Psych Central Professional For mental health, psychiatric and psychological professionals. 2016-07-26T14:31:48Z Christine Hammond, MS, LMHC <![CDATA[How to Set Adult Boundaries with Narcissistic Parents]]> http://5.806 2016-07-26T14:31:48Z 2016-07-26T14:31:48Z adult yellingWhen adults realize they were the product of a narcissistic parent, it can shock them into a state of grief. Instantly, they go from idealizing the narcissist to grieving their lost childhood and the God-like image of their parent. Suddenly, the parent is transformed from larger than life to a deeply insecure human being. With the rose colored glasses off, the adult struggles to rewrite their history without a narcissistic perception.

It is not an easy process. It requires time to recall events and alter them to a newly discovered reality. It entails massive energy to reprogram the negative words and competitive actions of the narcissist. It necessitates motivation to complete the process until a new level of healthy is achieved. But now that this process is finished, what new boundaries can keep the adult from falling back into old habits?

  1. Think before speaking. Before visiting or speaking to a narcissistic parent, the adult should remember the parent is a narcissist. It might be helpful to review some of their glaring characteristics so expectations can be more appropriately set. Once a person knows a lion is a lion, they should not expect a lamb. Thinking about the conversation before it begins allows the adult to plan accordingly. Boundary = I’m going to set reasonable expectations.
  2. Remember, it is all about them. It helps to have an expectation that the conversation will turn towards the narcissist. While the initial question may be about the adult, it very quickly switches to the narcissist. Adults should expect this and keep answers short and sweet to avoid giving away too much information. The narcissist will only use the additional data against the adult at a later date. Boundary = I’m not going to give away information.
  3. Refuse to be interrogated. A typical tactic of narcissists is to overwhelm others into a state of heightened anxiety so they are less able to think straight. Adults fall into this trap easily as the narcissistic parent groomed them through intense interrogation as a child. This is about power and control for the narcissist. As soon as the narcissist begins, the adult should slow down their breathing. Then answer the question they wish the narcissist asked instead of the one that was asked and immediately follow it with a compliment. This disarms and distracts most narcissists. Boundary = I’m going to be treated like a peer.
  4. Reject verbal assaults. Another typical narcissistic tactic is to verbally assault anyone they believe is a threat. The adult might find themselves a target for an aggressive (“You are lazy”), passive-aggressive (“Your sibling is so successful”), or guilt ridden (“I invested so much in you”) comment. This is about comparison maintains the narcissist’s superior status. If the adult becomes defensive, the narcissist has won. Rather, the adult should ignore the comment or say “that’s not appropriate” and again offer a distracting compliment. This prevents the adult from acting like the narcissist. Boundary = I’m not going to act like a narcissist.
  5. Be free of victimization. When all else fails, the narcissistic parent becomes the victim as a way of guilt tripping the adult into submission. Their “wow is me” routine is customized to match the weakness and vulnerability of each adult child. It is generally effective or the narcissist would stop this behavior. It helps if the adult child views this sequence like that of a two-year-old temper tantrum. The more positive or negative attention that the two-year-old receives, the more the performance is repeated. The key here for the adult is to ignore the narcissist’s conduct entirely. Just like a two-year-old, it will take several attempts before the new reality sets in and is not repeated. Boundary = I’m not going to cave to manipulation.

After a period of time, these new boundaries will become habits for the adult and the impact of the narcissist will be greatly diminished. The best part is that even though the relationship seems shallow, it functions at a much safer and healthier level.

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

Jessica Dore <![CDATA[The Beginner Teacher’s Guide to Teaching Mindfulness in Clinical Practice]]> 2016-07-26T14:17:13Z 2016-07-26T14:17:13Z Man Hand Writing Mindfulness With Black Marker On Visual ScreenMindfulness-based interventions have become extremely popular in large part because of the growing body of evidence of their success in alleviating suffering across a range of human problems and populations.

Formal mindfulness practice is no longer limited to Buddhist monasteries and retreat centers; it’s now being taught in hospitals, youth centers and community clinics.

But whether you’re a seasoned mindfulness practitioner or have recently begun a formal practice, teaching mindfulness in your clinical practice can be daunting. In their book, A Clinician’s Guide to Teaching Mindfulness .

Christiane Wolf, MD, Ph.D, and Greg Serpa, Ph.D—a physician-turned-mindfulness teacher and clinical psychologist, respectively—present tips for getting started. The following have been adapted from their book.


  1. Stick to teaching what you know.

Even if you only have a few months of personal mindfulness practice under your belt, it’s still entirely possible to teach beginning mindfulness to your clients. But be mindful—no pun intended—of going too deep into exercises that reach far beyond what you have personal experience with.

“The closer you stay to what you know through your direct experience, the better,” write Wolf and Serpa.

  1. Practice what you preach. Literally.

Teaching is a great way to support your own mindfulness practice. By instructing others in mindfulness meditation you’ll likely refine your own understanding and learn new ways to approach practice through the feedback you get from students. But teaching also comes with a level of responsibility.

Don’t be in a hurry to encourage students or clients to do anything that you yourself wouldn’t want to do. Be accountable for the practices you teach and practice them on your own first before bringing them in to the space for others to try.

If you tell students to practice for a short time each day, make every effort to do the same. Not only will this accountability deepen your practice, it will help you better empathize and understand the potential challenges and setbacks that your students face which will make you better able to help them.

  1. Remember that you are a model of the practice for your students or clients.

Part of teaching mindfulness to your clients will involve modeling the practice. In fact, a study conducted in the early 1990s showed that when mindfulness-based cognitive therapy (MBCT) students were taught mindfulness exercises by teachers who did not participate in the exercises themselves, the results were disappointing.

“The teacher is an important model, demonstrating to the student how to gently be with everything, including difficulties, just as it is,” write Serpa and Wolfe. “Our own sustained, continuous effort and practice of mindfulness is a nonnegotiable prerequisite of our being ‘good enough’ mindfulness facilitators.”

  1. Take cues from the teachers who have inspired you.

To a certain extent, it is true that the practice itself is the teacher. What we learn through mindfulness meditation is only accessible through the experience of practice. And yet, teachers play a crucial role in that they are the facilitators and transmitters of the methods that we use to heal ourselves and others. Without the skills and wisdom of the teachers who’ve come before us, many of us would not have been exposed to mindfulness practice in the first place.

“Model yourself after a mindfulness teacher who inspired you or is still doing so. Ask yourself what it is about him or her that inspires. Is it her intimate knowledge of the teachings? His enthusiasm and kindness? Her deep trust in the transformational power of the practice? His way of walking the talk?” write Serpa and Wolfe.

  1. Invest in your own practice by finding a good teacher, joining a facilitator group, and attending retreats.

Having your own teacher is another good way to hold yourself accountable and to keep your practice evolving. Your own teacher can also be a great resource for questions related to teaching and instructing others in mindfulness practice. If there aren’t any teachers in your immediate area, you may be possible to find someone who presents mindfulness seminars online or who hosts a retreat once a year in a location that’s doable for you.

There are also groups of mindfulness facilitators that can provide an excellent source of peer support and consultation around things you may be stuck on either in your teaching or your personal practice.

For more about teaching mindfulness meditation in clinical settings, check out this website   

Susan Gonsalves <![CDATA[Behavioral Health Integration: A Great Way to Save Lives]]> 2016-07-24T20:40:49Z 2016-07-24T20:40:49Z behavioral health integrationWhile the mind-body connection is frequently talked about in therapy circles, the ‘body’ part of the connection is sometimes left out. Most behavioral health professionals know that they should encourage a client to visit a primary care doctor if they suspect there is a physical health condition, but the problem is that many behavioral health professionals do not have a lot of training in health care.

A behavioral health professional may argue that it is not their responsibility to understand different medical problems, and that they have little interest in working on issues that they see as medical in nature.

They may choose to stick with the traditional issues found in mental health.  After all, this is why we have physicians and nurses to address those things, right? Well yes, but the answer should be no and there are many reasons why.

For example, it has long been thought that half of all smokers die from tobacco-related diseases, but newer research shows that it may be more than 60%.

And since only 22% of smokers have never had a diagnosable mental health disorder, this issue fits well within our patient population.

On average, people with serious mental illness will live an astonishing 25 years less than the general population and tobacco use is one of the major reasons why. While we rightfully worry about issues such as depression, anxiety, psychosis and addiction to alcohol and drugs, many of our clients are actually dying from something else.

According to the National Institute on Drug Abuse, the majority of alcoholics will die from tobacco-related illnesses and not alcohol-related ones.

In addition to the fact that it is our clients who are doing the majority of the tobacco use, the other main reason why behavioral health professionals need to get on-board in addressing health behaviors is because we are the experts in behavior change, not the majority of the medical profession.

When a primary care provider tells their patient that they are pre-diabetic and weight loss may help them, the provider usually does not personally coach the patient on how they should lose that weight. They may tell the patient to go to a gym, take a walk or take the stairs, but behavioral health providers know that changing behavior usually requires a specific plan that also includes reinforcement.

It may require identifying triggers and stepped goals. We have the ability to help our clients make changes that may truly save their lives.

I do not want my clients to work their way through the dark days of depression and anxiety, only to die 25 years before their time from a preventable disease.

We usually ask medical questions on our intake forms; certainly it would not hurt to take a few minutes to determine if there is some aspect of the client’s health with which we can assist. The client may be very happy and surprised that you asked because they may be unaware that you can help.

The main chronic diseases that cause the most death and disability in our country have all been linked to co morbid mental health conditions and together these issues lead to higher mortality rates.

Cardiovascular disease, diabetes, stroke, COPD and cancer have all have been correlated to mental health disorders such as depression or anxiety.

People with epilepsy have a serious increased risk of suicide compared to the general population. Ask yourself, when looking through your intake form, would the patient’s disclosure that they have epilepsy alert you to be aware of the suicide risk? It is safe to say that many behavioral health professionals would not be aware.

When I say “behavioral health,” I not only mean mental health or substance abuse, but also general medical conditions that are influenced by a client’s health behaviors or can impact the patient’s mental health. So, in my opinion, diabetes is a behavioral health issue because in some cases, a person’s health behaviors leads to the development of the disease.

