Psych Central Professional For mental health, psychiatric and psychological professionals.2015-11-29T11:36:48Z Raj Persaud, FRCPsych, M.Sc M.Phil <![CDATA[The Lipstick Effect: How Boom or Bust Affects Beauty]]> 2015-11-27T20:37:11Z 2015-11-29T11:36:48Z

Sales figures from one of the world’s largest cosmetics companies, L’Oreal, revealed that during 2008, a year when the rest of the economy suffered record declines in sales, the cosmetics leviathan experienced sales growth of 5.3%.

Now a series of psychology experiments have confirmed for the first time that while tougher economic times decrease desire for most items, they also reliably increase women’s yearning for products that boost their attractiveness.

Psychologists contend that this ‘lipstick effect’ is operating largely below conscious awareness of men and women, and therefore, requires precise experiments to reveal them. The results suggest this phenomenon is driven by women’s desire to attract mates with resources.

The authors of the study, Sarah Hill, Christopher Rodeheffer, Vladas Griskevicius, Kristina Durante and Andrew Edward White, argue that over evolutionary history, our human ancestors regularly went through cycles of abundance and famine.

Mate-Seeking During Tough Times

This fact has genetically disposed people toward prioritizing mate-seeking when times get tough, as passing on our genes becomes a greater priority in harsher environments.

For example, wars are known for moments of most intense romance.

Women’s reproductive success through history, according to evolutionary theory, rests on their ability to secure a partner able to invest resources in themselves and their offspring. An economic recession may signal that financially stable men are becoming scarcer, so women should, according to evolutionary theory, compete more ferociously for richer men during financially tougher times.

The study, entitled “Boosting Beauty in an Economic Decline: Mating, Spending, and the Lipstick Effect,” examined monthly fluctuations in U.S. unemployment over the last 20 years and found when unemployment increased, people allocated smaller portions of their monthly spending budgets on electronics or leisure/hobby products.

Yet relative spending on personal care/cosmetics products went up.

But was this men or women who were buying cosmetics or personal care products? In another part of this study, published in the Journal of Personality and Social Psychology when men read a news article about a recent economic recession, they developed less desire to purchase consumer products in general.

When women read the same magazine article on a recession, in comparison with reading an article on modern architecture, unlike men, their desire to purchase products that could enhance appearance, including lipstick, increased.

Recession Reflection

In another part of the series of experiments, undergraduate unmarried women were prompted to reflect about economic recessions by viewing a slideshow entitled, “The New Economics of the 21st Century: A Harsh and Unpredictable World.”

This presentation portrayed the current state of the US economy, including unemployment lines, home foreclosure signs and empty office buildings. In the comparison condition of the experiment, participants viewed a slideshow titled, “Making the Grade: No Longer a Walk in the Park.” This slideshow represented students working to meet stringent academic requirements imposed by college administrators.

As predicted, the recession slideshow led women to report much more wanting members of the opposite sex to perceive them as pretty, that it is important to look good, and to report caring much more about how attractive they look.

So, economic recession reminders mean women become more concerned with looking physically attractive to men.

Women viewing the economic recession slides also placed a significantly greater emphasis on a potential relationship partner’s access to financial resources.

But does the ‘lipstick effect’ reflect women in recessions being drawn to cheap pleasures, such as lipstick, rather than expensive indulgences? If women believe that an expensive luxury product will make them more desirable to men, recessions should still increase women’s desire for that product (according to evolutionary theory).

Sharie Stines, Psy.D <![CDATA[How to Cope With a Master Manipulator]]> http://7.92 2015-11-28T18:14:03Z 2015-11-28T17:13:15Z freedomCoping with a manipulator is hard to do.  First of all, I don’t think most of us realize when we are being manipulated, because the best manipulators are very covert in their process.   It takes years of research and feeling crazy before it finally dawns on us that what we are experiencing is manipulation.  The manipulator could be your mother, your father, your spouse, or some other significant person in your life.   The first step, then, in coping with a master manipulator, is to realize with whom you are dealing.

