheduled annual visit to a doctor expands to concern that cancer will be discovered. A routine phone call from a boss strikes fear that termination is emanate. This type of anxiety produces intense feelings of fear which can greatly impair decision making.

Having it is one thing, but living with a person who has it can be frustrating.  So how can such attacks be handled?

  • Keep fears at a distance. Allow the anxious person to express their fears but don’t absorb it. Think of their fear as beading up like water off a duck’s back. Because of the oily feathers, it just rolls right off without penetrating.
  • Don’t add to the worry. Remember that the anxious person’s fear does not need to spread. When others give the nervousness weight, it can grow to a size much larger than anticipated. Don’t feed it.
  • Express boundaries. Don’t be afraid to insert a boundary when the anxious person is speaking. For example, “This is not the time for this discussion,” or “Can we talk about this later this evening?” Boundaries give a chance for reflection before things get out of control.
  • Step away. When the downward spiral of anxious thinking takes over in an obsessive manner, walk away. This will likely frustrated the anxious person but that is their share of the responsibility. Stepping away is self-care.
  • Don’t replay. No matter how hard a person tries to get distance from the projected anxiety, a bit still seems to creep in. Allow for a few minutes of reflection but come to a decision quickly and then stop replaying the conversation.
  • Use logic. Apply logic to the anxiety. Is it well founded? Does any of it have merit? Keep the parts that do and discard the rest. Usually there is an ounce of truth in each anxious attack so acknowledge that and place the rest aside.
  • Find calm. After an anxious engagement, find some calm. A personal favorite of mine is going outside and breathing in a natural environment. There is something about nature that helps to put things into perspective and reset heightened senses.
  • Don’t reengage. One observation about anxious people is that usually after the worry is expressed, they feel better while others feel worse. There is no need to rehash the moment if the anxious person is done. Leave it be or things might get more intense on the second go around.
  • Understand anxiety. Some anxiety is a manifestation of a mental disorder, a learned behavior from a parent, a triggered trauma memory, an allergic reaction to food, an undiagnosed medical condition, an addiction, or unresolved depression/anger/guilt. The initial reasons for the restlessness may not be apparent and do require some expert opinion to properly diagnosis. Encourage the anxious person to see treatment. Some anxiety can be easily resolved.

There is always hope for the anxious person and those living with the anxiety. Properly addressing the issue takes some time but is worth the effort in the end.


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

Jessica Dore <![CDATA[Mindfulness for Relapse Prevention]]> 2016-04-28T13:15:05Z 2016-04-28T13:15:05Z mndfulness for relapse preventionAddiction relapse prevention approaches have traditionally focused on challenging the thoughts that contribute to and exacerbate addictive behaviors as well as helping those in recovery develop healthier coping strategies in challenging situations.

These approaches, which are rooted in the cognitive behavioral tradition, have rarely co-existed with Buddhist or third wave approaches in relapse prevention protocols.

But during the last several years, an integrative mindfulness-based relapse prevention (MBRP) program has emerged. This approach, which is based largely on the research of addiction expert Alan Marlatt, Ph.D, combines mindfulness meditation and the cognitive behavioral-oriented relapse prevention therapy. It has been developed by Sarah Bowen, Ph.D, Neha Chawla, Ph.D, Joel Grow, Ph.D, and Katie Witkiewitz, Ph.D.

The following principles, which are adapted from the edited volume, Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions, provide the foundation for understanding a mindfulness-based approach to addiction.

  1. Nonacceptance

From a traditional mindfulness perspective, the unchecked urge to grasp for what we don’t have or to escape from situations that we don’t want is at the heart of addictive behaviors.

“Addiction might thus be viewed as a non willingness or perceived inability to accept what exists in the present moment. There is a grasping for something that we think will deliver the experience we yearn for instead of the one we currently have,” write Bowen, Chawla, and Witkiewitz.

The practice of mindfulness meditation provides a way out of this trap. When we practice noticing the way our thoughts, emotions and physical sensations constantly change, we begin to transform our relationship to the activity of our minds.

With time and sustained practice, we become privy to the fickle nature of our internal experiences and therefore less likely to allow them to dictate our behavior.

Even when our internal experiences are not the way we’d prefer them to be, certain kinds of mindfulness meditation can help us relate to such unwanted experiences with a sense of curiosity and compassion. This allows us to behave in more flexible ways, even in the presence of challenges.

  1. Negative Reinforcement

Let’s face it, when the primary goal is to escape unpleasant thoughts and feelings, substance use is, in fact, highly effective. It is temporary, and it most often always makes things worse, but it works for instant, fast-acting relief.

Research shows that the urge to escape or avoid unpleasant emotional states is the most common trigger for relapse, and addiction as traditionally been viewed as a way of self-medicating, meant to treat emotional discomfort.

When difficult thoughts or feelings are dulled, numbed or soothed through substance use, the addictive behavior is reinforced as a useful method. But of course, in the long-term, this is a dangerous trap.

Relying on substances to treat distressing thoughts or feelings may provide immediate relief, but the cost of that relief is typically more distressing thoughts like shame, depression and stress, which will also beg to be numbed. Because substances do provide temporary relief, it is easy to fall into the trap of continuing to rely on them as a coping tool.

Simply building awareness around these behavioral patterns is useful for those struggling with addiction. Understanding why the temptation to use substances is so strong, particularly in moments of stress or other emotional discomfort, is an important part of recovery and relapse prevention.

Understanding the relationship between substance use and the very human desire to avoid difficult feelings has the potential to short circuit the automatic urge to use when things become challenging.

  1. Positive Reinforcement

Of course, addiction is not always motivated by the urge to escape discomfort. For some, addiction is about chasing pleasant feelings or things like excitement, intensity and other appetitive experiences. From a mindfulness perspective, this is another case of nonacceptance or wanting things to be other than what they are in the present moment.

Once again, mindfulness can help.