We should use our expertise in helping clients change behaviors to address these chronic health conditions.

I would recommend skipping yet another training on motivational interviewing and finding some basic training on common medical conditions, especially those that are linked to health behaviors. The SAMSHA-HRSA Center for Integrated Health Solutions is a great place to start your search.

Be advised that your conversations with your clients will look differently after you begin incorporating these discussions in your practice. You will not just skim over the medical questionnaire anymore. Your clients may appreciate that you care about their entire self, which could lead to deeper conversations.

Nobody is asking you to practice medicine, only to use your already developed behavioral change skills for a broader purpose.

The good news is that all of that motivational interviewing training can be put to very good use when working with patients on the medical and mental health issues that greatly influence each other.

Robin J. Landwehr, DBH, LPCC, NCC is a Licensed Professional Clinical Counselor in North Dakota. She works full-time at a Federally Qualified Health Center as a Behavioral Health Integration Coordinator.

The Carlat Psychiaty Report <![CDATA[Diagnostic Comorbidity in DSM-5: Origins, Current Status, and Potential Solutions]]> 2016-07-21T01:51:21Z 2016-07-23T10:50:39Z diagnostic comorbidityThe epidemic of psychiatric comorbidity has been a problem since DSM-III appeared way back in 1980. Not much has been done to improve this area in the subsequent editions of the manual. Nonetheless, in this article we’ll explore psychiatric comorbidity in DSM-5: its origins, current status, and potential solutions for the next go-around.

Comorbidity is the concept that individuals can have more than one distinct disease. Shortly after epidemiologist Alvan Feinstein began exploring the concept of comorbidity in internal medicine in the 70s, the idea found fertile ground in psychiatry. Some authorities, however, think the jump from general medicine to psychiatry was a huge mistake. Scott Lilienfeld and collaborators stated that “the application of the term and concept of comorbidity to psychopathological syndromes is almost invariably misleading and arguably has led to more confusion than clarification” (Lilienfield SO et al, Clin Psychol Sci Pract 1994;1(1):71-83).


Prevalence data concerning mental illness and comorbidity come from the National Comorbidity Survey (NCS), a study that begin in 1990. Household surveys of representative samples of the US population have been conducted at intervals using structured clinical interviews and reported over the years.

The first wave of data demonstrated a 48% lifetime prevalence of mental illness with a roughly equal rate for both men and women (Kessler RC et al, Arch Gen Psychiatry 1994;51(1);8–19). The corresponding 12-month prevalence was about 30%. Major Depressive Disorder (MDD) was most common (17% lifetime prevalence), followed by social phobia (13%) and alcohol dependence (14%).

A second round of the study found that of patients with any mental disorder, 21% had just one diagnosis, 13% had two diagnoses and 14% had three or more diagnoses on a lifetime basis. The 12-month prevalence rates were in the same ballpark. A replication survey was conducted starting in 2001 and found similar numbers (Kessler RC et al, Arch Gen Psychiatry 2005;62(6):593–602; Kessler RC et al, Arch Gen Psychiatry 2005;62(6):617–627).

These data likely underestimated the true prevalence of mental illness. People who were homeless and institutionalized were excluded from the study, and primary psychotic disorders and most personality disorders were not assessed.

Causes of the Controversy

A moment of sober reflection raises a question: Our patients are ill, to be sure, but can they really be that ill? We know patients can have tremendous symptom burdens, which would lead one to say, “Yes.” But do they have multiple illnesses? Perhaps not.

Michael First, editor of DSM-IV, observed “in psychiatry, cases of true comorbidity are relatively rare since, for most disorders, we do not know enough about the underlying pathophysiology to be able to determine whether the disorders are truly clinically distinct” (First MB, Psychopathology 2005(4);38:206–210).

Other authors have offered various explanations for apparent comorbidity (Dell’Osso L and Pini S, Clin Pract Epidemiol Ment Health 2012;8:180–184). The primary causes are artifacts of DSM’s categorical structure involving hundreds of criteria sets. For example, patients with MDD often meet criteria for generalized anxiety disorder (GAD). When one parses symptoms, however, dysregulated sleep, fatigue, and cognitive problems are common to both criteria sets. Instead of two mental disorders, maybe we are really dealing with just one underlying illness with various manifestations.

Dimensional Solutions

Various DSM luminaries have pointed out that psychiatry wasn’t always so confused (Pincus HA et al, World Psychiatry 2004;3(1):18-23). Previously, clinicians were more parsimonious and employed a “one disease, one diagnosis” model to describe patient presentations. This lumping was achieved through the use of various “qualifying phrases” to capture all of the texture.

A dimensional approach to diagnosis, which is a sophisticated throwback to this earlier era, has been proposed as a possible solution to artifactual comorbidity (Goldberg D, Br J Psychiatry Suppl 1996;30:44). This involves looking carefully at the connections between various mental disorders that seem to be closely related, such as affective and anxious symptoms. Other dimensional solutions view symptoms on a continuum—for example, the degree or severity of anhedonia—rather than the current yes/no criteria involving clinical thresholds (eg, “most of the day, nearly every day”).

There is considerable empirical support for lumping mental disorders together. Robert Krueger, using NCS data, derived a three-factor model that organizes mental disorders into broad themes or patterns: internalizing problems and externalizing problems (Krueger RF, Arch Gen Psychiatry 1999;56(10):921-926). The former is further divided into two groups: anxious-misery and fear.

Using this approach, DSM categories cluster together. MDD, dysthymic disorder, and GAD become related forms of anxious-misery; panic disorder, agoraphobia, and various phobias represent fear; and addiction and antisocial personality disorder are lumped into externalizing problems.

DSM-5 strongly considered some dimensional solutions. One involved mixed anxiety/depression (MAD), which is already recognized by the World Health Organization’s International Classification of Diseases and was buried at the back of DSM-IV-TR for further study. Ultimately, however, MAD was torpedoed and does not appear in DSM-5.

Another dimensional solution involved completely retooling personality disorders (PDs). Some of this was driven by studies that demonstrated that patients often meet criteria for multiple PDs (Torgersen S et al, Arch Gen Psychiatry 2001;58(6):590-596), which is a little hard to wrap your mind around using categorical constructs.

The model that DSM-5 floated involved two components: personality functioning and pathological personality traits (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA: American Psychiatric Association, 2013, p. 761-781). Personality functioning was further divided into an assessment of identity, self-direction, empathy and intimacy, all of which were rated on scales from 0 (little or no impairment) to 4 (extreme impairment). Patients with at least moderate impairment in personality functioning were diagnosed with a personality disorder if they also had pathological personality traits.

Like MAD, this proposal didn’t make the final cut. It has, however, been retained toward the back of DSM-5 as an “alternative model” that might be ready for prime time in the future.

CCPR’s VERDICT: DSM-5 does little to resolve our issues with diagnostic comorbidity. It remains narrowly categorical and took a pass on some attempts at dimensional constructs. But that doesn’t mean we should limit ourselves. Get creative and start adding some texture to your diagnoses (eg, generalized anxiety disorder, moderate, improved). This will better describe the nuances of each patient and improve communication with other clinicians. Plus, just because the DSM categories don’t fit our patients, doesn’t mean we have to use just those. Dust off the descriptors and dimensions. We don’t have to limit our formulations to insurance reimbursed diagnostic coding for anything other than the bill.

Susan Gonsalves <![CDATA[Is Self-Efficacy an Antidote to Burnout for Therapists?]]> 2016-07-21T01:48:00Z 2016-07-22T10:47:38Z is self-efficacy an antidote for burnout for therapists?Difficult Clients are Not the Cause of Burnout

Chronic job strain can make therapists want to ditch the couch forever. This strain can lead to burnout, a feeling of emotional exhaustion, cynicism and ineffectiveness, or what is commonly called burnout.

It is common wisdom that seeing difficult patients is at the heart of therapist burnout. Many studies have found that challenging clients do contribute to burnout but there is also a much more fundamental cause.. In a classic study on the causes of burnout, Barry Farber and Louis Heifetz interviewed 60 psychotherapists about their work experiences. The most commonly reported cause of burnout wasn’t money concerns or workload but a lack of effectiveness in the therapy room.

As they explain:

Professional satisfaction derives from the ability to promote a helpful therapeutic relationship; dissatisfaction stems primarily from a lack of therapeutic success; and burnout is primarily a consequence of the non-reciprocated attentiveness, giving, and responsibility demanded by the therapeutic relationship.”

In other words, the feeling that we aren’t creating a helping and healing relationship with our client is the main reason therapists felt burnt out.

Interestingly, the severity of mental health problems in clients wasn’t a major cause of burnout. That’s not so surprising if you think about it. Whether we are treating mild or severe mental health problems, what makes our work as therapists frustrating or fulfilling is our ability to help clients change.

In fact, I feel at my best when I can throw a rope to clients in crisis by convincing them to stop self-destructive patterns, escape abusive environments or confront long-avoided traumas.

We need these challenging clients to put our relational and conceptual skills to the test. Through this work, we discover passion for our work and we become more effective with all our clients.

Self-Efficacy and Burnout

Therapists are not alone when it comes to the impact of feeling ineffective. Many studies find that self-efficacy, the feeling that one can exert control over challenges and bring out desire results, is a consistent predictor of burnout across numerous professions, including teaching, nurses, physicians, and various office jobs. A recent meta-analysis of 57 studies found that having lower levels of self-efficacy was related to higher levels of burnout.

To apply the latter findings to mental health workers, therapists who don’t feel that they can deal with clients’ challenges in session effectively or help their clients improve their depression, anxiety or other maladies are less likely to feel a sense of accomplishment, have negative attitudes about the meaning of their work, and feel emotionally exhausted, in other words – burnt out.

This suggests a solution that at first seems paradoxical but hear me out before you hit the back button on your browser.

If you are feeling burnt out, one strategy is to put an additional task on your plate – seek training (in interventions) as well as supervision) and engage in self-reflection to improve your practice and improve your skills.

This advice even applies if you’re chronically overloaded with work. For example, you may need to guidance in time management skills, getting over the guilt of ending sessions at 45 instead of 65 minutes, or assertiveness in turning away work that might rightly belongs to others.