The best way to handle a manipulator is to realize you’re with one.  The only way to do that is to be self-aware and recognize the feelings this person stirs up in you.  Here are some common feelings you will have when you are with this person for any length of time:

  1. You feel defensive.
  2. You feel guilty.
  3. You feel confused.
  4. You feel angry and have to try really hard to remain calm.
  5. You feel trapped.
  6. They seem to generate a feeling of obligation within you.
  7. You experience anxiety when with this person or when thinking about having to be with him or her.
  8. You try to fix the “problem” in order to satisfy this person’s unhappiness and no matter what you do you just can’t seem to figure out how to fix the problem.

On the other hand, you can observe your manipulator and recognize his patterns:  He seems to always portray himself as the victim, while all the relationship rules that apply to you don’t seem to apply to him; that is, he lives by a set of double standards.

Your manipulator tends to pout and sulk a lot, and without saying anything, you start trying to repair whatever the damage is, all the while, not being able to figure out what went wrong.

You feel impotent and powerless.  It is frustrating to you to not be able to fix the problem and you end up feeling guilty because your manipulator has manipulated you into believing that you have the key and you’re just too selfish to do what “you know” needs to be done.

Their primary tool is implication.  If they can somehow get you to feel responsible for their feelings and happiness, they will use whatever means necessary.

Implication is a powerful tool.  It isn’t obvious; it’s covert and underhanded.  You get the message that you are the reason that they are unhappy.

Another tool they use a lot is the tool of incessant and persistent requests.  They can wear you down this way.  They try going through the back door, the side door, the front door, and finally the window in order to get you to do something for them or be someone for them.  They do not respect your boundaries or your personhood.

Being in a relationship with a master manipulator is unhealthy and toxic.  You are in a double bind, and being a relatively “normal” person who tends to play by the rules, it is very challenging for you to not be able to smooth things over with your loved one.

Somehow, the gift you so laboriously shopped for to give this person did not generate the type of appreciative response you expected.  You were so excited to have finally found them a gift that showed your thoughtfulness and how you really care about that person, but somehow they look at the gift and set it aside with a tinge of disappointment in their face.

The master manipulator uses some very clever strategies to maintain her control over your relationship with her.  Remember this, manipulation is all about control.  The manipulator wants to control you.  And in general, their methods work.

Some people actually spend their entire lives trying to please their manipulative loved ones.  Sometimes, the manipulator actually gives you a hint of positive reinforcement, just enough to keep you coming back for more.

They may act happy about something you’ve done for them and the reward of pleasing them is that much more gratifying because of its rarity.  You love the feeling of finally “getting it right.”  This keeps you hooked for the next time when your inner child’s excitement or rise in dopamine, will once again be satisfied.  When we receive inconsistent reinforcement we feel even more compelled to try harder because the prize is so great and so rare.

Rather than continuing to put yourself in harm’s way by subjecting yourself to more manipulation, here are some suggestions to help you the next time you are around this person:

  • Arm yourself with self-knowledge. Develop a solid sense of who you are so that no one can convince you otherwise.  Do not let anyone, particularly the manipulator, tell you or imply to you who you are.
  • Develop a strong sense of compassion for yourself and continue to have a firm positive compassionate inner dialogue with yourself when encountering your manipulator.
  • Imagine yourself with a heavy-duty barrier over your heart and mind and refuse to let any of your inner schemas or buttons be activated by your encounter with the manipulator. Instead, let their words slide right off the barrier.  Visualize
  • Remind yourself that you have just as many rights as your manipulator and you can choose to enjoy the night without being subjected to bad feelings. If you must, walk away and find someone who helps you feel calm to talk to instead.
  • Notice how you feel. Give yourself some rules to cope in a healthy way with the feelings that come up.  For instance, if you find yourself feeling defensive, guilty, fearful, angry, frustrated, or confused when encountering this person, do not engage in conversation, instead, make a quick excuse and a hasty retreat into a new location.  Do not engage in the insanity that inevitably occurs when dealing with a manipulator.
  • Spend more time with healthy people who are easy to be with and who love you the way you are.

My final recommendation for coping with a manipulator is this.  Remember that your primary prisoner is your own belief system.

If your manipulator is a parent, then you have most likely been brain-washed since birth.  To overcome the psychological training that has occurred, you need to start challenging your own belief system.  Ask yourself some challenging questions and rewire your thinking.