“Mindfulness practice may help clients find the naturally reinforcing or nourishing aspects of day-to-day life that are often deemed trivial and thus unworthy of attention of presence. By bringing purposeful attention to what gives us pleasure, not only is contact with natural positive reinforces increased, but we may also notice pleasure where previously we had missed it,” write Bowen, Chawla, and Witkiewitz.

The present moment can be a surprising source of pleasure for people who are used to going through their days on autopilot. Feeling the warm water run over your hands when you’re washing dishes on a chilly fall day, for example, can feel great.

Or being aware of a cool breeze blowing through the office window on a hot summer day, can be a source of pleasure. These moments certainly don’t guarantee euphoria, but they can also help ease or regulate otherwise stressful times that may otherwise challenge sobriety.

If you’d like to learn more about mindfulness-based relapse prevention and other mindfulness- and acceptance-based approaches to treating substance abuse, check out the book Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addiction

Sunset photo available from Shutterstock

Bret Moore, Psy.D. <![CDATA[Shared Personality Traits of Your Military and Veteran Clients]]> 2016-04-27T12:31:44Z 2016-04-27T12:01:13Z personality traits of military clientsOver two- million men and women have served in the recent wars in Iraq and Afghanistan.  It is estimated that a significant minority of them will require ongoing psychological care for conditions like posttraumatic stress, depression, and anxiety.  Consequently, non-military behavioral healthcare providers will shoulder a sizeable portion of the care these men and women will receive.

Appreciating the Culture

In order to provide the most effective level of care possible, it is believed by many within the military and veteran psychological communities that civilian practitioners should be knowledgeable regarding the unique culture of the military.

One aspect of the military culture is the various personality traits military personnel share.  Please keep in mind, however, that the attempt to homogenize any group of people into a unified whole ignores the importance of individual differences.

It also is fraught with necessary assumptions, many of which may be inaccurate. Nevertheless, I believe there is value in looking at collective traits for the purpose of trying to better understand a particular group as long as the previously noted cautions are kept in mind.

With that being said, there is no one personality type that defines those who serve in the military.  There are, however, several personality characteristics I believe are shared by many.

To be successful, military personnel must possess certain traits that allow them to manage living and working in stressful environments.  These traits allow them to adapt to a structured, rule bound, and hierarchical way of life.

If not present, adapting to the military life can be difficult for some. I can also cause challenges for the military.  The military understands the importance of recruiting individuals with these particular characteristics.  Doing so ensures career longevity and mission success.

The Adventurous

It is no coincidence that military recruiting commercials show Soldiers, Sailors, Airmen and Marines jetting or sailing off to exotic ports of call and distant and enchanted lands.  The military understands that those who crave adventure are a good fit.

And the opportunity to living in Japan, Italy, or Germany is an attractive option for someone who grew up in Brookhaven, Mississippi or Muncie, Indiana.  In my opinion, those individuals who join the military tend to be more open to change, comfortable taking risks, and willing to explore new ways of life.  Considering that the average military member is forced to move every few years this is a valuable trait.

Love of Country

It probably goes without saying, but a high degree of patriotism is necessary to be successful in the military.  Love for one’s country is a powerful force that prompts countless men and women to take risks the average person would not even consider.

Often times, it seems that this value is coded into their DNA and passed down from previous generations.  It is quite common to find that a service member had a parent, grandparent, sibling, aunt or uncle who once served.  Many also have high school friends who aspired to serve, which reinforced their own latent interests of National service.

Being Flexible

Flexibility is a must for someone to succeed in the military.  “Adapt and overcome” is the only comment more commonly heard in the military than “make sure to hydrate.”

Without the ability to adjust to ever changing demands, one will either fail at important tasks or grow so frustrated that leaving the military is the only viable option.  This trait is not unlike the adventurous streak described above.  Without the ability to shift to ever changing demands, expectations, and environments, the service member will struggle with the military lifestyle.

Being Rigid

Rigidity is a double-edged sword.  It allows a person to more easily adapt to a highly structured and regimented way of life, but at times can conflict with the need to be flexible.

The most successful military members are those who maintain a structured and organized approach to life, but know when a situation requires adaptability and a different perspective and approach.  This skill does not come easily for many.

The military recognizes this fact and provides substantial training with regard to meeting and exceeding explicit standards while teaching young troops how to make sound, evidence-based decisions in a variety of contexts.

National Service

There are many ways to serve one’s town, state, and country. Some go into education, law enforcement, or healthcare.  Others join the military.  The desire to serve others is a trait that sets the stage for a successful military career.  In fact, the best military leaders are those who can put others before themselves.

You will likely find that those veterans who sit across from you in the therapy room possess a strong and unwavering sense of purpose and desire to make a difference.  It is important to acknowledge this desire and use it within treatment as applicable.

As I mentioned above, trying to fit the men and women of the military into a single personality category is very difficult if not impossible. The diversity of our Armed Forces is tremendous and in part is what makes it great.  But recognizing those traits which contribute to successful service helps ensure we provide the best level of care possible.

*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[Understanding the Shooters at Columbine from a Mother’s Perspective]]> http://5.653 2016-04-26T19:42:49Z 2016-04-26T19:42:49Z a mother's reckoningAfter sixteen years, I can still remember the day of the Columbine shootings. Two high school students, Eric Harris and Dylan Klebold, injured 24 people, killed 13 and then killed themselves. The media coverage continued for months with many stories of the deaths and survivors of the tragedy. Admittedly, I did not give much thought to the families of the two shooters except to dismiss them as examples of poor parenting. I couldn’t be more wrong.

Sue Klebold, in her book A Mother’s Reckoning: Living in the Aftermath of Tragedy, honestly and transparently addresses the most dominate question. How could you have not known? She willingly exposes her own journal entries, thoughts, fears, insecurities, and mixed emotions of guilt, anger, deep sadness, and remorse while bravely confronting her own and society’s mischaracterizations about Dylan. It is an important read for any professional dealing with teenagers, parents, and families.