Really, the solution isn’t much different than what we ask of clients. Think about it from this perspective: when depressed clients seeks our services, we ask them to do additional tasks to pull themselves out it such as finding enjoyable activities, learning assertiveness training, engaging in self-reflection and completing other homework assignments.

The remedy for our own problems isn’t different from that of our clients.

The Stages of Change Model

Addressing burnout may also require us to think about effectiveness from a more flexible perspective. As a supervisor of doctoral interns, I often address the issue of effectiveness with trainees. They feel ineffective because patients are not responding with enthusiasm to their interventions, following through on homewor, or attending session as regularly as they want.

Many expect a level of compliance that is typical of highly motivated persons, those in the action stage of change.

However, many clients enter therapy in a contemplative state of mind, often torn between the desire to change and maintaining the status quo that has caused their problems.

Expecting quick and easy successes with these clients can actually lead to frustration, client dislike, or feelings of ineffectiveness.

But thinking about these patients from a stages of change model, we may begin to understand that some clients aren’t ready for action. Effective therapy for many clients involves raising awareness of the consequences of their problem, increasing personal responsibility or just helping them get over the stigma of being in therapy.

If we adopt this flexible approach to defining success, change is not just limited to reducing depression or anxiety scores on standardized measures but encompass the many ways we help our clients take essential steps that set the stage for later change.

Change is difficult and therapy is a tough venture for many. If it was easy to change, we’d never have become a profession in the first place.

To evaluate the challenges of doing PTSD therapy, Lisa Najavits, the creator of the trauma therapy seeking safety, reviewed studies of evidence-based PTSD therapies in actual clinical  (as opposed to research) settings. These therapies demand a high degree of commitment from clients, including hours of homework every week and a willingness to talk about the most upsetting parts of the trauma.

Najavits found that dropout from evidence-based therapies was often high (much higher than in the typical research study) and that many patients attended only a few sessions before calling it quits.

What Can Therapists Do About Burnout?

When it comes to burnout, feeling effective is and often overlooked buffer. But how can you feel more effective? Here are several suggestions:

  • Attend trainings. The more you help clients, the less you feel burnout. Regular training is one way to accomplish this goal. There are so many techniques now available to treat nearly every mental health problem conceivable. Training can expand your perceptiveness, teach you new techniques and get you thinking about your clients’ problems in new ways.
  • Get supervision. Getting consultation and advice from a more experienced colleague is, well, much like what happens in therapy. Getting outside feedback allows you to see patterns in your work that you are unaware of and to learn how they affect you. Outside feedback can also open your mind to new ways of working with clients. You probably have your favorite one of two techniques but supervision can open your eyes to other valid interventions.
  • Take a more complicated view of change. Give an honest and accurate assessment of what your clients have to overcome to start changing and appreciate all the steps that are necessary. Many patients are not in the action stage of change, that is, ready to start changing their problems now. For example, you may not be able to get someone to leave an abusive relationship, but if you get him or her to see how destructive it is and break down his or her denial, you have accomplished something quite significant.
  • Success is your clients’ goals not yours. Sometimes, we as therapists want to get the maximum results for our clients. We expect them to change in the most ideal way possible, especially symptom reduction or even disorder remission.

For example, in working with trauma survivors, we may expect them to confront their traumas. However, our clients may be struggling just to achieve something much simpler, like sharing a trauma for the first time. Of course we should encourage as much change as possible, but our clients may be thrilled with something as basic as just committing to come to therapy. Given that the modal number of therapy sessions is one, we should really try to attune to our clients’ goals from our first meeting.

Whether you’re a new therapist or a seasoned veteran, burnout is an ever-present concern.  You can combat burnout by appreciating all the subtle ways you help clients. Set realistic expectations of what you can accomplish with your clients. Additionally, adopt a continual model of learning and growth as a therapist. Don’t become complacent or think you’ve mastered it all.

The bottom line is that if you want a long and healthy career as a therapist, you not only have to see yourself as effective you have to be effective as well. If you do, not only will you appreciate it, but also your clients will too.


Christine Hammond, MS, LMHC <![CDATA[7 Steps in Healing From a Narcissistic Parent]]> http://5.800 2016-07-21T14:28:06Z 2016-07-21T14:28:06Z narcissistic parentHealing from a narcissistic parent has a positive effect on all of the other close relationships in a person’s life. The distorted perception of reality a narcissistic parent imposes on a child can have damaging consequences as an adult at work and home.  The lack of self-esteem, obsessive thinking, minimization of abuse, excessive anxiety, and fear based reactions are common among adult children of narcissists. By addressing the impact of narcissism, a person finds relief. Here are the seven steps towards healing:

  1. Recognize Narcissistic Behavior. The first step in the healing process is to admit that there is something wrong with a parent’s behavior. A person can’t recover from something they refuse to acknowledge. Most narcissistic parents pick a favorite child, the “golden child,” who is treated as if they walk on water. The other children are frequently treated as inferior through belittlement, comparing, ignoring and even neglect. Occasionally, the parent switches their favoritism depending on the performance of child. The key to remember is that narcissistic parents see child as an extension of themselves so they take credit for the successes and reject the child who fails.
  2. Study Narcissism. Once the narcissism is identified, it is important to gain an education about the disorder and how it affects the entire family system. Narcissism is part biology and part environment. So chances are there might be other narcissists or personality disorders in family. The environment can further draw out the narcissism in a child which is cemented by age eighteen. Become familiar with the signs and symptoms of narcissism and begin to pick out the other narcissists.
  3. Connect the Dots. This next step will be easy in the beginning but becomes more difficult as the impact of the narcissism is realized. For each individual sign and symptom of narcissism, recall several examples in childhood and adulthood when the behavior is evident. It helps to write these down for reference later. The more time that is spent doing the step, the greater the impact of the healing. Recollect both positive and negative events that resulted out of the narcissism.
  4. Identify the Abusive Behavior. During the previous step, it is highly likely that some abusive behavior on the part of the narcissistic parent became evident. Abuse for a child can be physical (restraint, aggression), mental (gaslighting, silent treatment), verbal (raging, interrogating), emotional (nitpicking, guilt tripping), financial (neglect, excessive gifting), spiritual (dichotomous thinking, legalism), and sexual (molestation, humiliation). Not every event requires trauma therapy but some of them might, depending on the frequency and severity.
  5. Release the Anger. Anger is a natural response after the dots have been connected and the abuse has been identified. It is hard to believe that a parent who should be loving and kind would do the things they have done. Whatever glorified image a person had of their narcissistic parent is now completely shattered. Sometimes the anger is projected on the other parent for not fully protecting their child from the trauma. Or the anger is internalized for not realizing or confronting sooner. It is important to release the anger in a healthy manner such as physical activity, crying or venting to a safe friend.
  6. Gain Perspective. This is a good place to step back for a while to gain a better perspective. Begin by reflecting on how the narcissistic parent’s distorted image of the world and people shaped current beliefs. Then drill downwards towards the vows or promises that were made internally as a result of the narcissism or abuse. Counteract the distorted images, vows, or promises with a newly gained perspective of reality. This essential step frees a person from the narcissistic lies and false truths.
  7. Move Forward. The past cannot be changed, only understood. When forgiveness is genuine, it has a powerful transformational effect. Remember, forgiveness is for the forgiver not the offender. It is better to honestly forgive in small chunks at a time, rather than granting blanket forgiveness. This allows room for other future or past offenses to be realized and worked through in a thorough manner.

After doing all of these steps, it will be far easier to identify other narcissists at work or in the community. No longer will their dysfunctional behavior generate instant anxiety or frustration. Rather, the narcissist will be disarmed because their behavior no longer has an intimidating effect.

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

Susan Gonsalves <![CDATA[Tips for Collaborating Effectively with Parents and Caregivers of Teens]]> 2016-07-21T01:47:16Z 2016-07-21T10:46:44Z collaborating effectively with parents of teensAs counselors, teachers and educators who work with teens, we know that our effectiveness often relies on parent and caregiver collaboration and buy-in. Nurturing relationships with the teens we serve while maintaining supportive relationships with their parents and the other adults in their lives is one of the most common challenges we face.

Even if the majority of parents you work with are cooperative, there will always be those who do not support your efforts with their teen, for one reason or another.

Here are some tips to help you build effective, collaborative relationships with parents and caregivers of teens.

  1. Remind yourself that parents and caregivers are doing the best they can.

It’s helpful to remember during moments of frustration that parents and caregivers really are doing the best they can given the set of circumstances they’re in. Teens each bring their own unique strengths and challenges to the adults in their lives who are responsible for caring for them—some have extreme or intense emotions, for example.

In most cases, raising children is not the only thing parents and caregivers have to manage; lives are complex and involve many, often competing obligations.

Whenever possible, give parents and caregivers the benefit of the doubt by consistently using empathy and forgiveness in responding to their frustrations. Validate and find truth in their perspective while offering yours. Remember that we share a common goal in improving the lives of the teens we have in common.

The same perspective-taking practices we use with teens can be tremendously helpful in addressing the dilemmas of parents.

  1. Help parents be consistent, and practice patience.

Parents aren’t always consistent in helping us help their teens. It can be really hard to help teens comply consistently with treatment plans, assignments or strategies when their parents and caregivers aren’t able  to provide the support required.

In your work with parents, remember the value of patience and understanding. Consider the tone you use when you speak with them, when speaking with colleagues about them and even in your own thoughts about them.

It’s understandable to feel frustrated when parents aren’t consistent, but try your best to patiently and respectfully repeat and remind parents to follow through on recommendations, treatment plans or appropriate oversight with their teens.

It also helps to consistently make a connection between follow-through and achieving goals. Parents may be invested in the end result, but may still have difficulty doing what it takes to play the supportive role their adolescent needs to make changes to achieve those results. Remember that parents also need our support to encourage their consistency.

  1. Accept reality.

While there is certainly much we can do to encourage and support parents’ efforts, there are times when we have to accept that the challenges parents face are too great for us to affect. The reality is that many families face insurmountable challenges that render them unable to be physically or emotionally available in ways that allow for creating consistent and predictable environments in their teens’ lives.

Whether we understand or agree with the barriers to consistency, there are times we have to accept that parent support and consistent response is not realistic.