Am I really responsible for my mother’s happiness?  Am I really a selfish person?  Do other people around me seem to take on the responsibilities of their mother’s happiness?  How am I substituting intensity for true intimacy and connection in this relationship?  Are there realities about this relationship that I’m unwilling to address?  Can this person be close to anyone?  How much of myself am I willing to sacrifice in order to continue in this relationship?  How can I be true to myself and still honor this person?  How can I best take care of myself and be myself?

No matter how hard it is to overcome the brainwashing and implications of a manipulator, you can do it.  The key resides within your own belief system.  In order to live in recovery from this type of abuse, it is necessary to be committed to truth at all times.

To live in the truth for the rest of your life, stay committed to your own self-care.  Educate yourself and counter the cognitive dissonance by immersing yourself in reality.  Read, talk, write, and learn how to set up and stick to your own boundaries with regards to what is necessary for your own mental and emotional well-being


Joseph R. Sanok, MA, LLP, LPC, NCC <![CDATA[How to Get Your First Client, Part 3]]> 2015-11-27T20:36:16Z 2015-11-28T12:35:49Z

I’m amazed at how few counselors put their phone number in the header of their website. The #1 reason people come to a counseling website is to make a counseling appointment! Why make it more difficult? What do we want the person to do? This question should be the leading one.

What Are You Doing?

Every page, blog post, social media post or networking connection, we should ask ourselves, “Why am I doing this?” If we don’t look at why we are spending our time there, it’s harder for us to know what we want the person to do. Here are reasons you may be on social media, writing a blog post or updating your website:

  • Clients to call and make an appointment
  • Clients to email and make an appointment
  • To build your perceived expertise
  • So people know that you exist
  • To be educated on a specific topic
For most counselors, the goal is to have someone make an appointment. Therefore, every page, blog post or social media, should somehow lead to that decision. For example, if you wrote a blog post “What every principal should know about ADHD,” you might have a PDF download for a principal to give to parents. On that PDF (which is really useful), you’d want your phone and email.
The call to action for the principal is to download the PDF and give it to families. You may even have a walk through in the blog post “How to talk to families about ADHD.” So you tell them exactly how to do what you want.
Then, they follow your steps and hand out the PDF to families. Within the PDF, you might have a section “When to get extra help.” In this section, you might list common reasons people connect with you as a therapist.

When you know the why of a situation, it makes it easier to create the “how.”

Make Counseling Referrals Easy

Here are a few tips to make it easy for people to refer to you: 

Give your referral sources your personal cellphone number. If they ever have a question, if they ever need to consult on a case, you know what, they’ll call you!  

I have a handout that I give to doctors that’s for them to give to their clients. When they give it to their patients, it basically walks them through how to make an intake appointment?

  • Have a scheduler that can quickly get someone scheduled.
  • Get involved professionally with other counselors. Counselors refer to each other.
  • Work with other professionals. Get involved professionally with your local counseling social work, psychology group so that they can refer to you and know what types of people to refer and what types of people not to refer. Remember that networking is your job at this point.

Put In the Time

The biggest reason that people don’t get results when they are first starting, is that they don’t put in the time. It’s not easy to rank high in Google, get referrals and connect locally. But here are a few first steps:

  • Blog three to five times per week around your keywords
  • Meet weekly with one new referral source
  • Set up a Psychology Today profile (email me if you need a referral for a free 6 months)
  • Update your website with your phone number at the top
  • Get to know other counselors locally

Overall, the big thing that you’re trying to do is to develop a network of people that know and like and trust you. 

Business card photo available from Shutterstock

Christine Hammond, MS, LMHC <![CDATA[20 Things to Consider Before Marriage]]> http://5.423 2015-11-27T13:47:29Z 2015-11-27T13:47:29Z Pre-marriageIt is hard to know if a person will be a good fit as a spouse. It is even harder to stop and evaluate a potential spouse from a logical, non-emotional point of view. Yet this is precisely what needs to be done.

Friends and family can be helpful in pointing out some concerns but their excitement for the couple may cloud judgement. Even the best premarital counseling can’t detect all of the potential pitfalls. Instead, present these questions to a couple and have them individually answer. This can provide a more realistic viewpoint and offer some areas of discussion prior to marriage.