There are several things the book taught me as a result of Sue’s unfathomable exploration into her and her son’s inner life.

  1. Healthy families do not always result in healthy kids. There is a belief that if a child grows up in an excellent environment that everything will turn out fine. It stems from our desire to want to ensure positive and minimize negative outcomes. But somethings are beyond our control. The Klebolds (by their own account), Dylan’s, and independent verification from other Columbine authors such as Andrew Solomon and Dave Cullen, had a well-integrated family. Still, that was not enough to stop the tragedy.
  2. Murder-suicide begins with suicide than moves to murder. The decision process begins with an attitude that death is preferable to life. A person becomes comfortable with dying and then decides how they want to die. The desire to take other lives becomes part of a guarantee that that the suicide will be carried out. This does not diminish the intent of murder; rather it is another perspective of how a person may view it.
  3. Be careful about assuming parental irresponsibility. Early on during the coverage of the tragedy, there was much discussion about mistakes the parents made in not foreseeing such an event. But having read several books now on the issue, I can see that the boys were excellent at hiding their plans from everyone including their friends and parents. Too often society looks for someone alive to blame for the errors of others and parents are the first target. While there are some bad parents in this world, not every child who does a bad thing has come from a bad parent.
  4. Not everyone displays the warning signs. Most professionals are well versed on the warning signs of a troubled person but not everyone fits neatly into the mold. Some signals can be so subtle that even the most adept can miss it. Likewise, some people are so good at hiding their symptoms that even the closest of friends or family members might overlook the potential harm. This is not a popular lesson where diagnoses are generously given to place individuals into molds of predictable behavior.
  5. Even professionals can be misled. It was a revelation to me that Dylan and Eric both participated and completed therapy and a diversion program just a few months prior to the tragedy. Law enforcement, the judicial system and the therapeutic community all gave the boys a healthy prognosis. As a parent, if I were in that place just a month prior to the event, I too would be resting easy that the worst was behind having trusted the professionals. Again, I would be wrong.
  6. Tragedies don’t go away, they just change form. Sue’s candidness of her journey before, during and after the tragedy is captivating. She analyzes every aspect of her own beliefs, thoughts, reactions and emotions in an attempt to put the shattered pieces of her son’s life together. While she makes no excuses for his behavior, she does openly share her insights into the making of a horrific day. Her conclusions changed the way I saw the event and the participants.
  7. Early conclusions were completely wrong. There were numerous stories of bullying being the cause of the problem, the wrong peer group (Trench Coat Mafia), intentionally signaling out students, or detached/passive parenting. All of these were wrong. The truth is that the boys intended to kill many more than they did before committing suicide. Their reasons for doing so were different for each one. After their deaths, Eric was diagnosed as a psychopath while Dylan was diagnosed as avoidant/depressive. The rush to explain their actions resulted in much misinformation.
  8. There is such a thing as grace under pressure. If there is ever an example of grace under pressure, it is Sue Klebold. The personal death threats she endured, the deep sadness and grief over the loss of her child, the forced reality of what he did, and the scrutiny by media, family, friends, doctors, lawyers, other parents, and the police was intense. While she would most likely never call herself graceful, it is a testament to her character that she was able to persist despite severe circumstances and share her journey with anyone willing to read.

As a side note, I do not know Sue Klebold nor am I receiving any compensation for writing this. These observations are my personal takeaways from a very powerful book.

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

Susan Gonsalves <![CDATA[Just How Common is Paternity Surprise?]]> 2016-04-26T02:01:02Z 2016-04-26T10:00:33Z paternity surpriseBBC News and other media are reporting how a recent DNA test result reveals that the Archbishop of Canterbury was not fathered by whom he believed had been his dad.

The Most Reverend Justin Welby, 60, is reported to have said that the identity of his real biological father has come as a “complete surprise.” The Archbishop has now found out that he is, in fact, the son of Sir Winston Churchill’s last private secretary, the late Sir Anthony Montague Browne.

Before the DNA test Justin Welby had considered his father to have been a whiskey salesman named Gavin Welby, who died in 1977.

His mother, Lady Williams of Elvel, has now also confirmed, according to the BBC News website, that she had a “liaison” with Sir Anthony just before she married in 1955.

This news might add to the widespread belief, fueled by the kind of paternity tests that have become referred to in gossip magazines, talk shows and ‘trailer trash’ TV, that many fathers are deceived into raising children who are not theirs genetically.

Extra-Pair Paternity

The common urban myth is that there are extraordinarily high rates of what geneticists refer to as ‘extra-pair paternity,’ or EPP. Quotations of estimates typically range from 10–30%.

Perhaps one reason for these high estimations is that female adultery is supposedly common, occurring in an estimated 5–27% for people younger than 30 years old, depending on which survey you consider.

Some evolutionary biologists and psychologists even speculate that some females may also be driven biologically, through evolutionary selection pressures, to actively seek ‘extra-pair copulations.’ This might be a way to improve the genetic diversity and biological quality of offspring, argue evolutionary biologists and could be an insurance against male infertility.

Another evolutionary psychology theory is that extra-pair copulations allow women to have the best of both worlds. They obtain the benefits of parenting and fathering from more reliable domestic ‘safe’ types of male, even as they bear the genes of a child fathered by more exciting ‘alpha-male’ ‘hunter’ types.

But now a new investigation and review of the academic area, by scientists at the University of Leuven, Belgium, and the Department of Genetics, University of Leicester, is arguing that ‘extra-pair paternity’ in contemporary human populations is only 1–2%.

The study, by Maarten Larmuseau, Koen Matthijs and Tom Wenseleers, contends that the previously inflated figures are not representative of the general population, partly because they were mainly based on data from paternity testing laboratories where paternity was disputed.