In these situations, we may have to do a little extra to help the teens we serve get their needs and goals met. But beware of rescue fantasies; we would not be doing work with young people if we did not care and while there is much we can do, we cannot rescue.

We can also play a powerful role in helping teens be realistic in their own assessments of the supports and challenges in their lives and empower them to take charge of their success regardless of barriers.

For more about building cooperative relationships with parents and caregivers of the teens we serve, check out “What Works with Teens: A Professional’s Guide to Engaging Authentically with Adolescents to Achieve Lasting Change” here.

Wavebreak Media Ltd/Bistock

Christine Hammond, MS, LMHC <![CDATA[10 Signs You Are Married to Someone with a Personality Disorder]]> http://5.794 2016-07-20T12:09:34Z 2016-07-20T12:09:34Z Charm is DeceitfulIt is hard to remember a time when the marriage was tranquil. Rather, each year brings more drama, intensity, frustration, distance, and hostility. Efforts to improve the situation are temporary and shallow at best. There is something else happening other than poor communication skills. It might just be that one spouse has a personality disorder.

There are several types of personality disorders (PD): paranoid, schizoid, schizotypal, anti-social, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive. Each has their own flare of ego-centered behavior, inflexibility, distortion, and impulse control In multiple environments beginning in adolescence. Even though the PD existed during dating, it did not become apparent till married.

  1. Feel Crazy. The spouse feels like they are losing their mind. Often they can’t make sense or effectively communicate what is happening in the marriage. The PD has convinced the spouse that they are the problem with a laundry list of faults, failures, and fears. The spouse develops anxiety, appears distressed, is discouraged and even depressed.
  2. Jekyll, Mr. Hyde. There is the version of self that the PD has with friends and another one at home. While the disorder is pervasive (in every environment), it usually takes on a distinctive flare for different people. If the PD wants to impress someone, they are amazingly “on”. But once they become comfortable, the mask is removed and they are contrary.
  3. Walk on Eggshells. The spouse feels like they are walking on eggshells around the PD trying to avoid potential hot buttons. As a result the spouse becomes good at reading the PD to see what kind of night it is going to be. After a while, the spouse begins to enjoy when the PD is not at home because the atmosphere is lighter and less stressful.
  4. Resistant to Change. PDs will talk about change but what they really mean is that the spouse needs to change to accommodate them. However, the PD doesn’t want the spouse to get psychologically healthy, that might cause them to leave. Rather, the PD tries to mold the spouse into a more subordinate and subservient position so they have more influence to control.
  5. Couple’s Therapy Not Working. Traditional couple’s therapy or seminars have little lasting effect on the PD. Most PDs are very good at veering the attention towards their wants and desires while persecuting their spouse. Individual therapy for both which addresses the personality issues and incorporates new boundaries can be quite effective when both parties want to preserve the marriage.
  6. For the spouse, there is a continual feeling that they are being lied to by the PD. While it may not be very evident, there is a pattern of futile exaggerations, avoidance of sensitive subjects, and omission of key information. Interestingly, the PD often projects these behaviors onto the spouse in an effort to divert the negative attention away from them.
  7. Manipulative Behavior. The truth is constantly twisted by the PD’s distortion of reality. In order to get some compliance out of a spouse, the PD often resorts to some type of abusive and manipulative behavior. Typical ones include verbal assaults, isolating from friends and family, gaslighting, intimidation, sexual coercion, dichotomous thinking, and withholding of money.
  8. Refuses to Accept Responsibility. If spoken at all, the words, “I’m sorry,” are usually followed by a qualifier like “but you…” There is no real acceptance of responsibility or accountability. It is always the spouse’s fault at some level. Even when a third party points out an issue, that person becomes the latest target for the PD.
  9. Chaotic Environment. The amount of stress generated in the home is completely unnecessary. Yet, the PD seems to thrive in such environments. When there is little chaos, they tend to create something out of nothing just to complain about it. There is no lasting satisfaction. Temporary peace is achieved only when the PD gets their way.
  10. It’s all about them. It is about how they feel, what they think, and why they do what they do. The only time the conversation turns towards the spouse is to accuse or cast blame. Their emotions, thoughts, actions and perceptions are always right. This results in a superior attitude which makes true intimacy impossible.

This is not a marriage, it is an inequitable partnership. The PD may say they want a healthy marriage but their actions frequently create an unsafe environment for the spouse to be transparent. This can be resolved in a more balanced manner but it requires significant effort and commitment from both.

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

Rev Sheri Heller, LCSW <![CDATA[Reading Heals: The Power of Immersion]]> 2016-07-19T18:43:56Z 2016-07-20T10:43:21Z reading heals

Think your pain and your heartbreak are unprecedented in the history of the world, but then you read. It was books that taught me that the things that tormented me most were the very things that connected me with all the people who were alive or who had ever been alive.”

― James Baldwin

I am always simultaneously inspired and stunned by how books were an invaluable source of respite and salvation for a good deal of my psychotherapy clients who survived unspeakable traumas. Many have shared that by entering a fictional landscape replete with parallel narratives and plights, hope and direction was offered, and accordingly, abysmal adversity was more effectively endured.

In particular, trauma survivors early attunement to fairy tales, comic books and myths speaks of the metaphorical symbolism evident in the trials of heroes and heroines, who like the reader, were challenged to persevere and triumph over the harsh reality of brutal malevolence and inconceivable circumstance.

Through immersion in a fictional world, identification, catharsis and insight, (Russell and Shrodes) occurs, allowing the inspired reader to reframe her own situation, experience emotional release, clarity and possibly even behavioral shifts.

Healing Experience

Reading as a healing experience that can assist with resolving a multiplicity of struggles dates back to the middle ages. Samuel Crothers who coined the term bibliotherapy in 1916 imparted:

I don’t care whether a book is ancient or modern, whether it is English or German, whether it is in prose or verse, whether it is a history or a collection of essays, whether it is romantic or realistic. I only ask, “What is its therapeutic value?

As Crothers quote suggests, when applied in a therapeutic context, bibliotherapy comprised of fictional and/or non-fictional reading, can enhance the treatment process through psycho-educational, spiritual, and creative exploration.

Often when I recommend a book that resembles a client’s process or provides knowledge pertaining to a client’s condition, a deeper mobilization of analysis ensues. Frances Bacon’s quote “knowledge itself is power” is demonstrably evident when written word crystallizes into truth and recognition.

When the reader can give name to her struggles and afflictions, an enhanced sense of agency occurs.

The foremost authority on the psychological interpretation of fairy tales, Jung’s disciple analyst Marie-Louise von Franz has described fairy-tales as  “the purest and simplest expression of collective unconscious psychic processes.” Indeed, in fairy tales we discover our shadow side often depicted as monsters or as a witch, catalyzing in the maiden great power when she faces the darkness within.

We all live out our own personal myths and can relate to these archetypes on personal and transpersonal levels.

Shared Humanity

While one of the essential goals of clinical bibliotherapy is to enhance the client’s understanding of the issues being addressed in treatment, it is also a vehicle for affirming our interconnectedness. As we read about the fundamental nature of our very existence we remember the universality of our shared humanity.

Life-altering classic books about the human condition such as “Catcher in the Rye,” “Long Days Journey into Night,” “Hamlet,” “Death of a Salesman,” and “Frankenstein,” provide commentaries, which compassionately acknowledge the vicissitudes of life.

Powerful non-fiction books such as “Meeting the Madwoman,” “The Homecoming,” “Out of the Shadows,” “The Hero Within, Man’s Search for Meaning,” etc., poignantly explain the psychological ramifications of trauma and recovery.

Reading (and writing for that matter!) provides us with the solace of knowing our stories are shared through characters who champion our cause. Seeing the ailments and conditions one grapples with in elaborate descriptive detail and form, further reminds us what James Baldwin conveys in his beautiful quote, that even in our brokenness we are more alike, than we are different.


Jessica Dore <![CDATA[Targeting Shame + Stigma in Addiction Treatment]]> 2016-07-19T18:42:55Z 2016-07-19T18:42:55Z shame and stigma in addiction treatmentChronic shame and unworthiness are common among people who struggle with addiction and are often magnified by societal stigmas attached to being an addict. Shame can create barriers to a healthy, values-driven life and make it difficult for people to maintain sobriety.

In their chapter about shame and stigma in the edited volume “Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions,” Jason Luoma and Barbara Kohlenberg suggest that working with shame can be helpful during treatment for those struggling with addiction.

“Early data seem to indicate that facilitating clients in recovery in relating to their shame and negative self-judgment with compassion and mindful awareness and turning their attention toward values-based action may be helpful to them,” write Luoma and Kohlenberg.

Not only does research suggest that substance users are viewed as lacking willpower, worthless, incompetent, unreliable, and untrustworthy, to name a few, Luoma also found through his own research that substance users were discriminated against in the realms of interpersonal relationships, housing, and employment (Luoma, 2011).

To add insult to injury, people with addiction issues also tend to struggle with self-stigma, the internalized negative attitudes from those around them.

Luoma and Kohlenberg present a model based on acceptance and commitment therapy’s psychological flexibility model of human behavior that aims to “lighten the burden of shame and stigma on those in recovery.”

They outline three contexts that shape the way shame and self-stigma function for people with addiction. The following has been adapted from their chapter in “Mindfulness and Acceptance for Addictive Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions.”

Experiential Avoidance

The presence of shame, painful self-evaluation or fears about being stigmatized are not the root of the majority of the harm that comes from self-stigma. Actually, it is the attempts to avoid people, events and things that may bring on these experiences that come at the highest cost.

“A person in recovery might search for signs of being seen as immoral, resulting in interpersonal disruption. Or a person in recovery might give up parenting in part to avoid possibly confirming the stereotype of unreliability,” write Luoma and Kohlenberg

Of course, substance use itself may be a kind of experiential avoidance that is exacerbated by shame and negative self-evaluation.

But Luoma and Kohlenberg warn that clinicians should be cautious not to suppress shame; doing so can have adverse effects such as the continuation of substance use or deviant behaviors. Suppressing shame rather than working with it can mean violating personal values without feeling the shame that might otherwise deter such behaviors.

Conversely, a healthy expression of shame may help those struggling with substance use rebuild relationships and experience the benefits of social support.