  1. Are there frequent arguments over nothing?
  2. Do you or your partner use biting sarcasm to confront issues?
  3. Are you staying in the relationship out of fear?
  4. Do you have few areas of common interest?
  5. Are either you or your partner overly dependent on your parents?
  6. Is there any sign of physical, sexual, or verbal abuse?
  7. Do you avoid discussing sensitive topics to prevent an argument or because you are afraid of their reaction?
  8. Does your partner frequently complain about unreal aches and pains?
  9. Does your partner make excuses for not finding a job?
  10. Are you or your partner involved in any addiction such as alcoholism, drug use, gambling, or pornography?
  11. Does your partner avoid contact with others and prefer to be alone?
  12. Do you find yourself always doing what your partner wants to do?
  13. Does your partner harm themselves or have extreme irrational fears, bizarre behavior, or inability to be affectionate?
  14. Is your partner overly jealous, questioning you all the time about your whereabouts?
  15. Is your partner overly critical and demanding that you adjust to their expectations?
  16. Are you and your partner dishonest about your sexual past?
  17. Do you have an uneasy feeling about the relationship?
  18. Are your parents or friends strongly against the relationship?
  19. Do you have a feeling of settling for less than the best?
  20. Is there spiritual harmony?

Answering yes to a few of these questions does not mean the marriage is doomed.  Rather, it signifies a need to better evaluate the situation and seek additional counsel.  Some of these issues can be resolved quickly, allowing the foundation of the marriage to be even stronger.

However, if “yes” answers were given to numbers 3, 6, 10, or 13, please seek individual professional help immediately. Those issues are more long term in nature and marriage will not fix the problem, it will only make it worse.

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

Joseph R. Sanok, MA, LLP, LPC, NCC <![CDATA[How to Get Your First Client Part 2]]> 2015-11-27T01:05:34Z 2015-11-27T13:05:08Z computer

In the first part of this series, we discussed getting some basics set up so that you get referrals. We covered what doesn’t work what does work, and how to build a marketing flow.

As you start to meet more people, your practice will grow. It’s amazing because the more that you get breakfast with referral sources, the more that you get to know each other. The more that you develop that relationship with that person, the more trust there is, like authentic trust, not just like fake trust where they don’t know you but you just like each other.

When you know someone and you like them, and then someone comes to you and says, “You know what? I need counseling.” That person’s going to then refer them to the people they know and trust. They are at the forefront of their mind, not the random person that just sent one letter.

Getting Doctor Referrals

If you have a new doctor that refers someone eventually, follow up with them. If you don’t have your first client yet, get out and network. If you can’t speak to people, attend Toast Masters and learn. Doctor referrals work pretty much the same. A doctor will usually refer to the same person, because they have limited time. The easier you make it for them, the better.

How to Network

Here are the basic steps:

  • Find someone who has a similar Business Avatar (Ideal Client)
  • Hear their story and get to know them as a person.
  • What’s your personal story?

How to Develop Your Story

Your story is the best thing to make yourself stand out. No one can out-do you in that area. Why did you go into counseling?

A while ago, I was doing private practice consulting with someone that told me they used to weigh 400 pounds, at the time of our consulting they weighed under 200.

His story was:

“I used to be overweight and I changed my lifestyle and I want to help you do that too.”

He’d found his story. He’d found his niche as to what worked for him and what was his story.

There was another guy, he had a near-death experience where he was pronounced dead. Then he went from being a corporate banker to being a counselor. In the front page of his website he says his story:

“I was pronounced dead and I had a lifestyle change where I went back to school to become a counselor to help the world. I used to make six figures. Now, I’m a counselor. I just want to help people. I feel like life is too short.” He told his story and then he had specific niches around lifestyle changes about trying to help better the world.

The more that you can articulate what’s your story in a really short, almost Twitter style, 140 characters or elevator speech, whatever words you use, the easier it is for people to help refer to you.

For Mental Wellness Counseling:

“We help angry kids, frustrated parents and distant couples… and just about everyone else.”

Keys to Practice Marketing: Techniques That Work

At Mental Wellness Counseling, we help people across the life span. We have an infant mental person who works with infants and preschoolers and parents all the way up to someone that works with people that are empty nesters or they’re living post-divorce after being married for 50 years.