Critics, however, of these lower recent estimates from genetic techniques, which  have only become available over the past decade, point out that in historical times, ‘extra-pair paternity’ rates might well have been much higher, because of the lack of reliable contraception.

The era when the Archbishop of Canterbury’s mother had that “liaison,” was back in 1955.

The authors of this new investigation, entitled ‘Cuckolded Fathers Rare in Human Populations’, due to be published shortly in the academic journal, Trends in Ecology & Evolution, quote another recent study that did find a slight but significant decrease in ‘extra-pair paternity’ events following the introduction of the birth control pill.

Sharie Stines, Psy.D <![CDATA[Am I in an Abusive, Narcissistic, or Borderline Relationship?]]> http://7.238 2016-04-25T03:56:33Z 2016-04-25T03:56:33Z abusiveAnswer the following questions and see how many you answer “yes” and how many you answer “no” to. The more yes answers, the more likely you are in an abusive , narcissistic, and/or borderline relationship.

  1. My loved one calls me names, such as stupid or worthless, or other equally degrading terms.
  2. My loved one mocks, belittles, or uses a patronizing tone of voice when addressing me.
  3. This person often undermines my authority with my children.
  4. I try not to challenge or disagree with my partner.
  5. If I don’t agree with what my loved one wants me to do then I pay a heavy price in one way or another.
  6. My loved one threatens to leave or does leave abruptly when I say or do things he/she does not like.
  7. My loved one breaks things around the house when angry or upset.
  8. My partner pouts when “hurt.”
  9. My loved one yells at me and curses at me.
  10. My partner does not do his/her fair share of household responsibilities, often acting as if chores are beneath him/her.
  11. When I try to talk about my feelings with my loved one, he/she does not show caring and may even use what I’ve shared against me.
  12. My partner acts one way in front of others and much differently behind closed doors.
  13. When a conflict occurs, my partner does not try to resolve it. In fact, I don’t think my partner can resolve a conflict with me.
  14. My loved one often uses implications to make me feel bad about myself, frequently keeping me off balance in the relationship.
  15. I read a lot of books on how to improve relationships; and/or I research the internet and read as much as I can about abusive relationships, narcissism, or borderline personality disorder.
  16. I am usually, if not always blamed for our problems.
  17. My loved one disregards my needs and/or feelings and/or desires.
  18. My loved one badgers me and/or manipulates me to get his/her way.
  19. My loved one pouts or sulks when he/she is mad or upset with me about something, or does not get his/her way.
  20. My loved one blows up when I try to ask him/her a question in order to hold him/her accountable to something.
  21. My loved one refuses to listen to my point of view.
  22. My loved one uses sarcasm and ridicule to control me.
  23. My loved one has used threats against me in order to control me.
  24. My loved ignores my texts and phone calls, and only answers them on his/her time table.
  25. I feel trapped in my relationship with this person.
  26. I don’t feel like I can be myself in this relationship.
  27. I feel that I am treated like a child in this relationship.
  28. I often feel like the parent in this relationship.
  29. I usually feel tense around my loved one.
  30. I am afraid of this person.
  31. I feel physically ill when I am around this person.
  32. I do not like to tell others what is really happening in my relationship.
  33. My partner often acts like Dr. Jekyll and Mr. Hyde.
  34. I tend to use substances, food, or other addictive behaviors to cope with my relationship.
  35. My partner has an air of detachment about him/her, and oftentimes tends to be disengaged with others.
  36. My loved one often feels envious of others.
  37. When I’m around this person I often feel like I’m bad or failing at something, but can’t quite figure out what.
  38. I often ponder if I’m crazy or my partner is crazy or both.
  39. My relationship seems like an addiction.
  40. No matter how many “yes” questions I answer, I still stay in my relationship.


The greater number of “yes” answers to these questions, indicates a greater level of abuse or toxicity occurring in your relationship. While all close relationships will involve some level of misunderstandings and hurt feelings, a chronically toxic relationship will show consistent patterns of abuse.

L. Gordon Brewer, Jr. MEd, LMFT <![CDATA[Grief Therapy: Lessons Learned from the Mortuary]]> 2016-04-21T19:34:00Z 2016-04-24T10:33:42Z grief therapyAs professionals, most of us have hopefully received some rudimentary knowledge about grief and bereavement in our training.  You are probably familiar with Elisabeth Kübler-Ross’ work and her classic book, “On Death and Dying.”

She outlined the five stages of grief that we have all come to know well: denial, anger, bargaining, depression and acceptance.  That is all great stuff and things we need to know.  But what I have learned is that having that knowledge about the “stages” of grief really isn’t all that helpful.  When a client is totally overwhelmed by sorrow, they feel helpless.  In fact, it is a pretty helpless place to be for the therapists as well!  You can’t just say some “magic therapeutic words” to take the pain away.

Before becoming a therapist, I spent almost 18 years as a funeral director and embalmer before I changed careers.  It is kind of an unusual career change, but then again, not really all that different.  After all, both professions are in the business of helping people through a crisis.  Despite what you might think about the funeral industry itself, there are some really wonderful and caring people that I learned a great deal from over the years.

I have been in practice now as a therapist for 15 years. And what I learned as a funeral director has helped me immensely. I experienced and dealt with grief on a daily basis when I was working as a funeral director.  It taught me firsthand how to effectively provide grief therapy and work with people during the most difficult time that anyone can face–the loss of a loved one.

The truth of the matter is that there are very few theories or modalities of grief therapy.  Certainly, there is evidence for cognitive behavioral approaches being helpful for people when grieving. William Worden’s book, “Grief Counseling and Grief Therapy” along with Robert Neimeyer’s work, “Techniques of Grief Therapy” are both two I would recommend in learning some basics and techniques of grief therapy and theory.

And certainly, all we have learned about treating trauma and PTSD is a helpful knowledge base that for helping people that are grieving.