“Rather than trying to avoid, suppress or otherwise change unwanted shame, self-devaluing thoughts or fears of enacted stigma, acceptance fosters the ability to compassionately notice difficult experiences, accept them as they are, and non-avoidantly shift attention toward values-based actions,” write Luoma and Kohlenberg.

Cognitive Fusion

When we fuse with the judgments and evaluations we create with our thoughts we aren’t able to clearly see that these thought processes are just that—processes—and not ultimate truths.

“Evaluations of self and others tend to be global and negative, undermining the ability to respond flexibly. When a person is fused with the thought I’m bad, that thought says little about what to do next,” write Luoma and Kohlenberg.

This is where the teachable process of cognitive defusion comes in. People can learn to notice their thoughts rather than immediately fuse with them as truths, which diminishes the thoughts’ ability to dictate over behavior.

When people who struggle with addiction are able to see their negative thoughts, evaluations and judgments as cognitive processes rather than ultimate truths, they are more able to engage in values-based actions.

Rigid Self-Processes

It’s natural for us as human beings to want coherence in the stories we create about who we are and why we do the things we do. But this need for coherence in self-concept can cause problems when those views are negative or maladaptive. Behaviors that go against the things that matter to us can reinforce negative ideas we have about who we are, which tends to lead to further deviant behavior.

“People are often motivated to hide the “damaged” self in order to avoid rejection, leading to withdrawal and secrecy about their problems with addiction. Unfortunately, secrecy in the context of substance misuse has been related to poor outcomes and lowered social support,” write Luoma and Kohlenberg.

In the psychological flexibility model, clinicians would help those with addiction learn to hold less tightly to their rigid self-concepts in order to encourage more flexible responses and values-based choices. Like cognitive defusion, this allows people to step back from their negative self-evaluations and thoughts and foster a broader repertoire of behaviors that may or may not be consistent with their cognitions and existing story lines about who they are.

“We hope that this work can lead to more compassionate and effective treatments for people with addiction problems, freeing them from imprisonment by shame and stigma,” write Luoma and Kohlenberg.

Sharie Stines, Psy.D <![CDATA[What to Expect When you Marry a Narcissist]]> http://7.461 2016-07-19T01:57:36Z 2016-07-19T01:57:36Z marriageIf you are planning to marry a narcissist, here is a list of things to expect in your relationship.  Realize that you will be marrying a person who is incapable of having a healthy, intimate, interpersonal relationship because narcissism is a characterological disorder. Your marriage will be the most important relationship in your life; be wise in who you select to commit to.  If you marry a narcissist you will be uniting with a person who does not have empathy.  Empathy is necessary for sensitivity to others’ feelings and compassion.  While you may not be physically hit or physically abused in this relationship, your heart will be broken 10,000 times.  Even if you think you are a “strong” person and can handle it; your strength is not really strength, but rather, denial.  The following list is not exhaustive, but it is informative:

  1. He will always define the terms.
  2. You will live by a set of double standards.
  3. You will not be listened to.
  4. He will never resolve a conflict.
  5. He will rarely consider your feelings; and will only do so if it serves him some how.
  6. He will never apologize.
  7. What will matter most to him is how he appears to others.
  8. He will ruin all of your birthdays and holidays (probably  because somehow he needs to make everything about him.)
  9. There will be little to no mutuality, collaboration or cooperation.
  10. Your expectations will be managed down to mere crumbs; to the point where you will be happy just because he isn’t giving you the silent treatment, yelling at you, or cheating on you.
  11. You will never win.
  12. Your value will be diminished to the point of nothingness in his eyes.  In fact, mere strangers will hold more weight in his eyes than you will.
  13. He will tend to make you his scapegoat.
  14. He will dump his shame and rage on to you.
  15. Simple conversations will become crazy-making endeavors.
  16. You will find yourself walking on eggshells.
  17. You will lose yourself because you will be trained to focus only on his feelings and reactions; never mind yours.
  18. You will experience the silent treatment.
  19. You will experience cognitive dissonance, confabulation, and gas lighting.
  20. You will find yourself telling a grown adult how to have normal interactions with others.
  21. Your relationship will revolve on a cycle:  waiting – hoping – hurting – being angry – forgiving – forgetting – again.
  22. He will blame you for all of the problems in the relationship.
  23. You will blame yourself.
  24. He will use your weaknesses against you.
  25. You will experience many dramatic exits, followed by a reappearance of the N acting as if nothing unusual had ever happened.
  26. He will act like Dr. Jekyll/Mr. Hyde.
  27. He will not do his fair share of household responsibilities.
  28. He will come and go as he pleases.
  29. When you try to hold him accountable he will fly into a rage.
  30. He will not answer questions directly.
  31. He will never ask you about your day and wish you to “have a good day.”  He will never show concern for things that you care about (unless it’s something he cares about.)
  32. You will feel stuck and unable to leave him.
  33. You will miss him and wait for him all the time.
  34. He will project his bad behaviors onto you and you will project your good intentions onto him – neither is accurate.
  35. When you finally break because of his crazy making behaviors and the insanity of the relationship, he will call you are a lunatic, others will think you are a lunatic, and you, yourself, will believe that you are just as bad as him (realize, there is no moral equivalence between expressing frustration and intentional abuse.)
  36. No one else will see it (except maybe the kids.) This will cause you to question your reality.
  37. The entire experience will result in trauma for you because it is interpersonal violence.
  38. You will begin to feel crazy; then, over time, you will begin to feel numb.
  39. If you go to couples counseling it will not work, and will most likely back fire on you.  (Please realize you do not have a marriage problem, your partner has a mental illness.)
  40. You will pay a big price should you ever tell your loved one, “No.”

I could go on and on and on, but 40 points are enough for now.  You get the picture.

I am using the pronoun, “He” when these problems could apply to either gender.  Remember, there is no “one size fits all” description of anyone, even a narcissist.  These behaviors are general and in degrees, depending on the unique personality of your loved one.  That being said, it really is amazing how similar these people are.  Even if your narcissist is a parent, the relationship dynamics tend to be the same as with a narcissistic spouse.

So, in conclusion, my advice to anyone thinking of marrying a narcissist can be found here.

I have a free monthly newsletter addressing the psychology of abuse; if you would like to be on my mailing list, please email me at:


Susan Gonsalves <![CDATA[How to Use Your Money Story to Improve Your Overall Well-being]]> 2016-07-18T20:17:15Z 2016-07-18T10:19:08Z use your money story to improve your well-beingDo you, or your clients find the whole topic of finances a bit overwhelming? Does putting away money for savings or reining in expenses feel rather difficult?

If yes, you are not alone. Nearly half of all Americans are having difficulties covering their monthly expenses, making it difficult for them to build up an emergency savings fund, retirement fund or any kind of financial security (Gabler, 2016).

Half (56%) have less than $10K in retirement savings and over half (63%) do not have $500 to cover an unexpected expense (Kirkham, 2016; Wong, 2016).

Major Stressor

Compounding matters, money and/or financial concerns are a major stressor in people’s lives that take a toll on both mental and overall health. Most commonly reported stress symptoms were: feeling irritable/angry (37%), being nervous/anxious (35%), having a lack of interest/motivation (34%), feeling fatigued (32%), feeling overwhelmed (32%) and being depressed/sad (32%).

Stress, in turn, has led to unhealthy behaviors such as lying awake at night (42%), or eating too much/eating unhealthy foods (33%)(APA, 2015).

So what’s the solution to your or your clients’ money problems?

Explore Your History

Money experts will advise creating and strictly following a budget. However, this method tends to work only for the short-term, or for those who are extremely disciplined.

Another approach that you could take is to uncover your money story, as per the Financial Social Work model (Wolfsohn, 2016; Wolfsohn & Michaeli, 2014).  The process of exploring your money history will enable you to improve your relationship with your money.

Your money story includes your thoughts, beliefs and attitudes about money, many of which are unconscious and were developed while you were growing up.

Consider asking yourself:

  • What money beliefs, thoughts and attitudes did you learn from your primary caregivers? Some of these may have been directly, or indirectly, via their actions.
  • What money messages did you absorb from your other relatives, mentors and friends?
  • How would you describe your current vs. your childhood financial circumstances? What’s different? What’s the same?
  • Which of your childhood money lessons do you feel impact you and/or your actions today?
  • Which money beliefs do you find appropriate and relevant?
  • Which money messages would you like to adjust to better fit the person you are as an adult, and the goals you would like to achieve?

Taking the time to uncover your money story is a key component of the Financial Social Work approach to improving your relationship with your money.

A stronger relationship with your money, in turn, boosts your ability to establish healthy money habits leading to greater financial well-being.

Lastly, conduct a financial check-up to see which specific area(s) needs boosting (emergency savings, retirement savings etc.) and help you decide what healthy money habit(s) you are ready to start practicing to improve your financial and overall well-being.




American Psychological Association (APA).  (2015, February 4). Stress in america: Paying with our health. Retrieved from

Gabler, N. (2016, May). The Secret shame of middle-class Americans. The Atlantic. Retrieved from

Kirkham, E. (2016, March 14). 1 in 3 Americans has $0 saved for retirement. GoBankingRates. Retrieved from

Wolfsohn, R. (2016). Financial Social Work Certification. Retrieved from

Wolfsohn, R., & Michaeli, D. (2014, February). Financial social work. Encyclopedia of Social Work.

Wong, K. (2016, January 8). Most Americans lack reserve cash to cover $500 emergency: Survey. NBC News. Retrieved from



Dorlee Michaeli, MBA, LMSW, is a social worker consultant. For the Center for Financial Social Work, she helps educate social workers and their clients on how to establish healthier money habits to improve their financial circumstances. For the University at Buffalo School of Social Work, she provides coaching on how to employ social media to enhance social work practice, and teaches how to use social media to advance your career. You can find her at www.SocialWork.Career, or twitter or instagram.


The Carlat Psychiaty Report <![CDATA[News of Note: Research Indicates Schizophrenia is Eight Distinct Disorders]]> 2016-07-15T21:13:18Z 2016-07-16T10:12:55Z SchizophreniaResearch Indicates Schizophrenia is Eight Distinct Disorders

If you thought schizophrenia was a single disorder, new research suggests that you may need to rethink this point of view.