We say we help angry kids, frustrated parents, and distant couples… and just about everybody else because people remember them. They remember who we help and it’s just straightforward. I don’t have to explain it. It’s just easy to understand.

The other thing is once you’ve got your website going, making sure that you’re really trying to rank high (here’s a video about keywords).


Keyword Marketing Examples

For example, in Mental Wellness Counseling’s website we often say: “Mental Wellness Counseling, a Traverse City Counseling practice.” We only have one location but by saying Traverse City Counseling, that’s something that someone is going to google. We routinely rank usually number 1 in our area.

That is a great way to be able to rank higher in Google is writing a lot of things around your keywords. Maybe you write articles about angry kids, maybe you write about five ways to help your marriage today. Maybe you talk about how to get through the six weeks post-pregnancy, when you’re not having sex and you’re feeling disconnected and you’re dead-tired and I’m just talking about that because we have a new baby. I oftentimes am tired. How do you stay connected to your spouse?

So, creating articles that people want to share (sometimes known as content marketing) is going help you rank higher in Google, but it’s also going to get your name out there a lot more. All right.

Networking and telling your story is the next clear step in getting more referrals. In the final blog post in this series, I’ll be covering how to make referring to you easier!

At the computer photo available from Shutterstock

Joseph R. Sanok, MA, LLP, LPC, NCC <![CDATA[How To Get Your First Client Part 1]]> 2015-11-24T23:03:17Z 2015-11-26T13:02:47Z

I recently conducted a survey of my audience on Practice of the Practice. I found that 51% of people are either about to start a private practice or have just started a private practice. I remember when I first started how tough it was to figure it all out. Here are a few tips I learned along the way.


How To Get Your First Counseling Client?

So, today what I wanted to talk about is your very first client. A lot of what we’ve talked about has been more advanced things. When you have a practice that starts to plateau or those sorts of things. I recently got an email, it said, “All that you share is great and all, but what about my first client? Like I haven’t had a client yet. What I do?”

I’m assuming that you’ve already started. You’ve filed your LLC paperwork, you have a location — a location that hopefully, is one that you’re paying either by the session or as a percentage of what you bring in, not just going in and renting a space and hoping that it works.

I mean, very low risk that you have a counseling phone number, you’ve got your counseling website, you’ve got your counseling business cards — that you’ve got all that done. Now, what?

Let’s talk about some things that you can do to bring in that very first client.

I remember my first client. I received a referral from my therapist friend, Monica Lieser (who was in Podcast Episode 35). She actually gave me my very first client in private practice. I remember that day. I had been hustling and talking to people and networking and getting to know people.

When Nothing is Working

Nothing was working. It had been months and I was in a group practice. I thought to myself, “I don’t know what else I can do?” I wasn’t on insurances because I was a new graduate. I didn’t have those years of experience that you need in Michigan. The people that have called have insurance and want insurance and I didn’t know all about how to talk about private pay counseling and all that.

Monica, was seeing this couple and she referred the husband from that couple to me. For me, to be able to have that very first client and build that confidence was a key step. When I opened Mental Wellness Counseling, I still remember my first client that followed through with me. It’s such an awesome moment.

How to Improve Private Practice Marketing to Get the First Client

When you have no one,  what do you do? There’s a number of things that we’re going to talk about in kind of really big chunks.

So, the first big chunk is private practice marketing. How do you get your name out there? Now, I would say Psychology Today, in most communities is a really good resource because Psychology Today, when you google, almost any city, it’s the first or second thing that comes up: their therapist finder.

What Doesn’t Work in Setting Up a Counseling Private Practice

  • Letters: The letters where they say: “Hi! I’m new to the area. Or I just opened my practice.” From people I’ve talked to and from personal experience that really doesn’t work very well.
  • Nothing in Person: Lack of in-person appointments where you go meet with a doctor for 10 minutes, you go meet with a pastor and you meet with some lawyers. You meet with business people, just to shake to hands, introduce people — the kind of people that you want either as clients or you want referring to.