Taking the Pain Away

When someone experiences the death of someone close, needless to say there is a deep sense of loss.  With that deep sense of loss, there is very little anyone can say or do to take the pain away.  In fact, it is impossible to take the pain of grief away with words.

As therapists, we do have the opportunity do some emotional “first aid” to help the process of healing begin.  As it is with a physical wound, the emotional wound of grief has to heal from within.  We can tend to the wound and provide a semblance of comfort, but the “work” of grief has be done by the individual in his/her own way in his/her own time.

Providing support and being therapeutically present during this painful time goes a long way in helping people move through their grief.  So as therapist, what can we do to be of most help during these painful times with our clients?

How to Help

Here are some things to keep in mind when working with clients that are struggling with grief issues:

  1. Provide support and empathy– When it comes to working with grief, being able to turn on the counseling basics is always a good place to start. Carl Rogers had it right when it comes to empathic listening and unconditional positive regard; especially around grief issues.  A lot of times all that a person really need is just a therapeutic presence and to know that the person on the listening end truly cares and is concerned.  They know, and you know, that there is no way for your to “fix it”.  You can’t bring the person back.  You also are not going to be able to take the pain away.  Grief and bereavement are just painful.
  2. Be aware of your own grief – When working with people that are grieving and they are telling their story, it is only natural and expected, for your own grief issues to bubble-up.  As therapists, we tend to be naturally attune to people’s emotions and pain.   If you tear-up or find yourself feeling some of your own grief, just go with it! I believe it was Dr. Earl Grollman, another author I would recommend, who said, “Grief shared = grief diminished”.
  3. Understand that grief is an attachment issue– The whole reason that we as human beings experience grief is because of our attachments.  We are “hard-wired” to attach. We need that attachment for our emotional survival.  When we lose a loved-one that attachment is severed and we feel abandoned and lost.  Not unlike a toddler lost from their parent, panic ensues.  Providing reassurance that they are going to be okay is helpful.  They are experiencing pain, but they are okay and not really alone.  The detaching hurts.
  4. Grief is a process– William Worden describes what he calls the “Four Tasks of Mourning.” These are: 1.) accepting the loss, 2.) experiencing the pain of grief, 3.) adjusting to the environment without the person and 4.) emotional relocation or reinvesting emotional energy into something or others besides the loss.  It is helpful to remind those that are mourning that it is a process and is painful.  It is also helpful to remind those that are grieving that the “tasks of mourning” have no recipe and to be patient with themselves and the process. Grief is something you get through not over.
  5. Allow and encourage people to “tell the story”– One of the first things I do in a session with someone that is coming to me for grief therapy is for them to simply tell me what happened. (In some cases, such as with extreme trauma, we have to work up to that). But telling the story of what happened is something I revisit several times during the course of therapy. My thoughts on that are that when people are traumatized or the detachment occurs, “the story” controls them.  By telling the story again and again, it begins to take on new a meaning for them.  They eventually reach the place emotionally that story no longer controls them, but they control the story. (A little narrative therapy there!)
  6. Encourage rituals and memorials– one of the clichés of the funeral business is, “funerals are for the living.”  This statement is very true.  We have the need to remember and create meaning out of the tragic.  Think of 9/11 and the need we had to create memorials and say people’s names.  It helps with the healing.

The thing to remember is that in order for people reach that fourth task of mourning, they need to have a sense of hope. One of the best ways I have heard grief described is like standing in the ocean with 100 foot waves crashing over you.  They are unpredictable and seemingly relentless.

But over time, the waves shrink in size and they come in more predictable patterns. Hope comes when a person realizes they are able to not only going to survive the waves, but they able to stand in the ocean and not always get knocked down.  As therapists, our job is simply stand in the ocean with them.  We can only point the way to calmer waters.  But clients have to swim there on their own.

Susan Gonsalves <![CDATA[Three Tips for Engaging Authentically With Teens]]> 2016-04-21T19:33:29Z 2016-04-23T10:33:07Z tips for engaging with teens as a therapistIf you work with teens, you probably already know that the quality of your relationship with them is an important and potent predictor of success across a range of settings. But for many of us, engaging with adolescents is not always instinctive.  Even if we have great instincts, challenging adolescent dynamics can derail the relationship when we are not deliberately focused on key relationship skills.

Data gathered through focus groups, surveys and interviews with hundreds of teens and helping adults tells us that teens want us to help them. Helping professionals who work with teens also shared that they seek additional guidance in how to effectively connect with the youth they serve.

The following present just a few ideas taken from what was gathered from the research my colleague Britt Rathbone, LCSW, and I conducted prior to writing our book for helping professionals who work for teens.

These tips will provide you with a few useful guidelines for authentic engagement, and help you leverage the relationship into an effective vehicle for modeling healthy behavior and reaching goals effectively with the youth you serve.

Reaching Goals

  1. Be authentic about your boundaries.

Gaging boundaries can be tricky.  They can be idiosyncratic, shift based on the situation and relationship role and be unclear even to seasoned professionals. So it’s no surprise that for those of us who work with teenagers, situations that challenge our personal boundaries are quite common.

In order to be authentic in our interactions with others, we must first take an honest look at ourselves. One way to do this is to closely examine any areas in which we are blindly accepting ideas about what we should or should not say or do.

Boundaries must come from a genuine place and be relevant to the work and goals we are striving toward with that adolescent, not for any self-serving purpose. Of course, there are codes of conduct and ethical considerations to take into account.

The trick is in doing and saying what feels “right” in the situation and feels effective toward reaching stated goals while expressing what is consistent with your own thoughts, values, perspectives and limits.  These considerations will allow for the expression of authenticity.

Teens might challenge our limits by asking personal questions. While we want to encourage their authentic engagement, we need to balance offering too much information with maintaining our ability to set effective limits.