According to researchers schizophrenia may be a group of eight distinct disorders, each caused by changes in clusters of genes that lead to different sets of symptoms. The finding may lead to the development of better ways to diagnose and treat schizophrenia, C. Robert Cloninger, a co-author of the study, told USA Today (

In the study, which was published in September (Arnedo J et al, Am J Psychiatry 2014, Epub ahead of print), researchers compared the DNA of 4,200 people with schizophrenia to that of 3,800 people without the disorder. They found schizophrenia is a group of heritable disorders caused by a moderate number of separate genotypic networks associated with several distinct clinical syndromes. Certain genetic profiles matched particular symptoms. For example, people with one genetic cluster have disorganized speech while those with another genetic profile hear voices. Some genetic clusters give people higher risks of the disorder as well, with one set conferring a 95% chance of developing schizophrenia, the study found.

Cloninger, professor of psychiatry and genetics at the Washington University School of Medicine in St. Louis, told the newspaper he hopes the work will open the door to treating the cause, rather than just the symptoms, of schizophrenia.

Edie Weinstein, MSW, LSW <![CDATA[Twenty Feet From the Ground: Facing Fears]]> 2016-07-15T03:46:46Z 2016-07-15T10:35:13Z facing fearsOur clients come to us carrying hesitation, trepidation and sometimes full blown fears. Often, they have been burdened by the sometimes crippling emotion for decades and they have no viable tools for releasing them. Accustomed to toting this form of distress, their lives are shaped and sadly, defined by what limits them.

Fears are defined, in the Merriam Webster dictionary as: “an unpleasant emotion caused by the belief that someone or something is dangerous, likely to cause pain, or a threat.”

These may include:

  • Failure
  • Success
  • Socializing
  • Attempting new ventures
  • Being visible in the world
  • Heights
  • Flying
  • Public speaking
  • Being wrong
  • Death
  • Impostor Syndrome
  • Rejection
  • Driving
  • Medical procedures
  • Being wrong


 Phobias take fear to another level; as if pumping up the volume on the stereo, until the sound overpowers the room. More than excessive fear; they are irrational.  The belief is that by engaging in specific activities or being confronted with certain triggers, a devastating outcome will ensue. A list includes:

 Ablutophobia- Fear of washing or bathing.

  • Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place.
  • Arachnephobia or Arachnophobia- Fear of spiders.
  • Arithmophobia- Fear of numbers.
  • Arrhenphobia- Fear of men.
  • Arsonphobia- Fear of fire.
  • Bathmophobia- Fear of stairs or steep slopes.
  • Batophobia- Fear of heights or being close to high buildings.
  • Decidophobia- Fear of making decisions.

An example of such an entrenched belief was that of a young man who sought counseling because he was terrified of going bald, as had his father that he actually saw in the mirror, an image of himself as a bare headed man.

Even when his therapist told him that he had a full head of hair, he didn’t believe her. Even when; with his consent, she held up a mirror for him to face and still he described himself as losing his hair. Throughout their sessions, he would move in and out of the limiting thoughts, as got tired of the thought and was open to considering that he might be in error.

By the time he completed treatment, he had come to accept that perhaps his therapist was correct and that he was not bald or losing any significant amount of hair.

Managing Symptoms

Once a person recognizes that the apprehension exists, the next step is to determine how to manage the symptoms.

  • Do a body scan as you ask yourself about the sensations you are having. Is your heart racing? Are your palms sweaty?  Is your mouth dry? Do you experience the fight, flight or freeze response?
  • Take a few deep breaths. The American Institute of Stress suggests that when doing so:
  • Metabolism decreases
  • Heart rate decreases
  • Muscles relax
  • Blood pressure decreases
  • Make a list of facts vs. interpretation. An example could be: The fact is, that I need to choose between two colleges to attend. Interpretation is, if I choose the ‘wrong one,’ my career is over before it begins. The outcome is likely to be fueled and impacted by the view one holds.

An example I have offered over the years to therapy clients is to tap on the desk at which we are sitting. I ask them to imagine their school experience. If they felt successful, accomplished, liked by the teacher, (maybe even teacher’s pet) and had many friends, couldn’t wait to get to school each day and my desk reminded them of their teacher’s desk, how would they be likely to feel?  The answer was affirmative.

If, on the other hand, they hated school, got poor grades, felt singled out for bullying or intimidation of some kind and hid under the covers, when the alarm clock rang and my desk reminded them of their teacher’s task, what might be the reaction?  Could be the stress related reactions of heart palpitations, sweating, anxiety and fear.

  • Speak with someone you trust about your fears. A close friend or family member who can simply listen may offer the opportunity to just offload the emotions.
  • Working with a competent therapist, which they are already doing if you are seeing them, can go a long way toward resolving the issues.
  • Make a list of fears and then tear them up or burn them as you watch the smoke drift into space, taking the energy of the fears with them.
  • Draw pictures that exemplify the fears. Perhaps it will show up like a roaring tiger, a pouncing lion, a claw and fang bearing monster.
  • See the aforementioned creatures in front of you, as you imagine them diminishing in size, as the ferocious felines might become tiny meowing kittens.


Christine Hammond, MS, LMHC <![CDATA[Working with a Drama Queen / Histrionic Personality Disorder]]> http://5.788 2016-07-15T10:07:09Z 2016-07-15T10:07:09Z Drama queenIt’s hard to miss the drama in a conservative work environment where things are relatively calm. Granted there are pressures and tensions at the office but nothing compares to the constant barrage of theatrics. One person seems to stand out in suggestive appearance, inappropriate behavior, and a need to be the center of attention.
In modern culture, these people are frequently called drama queens. But in psychology, they are labeled Histrionic Personality Disorder. A personality disorder is pervasive, meaning it exists in all environments such as work, home and community. Individuals who fall into this category seem to have a constant flow of drama following them everywhere. Some of it is outside of their influence, but some is the result of poor judgement. Histrionics are characterized by the following in work settings:

  • Validation – An insatiable need for approval from co-workers and supervisors. This manifests by being easily influenced in order to gain even more approval.
  • Tasks – Has great initial enthusiasm for projects but lacks follow-through. Will begin a task highly motivated and committed but has difficulty finishing when the excitement dies down. Needs immediate gratification and becomes agitated with any delay.
  • Relationships – Quickly attaches and clings to co-workers calling them their best friend when the feeling is not reciprocal. Often co-workers will avoid them in an attempt to set better boundaries. Will seek out the excitement of new relationships and abandon old ones.
  • Day-to-day – Is impulsive and likes to engage in risk taking behavior. They are easily bored with routine and jobs that perform the same tasks over and over. They tend to act out to gain attention and when it is not received, they act out even more. This results in depression when they are not the center of things.
  • Responses – Is sensitive to stressful environments, worries excessively, is flippant with responsibilities, and lacks specific detail in speaking. They can be emotionally expressive and manipulative, but also very shallow and fake.
  • Ethics – Engages in inappropriate seductive behavior with people who are in other relationships or where there is a potential for conflict such as employer/employee. They use their physical appearance to sexually attract others, wear revealing clothing, and then will follow through with promiscuous behavior.

Because of this behavior, many Histrionics do not last too long in a job which is a shame because they tend to be highly creative. Their energy level and enthusiasm can be exciting to be around. While it may seem they work better in unstructured environments, too much flexibility can invite even more risk taking behavior. They function well in environments where the rules are constantly reinforced and there are frequent rewards.

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

Edie Weinstein, MSW, LSW <![CDATA[Center-of-the-Universe-itis: Recognizing Narcissistic Personality Disorder]]> 2016-07-14T01:34:00Z 2016-07-14T10:33:34Z center-of-the-universe-itisWhile working as a social worker in an inpatient psychiatric hospital, I noticed a bumper sticker on the back of a co-worker’s car. It read “It’s All About Me.” When I asked her if that meant she was responsible for everything in her life or if was expressing that she was the center of the universe, she laughed and said it was the second.

While most people would like to believe that their needs and desires supersede those of others, most of us have been socialized to accept that we ought to at least, consider our family members and friends when making decisions. We live on a planet with more than 7.125 billion people, as of 2013 and surely many more in the interceding three years.

The ‘me first/me only’ attitude is what contributes to violence and destruction and decimates relationships. Altruism redeems them.

Humans are complicated beings whose attitudes and behaviors are shaped by numerous factors. These factors might be biological, psychological, social or spiritual. Some are primarily neurobiological, others environmental. Sometimes these components combine to form one or more of the personality disorders; among them Narcissistic Personality Disorder, which is described as “characterized by a long-standing pattern of grandiosity (either in fantasy or actual behavior), an overwhelming need for admiration, and usually a complete lack of empathy toward others. People with this disorder often believe they are of primary importance in everybody’s life or to anyone they meet.”

The DSM-5 criteria includes:

  • Having an exaggerated sense of self-importance
  • Expecting to be recognized as superior even without achievements that warrant it
  • Exaggerating your achievements and talents
  • Being preoccupied with fantasies about success, power, brilliance, beauty or the
  • perfect mate
  • Requiring constant admiration
  • Expecting special favors and unquestioning compliance with your expectations
  • Taking advantage of others to get what you want
  • Having an inability or unwillingness to recognize the needs and feelings of others
  • Being envious of others and believing others envy you
  • Behaving in an arrogant or haughty manner

 Ways to Recognize Someone with This Condition

A sense of entitlement that they should always have the best, without regard to how it impacts anyone else.

Lacking in empathy and an inability or unwillingness to recognize the feelings of others.

An arrogant communication style, as if placing themselves on a pedestal.

Sees him or herself as special or privileged.

Elitist attitude that drives him or her to associate, or wish to associate with people perceived as ‘worthy,’ looking askance at anyone who fails to meet their criteria.

Figuratively walks over others to ‘get ahead’.

Personality Disorders on Screen

Movies have been a cultural platform for characters with these qualities. Michael Douglas plays a character with both antisocial and narcissistic personality disorders in the hit “Wall Street,” in which the ruthless businessman Gordon Gekko utters the classic line, “Greed is good.”

He has no regard for the existence of others except as they serve his ends. Power is his watchword, and he enjoys the trappings a lifestyle that carries with it an air of respect. As with the aforementioned characters, when he feels his power threatened, he attacks.