The Specific Private Practice Networking Strategy

Once you do that, you’re going to have an idea of the maybe 50 people that you go meet. That you figure, if you meet one person a day for 10 weeks, that’s 50 people over the business week. That’s like if you’re not seeing people you might as well be networking like it’s a full-time job.

You go shake hands, you meet people, and you talk to them.

From those 50 people, who are the 10 with whom felt you really connected?

Who were the people that you enjoyed talking to?

I think about who have been my biggest referrals?

My own doctor has been one of my biggest referrals. The pastor that married my wife and I — he, for a long time, was a big referral but he ended up moving to a different city so your referrals sometimes leave.

Then the rest are just kind of a handful of people that I tend to connect with here and there.

As you take these steps, you’ll begin to get the flow of referrals.

Handshake photo available from Shutterstock

Deepan Chatterjee, Ph.D. <![CDATA[Goodbye, Ms. Singleton]]> 2015-11-24T23:02:13Z 2015-11-25T13:01:48Z I walk out of her room with a heavy heart. Her bed lies empty in the glow of the hot August sun creeping in through the blinds. Earlier, I had asked the CNA standing outside attending to the medicine cart, about Ms. Singleton. She had told me matter-of-factly, “She died last night in her sleep.”

I sit down on the plush sofa that lines the wall of the nursing home passageway. This one is my favorite – I sit and write notes on it, reflect about life, catch a moment’s breath from my busy day to exchange texts with colleagues and friends, and also daydream occasionally on it from time to time. Today there are tears in my eyes. Why can’t I control them? Why am I losing my focus as a clinician?

`I Am Your Psychologist’

I first saw Ms. Singleton almost five years ago. I was new to the practice and this was my first visit inside a nursing home in America. There she was, my second patient for the day, lying down on the bed with a pearly smile on her face. I had asked her my regular intake questions. She had answered all of them with her smile in place. Now and then, she had looked up into my eyes and asked me about what I do. “Are you a priest?” “No, Ms. Singleton, I had replied, I am your psychologist.”

Since that day, I had seen her everywhere in the nursing home. At the ripe old age of 95, she still did her own laundry every day.

She was also a bit delusional and called the police a couple of times because she thought 9-11 was an inside job done by Mr. Bush, our 43rd President. She could be very stubborn at times, not wanting to talk to me or to anyone for that matter.

She would tell me about her daughter and her son-in-law, and how hard it was for them to drive to see her anymore. She would narrate to me incidents from her childhood in Alabama, where her ancestors had been sharecroppers for generations.

She would tell me about her dreams, and even about her nightmares. She would often pause in the middle of a sentence to look up into my eyes, and say, “Doc, don’t fret over me. I’ll be okay.” She was proud, she was temperamental, she could be a pain in the butt sometimes, but she always wore that trademark smile of hers in place.

When I went to visit my folks in India last year, she was very depressed. She told me that she thought I would never come back to see her again. When I came back and saw her, she was relieved to no end, and gave me that million dollar smile of hers in no mean measure.

I am still sitting and thinking of her. I am feeling a deep pain somewhere in my heart today. I slowly wipe away my tears as I see the unit nurse walk up to me, “Doc are you ok? We need you to see Ms. Keith in Rm. 208. She is talking about killing herself.”

As I rise up to go to my patient’s room, I say a little prayer in my heart, “Goodbye Ms. Singleton. Hope you are smiling that heavenly smile of yours through all the clouds up there. “ And I swear I can hear a wavering 95 year African-American lady’s voice somewhere in the distance, “Doc, don’t fret over me. I’ll be okay. The show must go on……”

Elderly woman photo available from Shutterstock

Sharie Stines, Psy.D <![CDATA[The Two Sides of Alcohol]]> http://7.89 2015-11-25T05:00:27Z 2015-11-25T05:00:27Z bottlesofalcoholThe following speech, written my Mississippi state senator, Noah S. “Soggy” Sweat, Jr., in 1958, describes the contrasting views of alcohol, which have always existed and still exist today (Goodwin, 1981).