When we feel that answering a personal question is not in the interest of our work, we can maintain engagement by inquiring about the teens’ intent that prompted the question or validate their interest without offering details with which we may not feel comfortable.

The consequences of not setting boundaries when necessary can lead to resentment and anger in our work with teens. Take the time you need to think through and clarify your boundaries and then state them clearly and directly. Remember that you’re not only establishing boundaries for this relationship, you’re modeling the life skill of setting boundaries, and setting a healthy example of how they can do so in their own lives.

  1. Normalize imperfection.

Making mistakes is a normal part of growing up, and in fact, it is a normal part of being human. The less we fear failure, the more willing we are to try new things and the more likely we are to succeed in the areas of our lives that matter most to us.

For teens, who are under the influences of constant pressure to fit in and heightened self-consciousness, it’s so important to have models who deal with fallibility in a sensible and straightforward manner. Add to the equation that young people are particularly adept at seeing your flaws and it becomes clear that the only sensible choice is to own your own imperfection.

When you mess up, misstep, or misspeak, own it. In the unlikely event that teens don’t immediately call attention to your mistake, you can still take advantage of the moment to teach them what it looks like to take responsibility, hold yourself accountable, and communicate honestly.

Trying to save face or skim over a mistake you’ve made is to risk your credibility if and when the truth emerges.

  1. Allow a safe space for disagreements, and model how they should be done.

Disagreement is not something that most of us look forward to and it is a basic part of life. We live in a society that functions on the shared unspoken agreement that we agree to disagree with one another about important topics and we can still come together as a people to stand strong and united.

And yet, between both news networks and social media, our political climate has increasingly allowed space for hostility and bullying between those with differing viewpoints. It’s no wonder that teens are confused about how to respectfully disagree, or hold an opposing view while still accepting another as a fellow human being.

As an adult who works with teens, you have the potential to influence the way the next generation disagrees. Model recognition of opposing viewpoints and verbalize acceptance that both views have validity. Encourage teens to look at all sides of an issue whenever possible, even with individuals or situations in which it may be particularly difficult to muster an ounce of empathy.

And when disagreements come up within your own interactions, respond authentically. This means respectfully sharing the truth about your point of view while also allowing space to acknowledge theirs, or gracefully bow out of the discussion by explaining that it’s a touchy subject for you. There is always a way to turn a disagreement into a learning experience.

Julie Baron is a licensed clinical social worker in private practice in Rockville, MD specializing in treating adolescents and their families. She is the co-author of What Works with Teens: A Professional’s Guide to Engaging Authentically with Adolescents to Achieve Lasting Change.

Teen in therapy photo available from Shutterstock

Sharie Stines, Psy.D <![CDATA[Do Fathers Matter?]]> http://7.234 2016-04-24T05:14:21Z 2016-04-22T20:04:00Z fatherandchildAs I was conducting my research to discuss a topic close to my heart – fatherhood – I came across a scholarly article written to deconstruct the necessity of a father in a person’s life.  The premise of the article was to describe how “neoconservative social scientists claim that fathers are essential to positive child development.”

For one thing, I resent that those who believe that fathers matter are labeled with the pejorative, “neoconservative.”  Sounds like a disease.  And for another thing, fathers do matter, and no amount of research is necessary to figure that out.  Sometimes people in academia are the most ridiculous people on earth, developing what they believe are lofty theories, using fancy words and scientific jargon to prove a ludicrous point.

What does a father provide for a child?  And what are the effects on a child who is fatherless?

First of all, let me state the obvious: Women cannot be fathers.  This is not to say that women are not just as valuable in a child’s life, it’s just to say that women are not fathers in a child’s life.

With regards to father loss, the statistics are unmistakable.  Fatherless adolescents are 2 times as likely to drop out of school, 2.5 times as likely to become teenage mothers, and 1.4 times as likely to be unemployed. Children who live in homes without their father are more likely to be incarcerated and/or juvenile delinquents, engage in teenage sexual behavior, suffer with an affective disorder, run away from home, and struggle with self-esteem issues.

I grew up in a fatherless home, and no amount of research needs to tell me how damaging that can be.  Without a father, I felt “less than,” unloved, unwanted, rejected, poor, and lost.  The presence of a father in a child’s life makes all the difference. A father’s strength, his provision, his confidence – all speak into a child’s heart.  Even with the most awesome and well put together mother, a child still misses the masculine parent, even if they never experienced one in the first place.  A child’s first memories are visceral, not cognitive. A child needs to feel the strong arms of a father, holding him as a baby, holding his hand as he crosses the street, steadying his balance as he learns to ride a bike…No research study can take away the intrinsic need for both a mother and a father.

As I work with male clients in my counseling practice, I watch as men who are overcoming drug addictions and trauma – even if they are not in continual contact with their children – send their families two-thirds of their incomes; they do this because they somehow believe it is their duty. They long to provide for their children. It is inspiring to watch these men, who on many accounts are selfish and self-indulgent, make a tangible effort to support their children financially, even if in no other way.

Another concept I’ve observed as a counselor, is how unmistakably loyal adults are to the fathers who abused and/or abandoned them.  I recall one woman who was bound and determined to reconnect with and forgive the father who had raped her when she was 5 years old; or the 28 year old man whose father left him when he was 7 years old and would do anything to reconnect with him, no questions asked.  I spent time with a client just yesterday who recalled how his father beat both he and his mother during his entire childhood, yet he states that his father is his “idol.”  Amazing.

Not only are fathers providers and protectors of their children, they also contribute to a child’s development of social competence, likability, dependability, positive sense of self, internal locus of control, motivation to achieve, and self-confidence.

Do you ever notice how so many children these days are being labeled ADHD and are acting out in school, being disobedient in general, unable to sit still and concentrate on anything other than video games; they get in fights, disobey teachers, etc.?  Did you know that 39% of children grow up in homes without fathers?  I do not think it is mere coincidence that 85% of youth in jail are fatherless, either.  Children need the strong, secure, presence of an attuned father to help them feel okay and content.  Without that important figure in their lives, they begin life with a deficit at best.