A behavior common to each of these personality disorders is “gaslighting.” The term comes from the 1944 film “Gaslight,” starring Charles Boyer as a husband so determined to protect a secret that he drives his wife, played by Ingrid Bergman, into insanity.

Psychoanalyst Robin Stern’s book The Gaslight Effect: How to Spot and Survive the Hidden Manipulation Others Use to Control Your Life explains that the person on the receiving end of this behavior is meant to doubt his or her perception of reality if it differs from that of the person in power.

To maintain control, people with personality disorders need to make the other people in their lives wrong. Manipulative people try to gain the upper hand by denying making certain statements, accusing others of disloyalty and encouraging second-guessing.

So how do you live with someone who exhibits these qualities? Try these tips:

  • As much as possible, trust your instincts. If your gut tells you something’s wrong, it likely is. Stay

grounded in reality, checking in with people whose perceptions you can believe

  • Communicate calmly. Your anxiety might encourage the other person. For example, he or she

might say, “See? You’re the one losing it” and suggest you’re therefore in the wrong. Those with

antisocial or narcissistic personality disorder often have a calm demeanor.

  • Seek therapy and encourage it for your loved one. Al-Anon might help if addictions factor into

the problem.

  • Keep in mind that dialectical behavioral therapy and cognitive behavioral therapy, as well as

mindfulness practices, can be helpful with these conditions.

  • Be aware that to maintain power, the person might try to cause rifts between you and others.
  • Get yourself and anyone else in danger to safety if behavior escalates to threats or violence.
  • Model consistency if possible, holding the person accountable for his or her choices.
  • Honor yourself and leave the relationship if your best efforts fail. Even in cases of mental illness,

you owe no one your safety or soul.

Treatment for this condition ranges from inpatient, to individual, from group to medication.

A Therapist Comes Clean

There is a quiz that can be taken to assess the signs of NPD. While doing research for this article, I elected to use the tool. While I perused the questions, I found it difficult to respond, since some of what passes for confidence and seeing my own potential, leadership skills and desire for success had me scoring high on the scale.

I laughed when seeing that my numbers were right up there with those of celebrities and a mere two points from tipping the scale into the red zone.

The traits I possess, such as compassion and genuine caring for others, might counterbalance and prevent me from teetering over the edge into narcissism. As a recovering co-dependent, I tended to place the needs of others before my own. I temper my assertiveness with wanting to go for a win-win in my interactions with others.

As a journalist and speaker, I enjoy being center stage, and paradoxically feel embarrassed by excessive attention. As a child who ‘tap danced for attention,’ like Shirley Temple, I had a desire to be ‘loved best of all,’ that impacts my relationships to this day. Awareness of my intentions is paramount.

I consider the recently deceased boxer Muhammad Ali whose signature line, “I’m the greatest!” would have had some placing him in that category. Confidence and skill, rather than pathology bolstered his claim. He also devoted time and money to various charitable causes. Other stage personas harbor massive insecurities that have them relinquishing control of their live to this condition, not seeing the chaos that it entails.

A few years ago, I asked a friend to call me on it should I ever become too big for my britches, full of myself or thinking that I am all that and a bag of chips. She smiled and reminded me, “You don’t need your friends to do that, you have Adam (my son) to keep you humble.” And so he does.


Bret Moore, Psy.D. <![CDATA[Helping Your Clients Recover from Traumatic Brain Injury]]> 2016-07-12T23:00:57Z 2016-07-13T12:00:32Z helping your clients recover from brain injuryEvery time you turn on the television or read the paper there seems to be a story about how tens  of thousands of service members have suffered a traumatic brain injury during combat.

There is no doubt that tens if not hundreds of thousands of men and women are dealing with the after effects of this cruel and devastating consequence of war. Indeed, traumatic brain injury is considered a signature injury of the Iraq and Afghanistan wars and has changed the way we look at head injuries.

The most common brain injury experienced by combat troops is called a concussion.  Although definitions vary a bit, a concussion is simply a mild brain injury.  For purposes of this article, it is defined as either an alteration of consciousness (feeling dazed or confused – you don’t have to be knocked out) or a loss of consciousness that lasts less than 30 minutes.   More severe brain injuries are often labeled as moderate and severe.

The days, weeks, and months following a concussion, people may experience a variety of symptoms.  Some of the more common ones include memory loss, headaches, sensitivity to light and noise, nausea, reduced concentration, fatigue, irritability, and insomnia.

It is also common for people to not remember the explosion (one does not have to get hit in the head to experience a concussion) or direct blow to the head that caused the problems.  This is referred to as posttraumatic amnesia.  Knowing how long the amnesia lasted can be help identify the severity of the head injury.


Healing from a concussion is mostly a natural process that occurs within our bodies and minds over time.  Just like any other injury, the healthier you are and the better lifestyle you lead, the better off you will be.

Also, understanding that full recovery from a concussion is the norm goes a long way in keeping anxiety and depression in check, which helps the healing process.  These are all things that need to be explained to your veteran client who has suffered a brain injury.

For some, just the simple tool of psychoeducation can be very effective.

In addition to reminding your clients to give themselves time, there are some other things they can do in the short-term to speed up their recovery and reduce the negative long-term effects of a concussion.  These are by no means all-inclusive.  Recovery from traumatic brain injury takes times, patience, and understanding.  Your clients will need to work closely with rehabilitation professionals.  But, research shows that the following are important and can help.

Recovery Tips

Do not Drink. Alcohol interrupts recovery in a number of ways.  It disrupts healthy sleep cycles. This situation can lead to worsening of mood related symptoms, concentration problems and fatigue.  It leads to poor judgment, which can lead to further injuries (see below for more). Alcohol is also believed to slow brain recovery.  And keep in mind, people who have experienced a brain injury are more susceptible to the effects of alcohol.

Take it Easy.  During the critical days and weeks following a concussion, physical exertion only serves to make the symptoms worse, particularly headaches and dizziness.  In fact, one of the ways some doctors make sure concussive symptoms are gone is to make patients physically exert themselves after it looks like their symptoms are gone.

If they do not come back after physical exertion, the person is usually considered recovered.  Encourage your veteran client recovering from a head injury to rest.  This advice is a must, and if it is not done, your client can expect a worsening of symptoms or delay in recovery.

Do Not Hurt Yourself Again.  This recommendation is probably the most important one.  After  a person has had a concussion, they are more likely to have another one.  Having more than one makes recovery take longer.  In young adults, a second concussion within a few days of the first one can result in serious damage and lead to lifelong problems.

And in some cases, repeated injuries in a short period of time can lead to death.  So, encourage your client to wear his seatbelt, stay off the sports field and fight the impulse to do a back flip off the tailgate of their buddy’s truck until their brain is fully operational.

Remember, the expected outcome after a concussion is full recovery.  But, your client has to be smart.  Instruct them not to drink, get plenty of rest, and avoid high risk activities.  And if their symptoms persist or worsen, make sure they talk with their healthcare provider.

For more information on traumatic brain injury, visit the Brain Injury Association of America or The Defense and Veterans Brain Injury Center.

*This article is adapted from Dr. Moore’s column Kevlar for the Mind published in Military Times.


Susan Gonsalves <![CDATA[Do Female Presidents or Prime Ministers Make Any Difference?]]> 2016-07-12T23:00:09Z 2016-07-12T23:00:09Z do female presidents or prime ministers make any difference?

The United Kingdom is going to be led by a female Prime Minister in the near future, as the only two candidates left competing for the post in the Conservative Party leadership contest are now both women–Theresa May and Andrea Leadsom.

Meanwhile in the USA, Hilary Clinton stands a strong chance of becoming the next President

Angela Merkel has led Germany over many years. Ulster Unionist Arlene Foster is the first woman to be First Minister in Northern Ireland while the Scottish National Party leader Nicola Sturgeon is first Minister for Scotland.

The idea that the West appears to be gradually being taken over by women (according to the press) raises the question of whether female leadership results in any noticeable difference in the way we are governed.

A study examining all the countries involved in international conflicts around the world over the last 50 years found that the more women were involved in the leadership of a society, the less militarily aggressive that society was and the lower the probability of violent conflict with other countries.

The researchers, Mary Caprioli and Mark Boyer, argue that their study, in the Journal of Conflict Resolution, is strong evidence for the proposition that, generally, women work for peace and men wage war.

Consensual Approach

Women are more likely to use a collective or consensual approach to problem-solving rather than focusing on the unilateral imposition of solutions.

Psychologically, at quite a profound level, the authors suggest, men tend to engage in power struggles for personal gain, whereas women tend to attempt to minimize power differences, to share resources and to treat others equally.

Yet despite these advantages of female leadership, Caprioli and Boyer found only 24 countries around the world, by the time the study had been completed in 2001, had placed a female leader in office since 1900.

The study entitled, “Gender, violence and international crisis,” found only 16.6 per cent of these countries led by a woman were involved in international crises at any point during the period of female leadership and none of these female leaders initiated the crises.

The researchers, who at the time of publishing their study were at the department of political science, University of Massachusetts-Dartmouth and the Department of Political Science, University of Connecticut, used political equality, measured as the percentage of women in parliament, as a measure of gender equality within society.

Put simply, their finding is that as the percentage of women in the legislature of a country increases, the less severe is the violence between countries.

Indeed, if the percentage of women in the legislature increases by five per cent, a state is nearly five times less likely to use violence internationally. In terms of the current warlike position of the USA compared with more pacifist Europe, it is interesting to note that the US had far fewer women in its legislature compared with most European countries .

For the US, the figure was just over 14 per cent compared with Sweden at 42 per cent at the time this study was published, which was 2001.

Indeed, Scandinavian countries generally take the top six consecutive spots in the world league table for highest female representation in parliament – followed by Germany with 32 per cent, at the time the study was published.

The UK, which has arguably been more aggressive in recent conflicts than the rest of Europe, is down at 17.9 per cent, when the study was published.

One theory behind this, argue Caprioli and Boyer, is that competition, violence, intransigence and territoriality are all associated with a male approach to international relations. Women, on the other hand, are less likely to see crisis negotiation as a competition or to advocate the use of violence.