“My friends, I had not intended to discuss this controversial subject at this particular time. However, I want you to know that I do not shun controversy. On the contrary, I will take a stand on any issue at any time, regardless of how fraught with controversy it might be. You have asked me how I feel about whiskey. All right, this is how I feel about whiskey:

If when you say whiskey you mean the devil’s brew, the poison scourge, the bloody monster, that defiles innocence, dethrones reason, destroys the home, creates misery and poverty, yea, literally takes the bread from the mouths of little children; if you mean the evil drink that topples the Christian man and woman from the pinnacle of righteous, gracious living into the bottomless pit of degradation, and despair, and shame and helplessness, and hopelessness, then certainly I am against it.

But, if when you say whiskey you mean the oil of conversation, the philosophic wine, the ale that is consumed when good fellows get together, that puts a song in their hearts and laughter on their lips, and the warm glow of contentment in their eyes; if you mean Christmas cheer; if you mean the stimulating drink that puts the spring in the old gentleman’s step on a frosty, crispy morning; if you mean the drink which enables a man to magnify his joy, and his happiness, and to forget, if only for a little while, life’s great tragedies, and heartaches, and sorrows; if you mean that drink, the sale of which pours into our treasuries untold millions of dollars, which are used to provide tender care for our little crippled children, our blind, our deaf, our dumb, our pitiful aged and infirm; to build highways and hospitals and schools, then certainly I am for it.

This is my stand. I will not retreat from it. I will not compromise.”

Reference:  Goodwin, D.W. (1981). Alcoholism: The Facts. New York: Oxford University Press

Heather Gilmore, LLMSW <![CDATA[BCBA Exam Study Topics: Intervention Strategies]]> http://3.552 2015-11-24T21:39:18Z 2015-11-24T21:38:29Z

More BCBA Exam Study Info….

This post will be addressing some examples of intervention strategies that a Board Certified Behavior Analyst (BCBA) might use while working to help an individual increase his skills or decrease certain types of maladaptive behavior (Cooper, Heron, & Heward, 2007). See Cooper, et. al. (2007) for more information on the following topics.

Differential Reinforcement of Lower Rates (DRL):

  • Reinforcement on a full-session DRL schedule is provided when responding (specific target behaviors occur) during an entire session is equal to or less than a predetermined level (criterion).
  • On an interval DRL schedule, the session is separated into equal intervals (amounts of time) and reinforcement is provided at the end of each interval in which the number of responses during the interval was equal to or less than a predetermined level (criterion).
  • Reinforcement on a spaced-responding DRL schedule looks at the interresponse time (IRT). Reinforcement is only provided when the IRT (time between instances of the behavior/response) is at a minimum amount of time. Increasing IRT between instances of the behavior decreases the overall frequency or rate of the behavior leading to lower rates of the behavior.

Noncontingent Reinforcement (NCR):

  • NCR is when stimuli that are known to have reinforcing properties are presented on a fixed-time (FT) or variable-time (VT) schedule regardless of the behavior of the individual.
  • 3 procedures of NCR
    • Positive Reinforcement (ex: providing attention)
    • Negative Reinforcement (ex: providing escape from tasks)
    • Automatic Reinforcement (ex: without social mediation; sensory experiences)
  • An NCR schedule may serve as an abolishing operation (AO) in regards to decreasing the likelihood of engaging in problem behavior. Since the individual will already be receiving the reinforcement they were receiving for problem behavior, they may have less motivation for engaging in a maladaptive response.

Reference: Cooper J.O, Heron T.E, Heward W.L. (2007). Applied behavior analysis (2nd ed.) Upper Saddle River, NJ: Pearson.

[Image Credit: Author: jolopes via Fotalia]

Miranda Palmer, LMFT <![CDATA[5 Important Tips for Prelicensed Therapists in Private Practice]]> http://4.691 2015-11-25T18:43:20Z 2015-11-24T15:00:15Z
  • Guest post by Rachel Moore, MA, MFTI. A huge thank you to Rachel for sharing these amazing tips.
  • 5 Important Tips for Prelicensed Therapists in Private Practice

    Being a prelicensed therapist can be hard. In many states, after completing your master’s degree, you are required to work in a supervised environment for a few thousand hours before being allowed to sit for marathon licensing exams. Whew!

    For many of us, therapy also is a second career. It can be humbling to be a middle-aged “intern,” with all that word implies. It is also disheartening, in my opinion, that many therapy internships are unpaid.