So as not to end on a negative note, I do not want the take away message to be that a person is hopeless if they have a bad relationship or no relationship with their father. I believe that life throws us our trials and that no one escapes unscathed.  I believe that we can live productive and satisfying lives no matter what our earliest experiences entailed.  I believe that fatherless people can grow up to be confident and strong and content.  I just think we have to embrace our wounds and heal. If we embrace our father wounds and grieve our unmet needs, we can process through our losses and get to a place of surrender and acceptance – a very healthy place to be indeed.


Fathers for Good. (2016). Why Fathers Count. Retrieved from:

Kruk, E. (2013). Father Absence, Father Deficit, Father Hunger. Psychology Today. Retrieved from:

Perrin, P. B., Baker, J. O., Romelus, A. M., Jones, K. D., Heesacker, M. U., (2009). Development, validation, and confirmatory factor analysis of the Father Hunger Scale. Psychology of Men & Masculinity, 10(4), Oct, 2009. pp. 314-327.

Silverstein, L. B., Yeshiva U. F., Auerbach, C.F., (1999) Deconstructing the essential father. American Psychologist, 54(6), Jun, 1999. pp. 397-407.

Strong Fathers. (2013). The Impact of Strong Fathers on his Child’s Education. Retrieved from:

Susan Gonsalves <![CDATA[Failure to Launch: What Happens Next?]]> 2016-04-21T19:32:55Z 2016-04-22T10:32:35Z failure to launch“A professional bull rider.”

Admittedly, the 20-something male sitting across the desk from me along with his father surprised me with his answer to my question of, “What do you want to do profession-wise?”  His name was Jonathan* but he’d introduced himself as “Rebel,” the moniker he used in online chat rooms talking to women and the name which his father used to refer to him, with something akin to pride, telling me, “Oh, he’s a hit with the ladies on the chat rooms.”

“Oh?  You have experience as a bull rider?”  Hey, I live in the South.  It could happen.

“No.  But, I beat the HELL outta the last level in PBR: Ragin’ Bulls.”  His tone was matter-of-fact, a little proud in fact.

I’m afraid my face reflected more than a clinically trained psychotherapist’s ought to.  This client, one of my caseload of roughly 80 at the mental health center where I worked, represented with what I’d come to think of as “Failure to Launch” (FTL) after the fairly recent movie.

These teenage and 20-something males were coming through my office on a regular basis with major delusions of grandeur brought on by mental images of themselves as the handsome, brave, muscular, impeccably trained, militarily accomplished hero, when they weren’t expert race car drivers, zombie killers or car thieves.

These males were in many cases barely high school graduates, though often not, with no appreciable skills or realistic goals for work, relationships or lifestyle, and just as often drug addicts.  Frequently, as their parents had no idea how to guide them, they showed up in my office thinking these maladaptive behaviors must be a mental illness.

I blame the internet.

The Generation Gap

I suppose it’s normal for one generation to criticize the next, to shake one’s head, wonder what changed in the space of roughly 20 years.  I suppose it’s also normal to tell one’s self that I’m not going to be the stereotypical curmudgeon who begins every other sentence with, “Back in MY day…”  However, I’m forced to wonder if there has ever, in the history of our society, been a larger generation gap than the one we’re seeing now.

When my generation was in school, we lived in the real world.  The internet was only just a gleam in Al Gore’s eye, and Windows was coming online, but computers were still only operable with the use of cumbersome DOS commands.

There were no virtual worlds to inhabit, no epic apocalyptic battles to win, no YouTube to inflate one’s ego with self-aggrandizing videos, no chat rooms in which to represent one’s self in suspect- if- not- downright- false light.

And nowhere near the number of FLT’s crashing in a wave onto our workforce, this client a case in point.

“Unfortunately, you probably know that professional bull riders usually start out young and live in parts of the country where they have access to competitions and sponsor opportunities.  What other jobs have you considered?”

By this time, two things were occurring:  First, I was starting to get a headache.  Second, I was beginning to wonder why this client’s father was sitting idly by and allowing this 25-year-old FLT to live in his home and spend his time in chat rooms (not to mention, how any of this was consistent with the nickname, “Rebel”).

Christine Hammond, MS, LMHC <![CDATA[Top Ten Wrong Assumptions about Personality Disorders]]> http://5.649 2016-04-21T13:32:14Z 2016-04-21T13:32:14Z Personality DisordersAfter working with many persons diagnosed with a personality disorder and their family members, there are several mistaken assumptions that seem to be commonly held. Here are ten of these errors:

  1. Personality Traits = Personality Disorder. A person can have the traits of a personality disorder without being fully diagnosed. For instance, they may demonstrate narcissistic behavior at work but not at home. In order to be a personality disorder, the symptoms must be pervasive in multiple environments.
  2. Personality Disorder = Abusive Behavior. Not all persons with a diagnosed personality disorder demonstrate abusive behavior. Nor does all abusive behavior mean a person has a personality disorder. A person can have a personality disorder and not treat others in an abusive manner. Likewise a person with a personality disorder may be abusive towards others. Abuse is not a natural outcome of a personality disorder.
  3. Personality Disorder Looks the Same on Everyone. The reason for the classification of different personality disorders is that there are noticeable similarities. But this does not mean that everyone will look exactly the same. A person with a diagnosed disorder of Borderline Personality Disorder may not look the exact same as another person. They might share similar characteristics but their life experience, emotions, reactions, work history, and relationship history might look very different.
  4. Personality Disorder = Work Dysfunction. While some individuals may struggle at work, there are many persons with a diagnosed personality disorder who function quite well in a work environment. Some professions are even better suited to a particular type of personality disorder. For instance, a person with Paranoid Personality Disorder can make an excellent detective, investigator or intelligence officer.
  5. Personality Disorder Explains Everything. To the contrary, a personality disorder is frequently the beginning of understanding not the end of it. Personality disorders can be co-mingled with a variety of other disorders including another personality disorder. The personality disorder just helps to frame the other disorders such as depression, anxiety, addiction, or conduct disorders.
  6. Personality Disorders Display All the Characteristics. There is a reason the DSM-V states that a person needs four or more of the eight possible characteristics of Obsessive-Compulsive Personality Disorder. Not all persons with the same diagnosis display all of the traits. Discounting the diagnosis because a few traits are missing does an injustice to the diagnosis.
  7. Culture Has No Bearing On Personality Disorders. A person’s cultural background must be taken into account prior to diagnosing a personality disorder. For instance, some cultures encourage emotional detachment while others encourage strong emotional attachment. Taken out of context, a person might appear to have a personality disorder when in actuality they are following the norm of their cultural background.
  8. Personality Disorders Should Be Avoided. Many people with a personality disorder make excellent friends, spouses, parents or co-workers. Some do not. The judgement call to engage or maintain a relationship with a person who has a personality disorder should be based on their individual merits not on the disorder as a whole.
  9. Personality Disorders Are Gender Specific. They are not. There might be more recorded cases of Histrionic Personality Disorder in females over males but this does not mean that it cannot occur in males. There are even slight differences in how a personality disorder manifests in each gender. The diagnosis does not take into account a gender before making the determination of one personality disorder over another.
  10. Personality Disorders Are Untreatable. As always in counseling, a person gets out of it what they put in it. Anyone can change if they make the choice but only the individual can choose. Begging, pleading, manipulating, or intimidating is not good methods for inspiring healthy change. Even a person with an Anti-Social Personality Disorder can change to conform to society norms but they must want to do it for themselves.

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

Bret Moore, Psy.D. <![CDATA[Anxiety and a Poorly Maintained System]]> 2016-04-20T11:38:48Z 2016-04-21T11:38:32Z anxiety and a poorly maintained systemIf your clients are like most people, they pay more attention to the maintenance of their car than their bodies.

This situation is unfortunate because the human body is a more sensitive and complicated system than anything on the road today.  Without proper upkeep, you can surely expect premature wear and tear, unusual sounds and sluggishness going up hills (yes, I’m talking about the body).

Your clients can also expect a host of psychiatric concerns over time, specifically anxiety.

The Spread of Anxiety

Anxiety takes hold and spreads in a poorly maintained and unbalanced system.  And when it comes to system neglect, there are a number of culprits.

The biggest ones are lack of sleep, excessive use of caffeine and lack of exercise.  If left unchecked for too long, these “big three” can lead to increased emotional and physical strain.  In turn, this increases worry, stress, feelings of being overwhelmed, fear, panic and numerous other anxiety related symptoms and problems.

Overall satisfaction with life drops, health problems start to occur and in some cases, depression sets in.  And in very severe cases, your client’s level of functioning will drop to the point where he or she can’t go to work, schoo, or even out to buy groceries.

Restoring Balance

Reversing the effects of prolonged wear and tear on the body takes effort, a willingness to manage some mild discomfort and persistence.

This will require your clients to make some relatively minor adjustments to their daily schedule.  Most of the people I’ve worked with in the past who needed help restoring balance to their system needed a “push” in the right direction.

For some it can be overwhelming regarding how and where to start.  And be realistic, humans are creatures of habit and resistant to change. That is why it is important to set your client’s up for success and be supportive throughout their journey.

Below are some key tips you can pass on to your clients in order to help them reset their “check engine light” and kick anxiety to the curb.


One of the worst things your clients can do is go to bed with stress.  Unless they leave the day’s stress in the day where it belongs, their body and mind will keep them from resting fully. 

One simple technique they can do is write down their thoughts and feelings about what’s been bothering them prior to bedtime.  In Barry Krakow’s book, “Sound Sleep, Sound Mind: 7 Keys to Sleeping through the Night,” he describes how this simple activity can clear the way for restful and restorative sleep.

Alternatively, talking with a friend or loved one about the day’s stress can be effective.  However, you will need to remind your client that it should not be with someone with whom they tend to argue. The last thing you want to happen is create new stress before bed.


Moderation is key when it comes to caffeine use.  In moderate doses, caffeine is considered safe and causes no noticeable problems in the average person.  So, what is considered moderate?  Moderate is somewhere in the neighborhood of 200 to 400mg per day. This amount equates to around two to four cups of coffee.

However, in people prone to anxiety, even small amounts can induce worry and outright panic.  If your client tends to be overly anxious or sensitive to caffeine, instruct them to be careful when getting their morning or afternoon fix.

And related to the discussion above, it can mess up their sleep.  If your client is ready to quit or cut down you can tell them about the 50% rule.  In essence, they can reduce their caffeine intake by half each week until they are able to stop completely.  Slowly weaning themselves off the morning eye opener helps them avoid withdrawal effects, which can be severe for some.


Exercise can be as effective at relieving anxiety as medication and talk therapy.  If done regularly and in moderation (too much exercise can weaken the immune system and cause injury), anxiety doesn’t have a fighting chance.

This step is easy enough for some as they may already have an exercise plan or routine in place.  For others, however, it requires blocking out some time four to five days per week and sticking to a routine.

Health experts report that approximately 150 minutes of moderate exercise per week can provide both emotional and physical health benefits.

For many of your clients, controlling anxiety will not be that difficult.  It requires some basic changes to their daily routine.  Encourage them to start small and go after specific and concrete goals. The big three is a great place to start.  With some sustained effort and perseverance they will certainly get the most out of their warranty.

*This article is based in part on a chapter in Dr. Moore’s book titled, “Taking Control of Anxiety: Small Steps for Getting the Best of Worry, Stress, and Fear.”

Late night TV photo available from Shutterstock