That said, female leaders are often perceived to be just as aggressive as men, Caprioli, now associate professor of political science and director of international studies program at the University of Minnesota, Duluth, and  Boyer, Board of Trustees Distinguished Professor at the University of Connecticut, argue in their study.

Hawks vs. Doves

Leaders of recent years such as Margaret Thatcher, Benazir Bhutto, Indira Ghandi and Golda Meir were seen as hawks rather than doves, and all were caught up in violent conflicts.

But perhaps female leaders must also contend with negative perceptions from male opponents.

For example, gender was a factor in the events and resolution of the 1971 Indo–Pakistan war in which Indira Ghandi had a key role.

Caprioli and Boyer remind us that President Yahya Khan of Pakistan stated that he would have reacted less violently and been less rigid as the leader of Pakistan in the conflict with India if a male had headed the Indian government.

Indeed, President Khan was quoted as saying:

If that woman [Indira Gandhi] thinks she is going to cow me down, I refuse to take it.

So the behavior of male leaders when faced with a female opponent becomes a factor – a sense of macho pride which makes them unwilling to ‘lose’ to a woman, lest their masculinity be questioned.

]]> Sharie Stines, Psy.D <![CDATA[The Silent Treatment]]> http://7.395 2016-07-12T06:06:24Z 2016-07-12T06:06:24Z sunsetAt best the silent treatment is an immature behavior used by spoiled brats and manipulative individuals.  At worst, it is a weapon used by abusers to punish their victims.  One demographic of the population that particularly loves the silent treatment is the narcissist.  In fact, the silent treatment is the narcissist’s favorite weapon.

Whether the person in your life is using the silent treatment immaturely or abusively, one thing is for sure, it is infuriating to receive; problems cannot be dealt with, conflicts remain unresolved, simple conversations are thwarted, and in the end, relationships employing this tactic become either toxic on nonexistent.

Abusers and/or narcissistic personality types love to ignore you and they love for you to know that they are ignoring you.  Why is that?  Let’s parse this concept apart.  The silent treatment is not blatant; it’s insidious.  The only person who really feels the silent treatment is the target.  The person giving the silent treatment is not being overtly aggressive, abusive, or unkind in any visible way.  This keeps him looking “good” and reasonable.  When challenged, the giver of the silent treatment can say comments such as, “I’m fine.”  “Nothing’s wrong.”  “I’m not mad.” Or some other innocuous comment.  Realize that these comments are forms of gas lighting and confabulation, which are other common narcissistic weapons (see Coping with Narcissistic Confabulators.)  The internal confusion results in the experience of cognitive dissonance, which is prevalent in abusive relationships.

When trying to explain the problem to others, the target may also encounter invalidation and minimization, with comments such as, “Give it time.”  Or, “Maybe he’s just not ready to talk yet.”  Or, “Don’t be so sensitive.” “Blah, blah, blah…”  There is really no understanding when trying to explain the hurt caused by the silent treatment.

I also found it interesting to see that when I Googled the words “silent treatment,” I came across sites on narcissism.  This is how I learned that the silent treatment is often the weapon of choice for the narcissist.  When in a close relationship with a narcissist you only have two available roles – either you are narcissistic food (ego-inflating fuel) or you are a scapegoat.  If, for some reason, you challenge the narcissist or fail to provide sufficient “food,” he will suffer a “narcissistic wound” (see, Beware the Narcissist Wound for further description.)  This would probably trigger a silent treatment event.

The silent treatment serves many useful purposes to the perpetrator.  The silent treatment is one means for him to keep his target under his control.  Not only does it enable the abuser to control his target, it also enables him to avoid discussing matters that he wants to avoid, and helps him to completely evade any types of responsibility he has in the relationship.  It is also an effective tool for devaluing and discarding a target and for remaining in the “one up” position.  Mainly, it’s used as a punishment. Think about how audacious that is – the silent treatment giver deems it his superior right to punish others!

Since the target is not as adept at playing emotional head games as most narcissists are, she is completely out of her league.  The target usually feels extremely anxious and, over time becomes very distressed over the lack of communication and connection.  Eventually, she will do almost anything to get her loved one to start talking to her again, even apologizing for things that she didn’t even do just to get the whole thing over with.  She is willing to wave the white flag because whatever caused the silence (and causes can be either imaginary or real) in the first place pales in comparison to the injury caused by being emotionally shut out with the silent treatment.

The silent treatment is emotional abuse.  When a victim is in a relationship with a person who causes the above mentioned distress, her mind and body remember how upsetting and anxiety provoking the previous silent treatment occurrences were.  Because of this negative association, the victim then becomes easily controlled by the perpetrator because she does not want to experience the silent treatment again.  This causes her to be very compliant and agreeable.  She starts walking on eggshells in the relationship and eventually loses her own voice and sense of self.


Melody Beattie, the Codependent No More author, has a great line for when  a codependent  doesn’t like what the addict in her life is doing.  I think the quote is perfect for those dealing with the silent treatment.  I recommend that you make it your own; it is:  “Celebrate the ‘no’!”  In other words, use this time to work on yourself and stop tryng to change someone else.  Indie author, Zari Ballard, also has some great advice for those dealing with the silent treatment; she calls it silence appreciation.  She likens it to the space in your life when you have a break from the “noise” the narcissist brings to your world. Celebrate the fact that you now have an opportunity to enjoy your life without the narcissist’s presence.  Take advantage of this “break” and savor this time with yourself.

Ask some questions of yourself and write your answers in your journal:

  1. How do I feel right now?
  2. What do I need?
  3. How can I take care of myself?

Not only can you ask yourself questions in your journal, write what you want.  If you believe in a higher power, write out your requests in prayer.  This will help you get clarity into your situation.  You can also talk to yourself in affirming ways in order to shut off the unhealthy and critical voices in your own head.  I heard a great quote that applies; it was:  “Don’t listen to yourself, tell yourself something.”  That is, tell yourself affirming statements, such as, “This too shall pass…” etc.  Take this time of silence to recover from the effects emotional abuse has had on  your psyche.  Embrace the opportunity to practice some healthy self-care. This will enable you to take back your own power and not hand over your emotional well-being to those who would exploit your weaknesses to hurt you.

Note: Disregard gender labels as the silent treatment is not a respecter of genders.

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Christine Hammond, MS, LMHC <![CDATA[How Sociopaths Deceive Others]]> http://5.782 2016-07-11T23:41:51Z 2016-07-11T23:41:51Z sociopathEver wonder how a person was able to earn trust so quickly and then exploit it for their own benefit? Perhaps they stole money, took over a business, or openly violated ethical conduct codes. One day they were a best friend and now for no apparent reason, they make themselves an enemy. Even now, it is hard to imagine that they were not the person they presented. How were they able to be so deceptive?

Anti-Social Personality Disorder (ASPD) is the technical definition for sociopathic and psychopathic behavior. Imagine ASPD as a spectrum where there is evidence of subtle to extreme versions of the behavioral dysfunction. Sociopaths are generally thought of as a milder type than psychopaths. This makes them harder to recognize in the average work environment. So how do they do it?

  1. Survey – Sociopaths begin their deception by carefully observing their new environment. Since most sociopath burn up relationships fast, they are frequently forced into new surroundings in order to survive. They look for potential targets: those with money, power, position or anything the other person has that the sociopath wants. Sociopaths scrutinize the target’s friends, work habits, routines, family, strengths, weaknesses, and social affairs. Basically, they are stalking their prey.
  2. Scoping – After choosing the target, sociopaths scope out an informant. This person usually has the dirt on everyone, likes to gossip, and puts themselves in the middle of things. The sociopath will quickly become best buddies with this person in an effort to glean as much information as possible. In the future, they will use this relationship to disseminate bad intelligence about others.
  3. Chameleon – Sociopaths literally transform themselves into the most attractive version of self for their target and the informant. For instance, if their prey likes to rescue people, the sociopath will need to be rescued. If their victim likes independent gregarious people, they will become that. The interesting part is that sociopaths can be two completely different personalities within the same environment.
  4. Seducing – Once the sociopath feels they understand their target, they begin a seduction. It usually begins with making small talk about a hobby or other interest. Then they use that incident to initiate further contact alternating between praising the target and asking for their advice. Shortly thereafter, the sociopath shares some made-up secret personal fear or anxiety to draw the target further in. If the victim responds with any degree of kindness, they proceed to the next step. If the prey repels the sociopath, one of two things happens: either the sociopath will move on or they will refine and intensify their approach.
  5. Courting – This is a one-way dance where the sociopath does all of the work. They magically appear where the victim is, they seem to be friends with the same people, and they often invite themselves to meetings, projects and events. The sociopath escalates the praise to a level of adoration which draws in the target even more. Their charm is enticing and disarming so the prey begins to feel at ease with the sociopath.
  6. Isolating – The sociopath begins to use the data gathered from the informant to isolate the target from friends or co-workers who may try to protect them one day. These are subtle non-flattering comments made about the friends or co-workers which are easily countered if confronted. The intent is for the victim to feel betrayed by their friends while learning to solely rely on the false loyalty of the sociopath.
  7. Vengeance – Anyone who tries to stop the sociopath along the way will be met with swift and severe revenge, threats, or punishment. They will use tactics such as inappropriate rage, the silent treatment, intimidating stares, twisting the truth, and playing the victim card to manipulate others into compliance. By this point, the sociopath has too much invested in the deception to walk away. So instead, they push away protectors while pulling in the target.
  8. Projection – Here is where things become tricky. The sociopath now secretly turns on the victim to the victim’s friends and co-workers by projecting the sociopath’s selfish motives onto the victim. This completes the betrayal cycle. When the sociopath removes themselves from the environment, everyone’s fingers will be pointed at each other with none pointed at the sociopath. This sets the stage for the final act.
  9. Deceit – Now the sociopath is free to embezzle, exploit, take over a business, and/or commit acts of fraud or felony. Because all eyes will be on the fight between each other and not on the sociopath. By the time the dust has settled, the sociopath will be long gone with whatever money, power, position, or prestige they desired.

At any point in the game, this can be stopped. But it usually takes an outsider looking in on the situation to bring about clarity. Sociopaths should be taken seriously and treated as potentially dangerous.

Christine Hammond lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook available from Amazon, Barnes & Noble and iBook