    That’s why a private-practice internship can be a good option for prelicensed therapists. Private-practice interns can earn money and also build up a clientele that may carry over after they’re licensed.

    I have been registered with the Board of Behavioral Sciences in California as a Marriage & Family Therapist Intern since 2013. I earn my hours at a nonprofit agency as well as private practice.

    There are a few important things to know if you are a prelicensed therapist considering private practice or if you are at a private practice now:

    1. Find a Good Fit

    After you’ve graduated and waited for the state to process your internship registration, it can feel like the pressure is on to start earning hours right away. It is important to choose your internship site carefully, however, especially when it comes to private practice.

    As a friend and fellow prelicensed MFT puts it: “One thing I found to be a big deal was choosing a practice that is in the area of town that you want to work. I know that sounds obvious, but I think it can be tempting to take whatever private-practice opportunity you are presented with.”

    Besides location, a good connection with your supervisor is vital. “It’s so important to find someone that encourages you and is willing to work with you and teach you, versus someone who is demanding and adds too much pressure,” my MFT intern friend says. “I would say make sure your supervisor is not just about the money.”

    How do you find a good supervisor? Here are some questions to ask a potential employer: What is your purpose in having an intern? Have you had other interns before; what has that experience been like? What do you expect of your interns (for example, how many clients do you want an intern to have within the first 6 months)? How will I get clients; will you give me referrals or do I need to generate most or all of them myself? What will my pay structure look like? (In California, private-practice interns must also be employees and receive the equivalent of minimum wage for the hours they work.)

    Some of the places private-practice internship opportunities can be found are Craigslist (really!), online job boards, school connections, Facebook groups for therapists, and a helpful website that launched recently:

    2. Know the Rules

    It’s key to know what all of the rules are in your state for prelicensed therapists. For example, California has something called the “6-year rule” for Marriage & Family Therapist Interns. This means the state board won’t accept internship hours that are more than 6 years old (there are certain exceptions regarding hours earned during school).

    If you take longer than 6 years to complete your hours, you must apply for a second (subsequent) intern registration number to continue accumulating hours. However, you are not allowed to work in private practice in California if you have a subsequent intern registration number. This can be heartbreaking for prelicensed therapists who have to walk away from their practices.

    It is important to make sure you know your state’s rules and expectations before you start building your private practice, and these rules can be easily found online through your state’s licensing board.

    3. Decide If You Also Want to Work at an Agency

    Most of the hours I’ve earned so far have been from my volunteer internship at a local nonprofit hospice. I love the work there, and I’m able to arrange my schedule and appointments around my private-practice job. The downside of working at hospice is I don’t get paid (fortunately, my husband’s income covers most of our expenses).

    A prelicensed social worker friend of mine has found an internship at a hospital that does pay her. She says this is helpful because she’s able to build her clientele at private practice without having to rely on private-practice work as her only means of financial support.

    I personally only know of one prelicensed therapist who works full time at a private practice. In most cases, a private-practice internship will help you build a client base but it probably won’t pay all your bills. It’s important to decide what your purpose will be for working in private practice.

    4. Mind Your Marketing

    I love doing marketing. I know that’s not a typical thing for a therapist to say. I like connecting with people, though, and when I can use my creativity to do that it feels even better.

    We need to let our ideal clients know about us if we’re going to work with them. It’s as simple as that. I don’t want to convince people who wouldn’t be a good fit that they should see me, but I do need to be visible enough that my ideal clients will find me.

    One of the things I’ve done to help myself and other clinicians is create a marketing group for fellow healers. We meet about once a month to share ideas and support. I encourage you to reach out to others. Marketing isn’t scary, although it can sometimes feel scary to put yourself out there. It helps to know you’re not alone.

    Check with your state’s rules about how to market yourself as a prelicensed therapist. For example, in California we must spell out “Marriage & Family Therapist Intern” if we use the initials “MFTI” in our advertising. Also, your supervisor may be obligated to provide certain marketing materials such as business cards and a website.

    A couple of popular online therapist directories are Psychology Today and Good You may also consider creating a Facebook page and/or a Twitter account. Again, please be mindful of the advertising rules in your state.
    There are many good resources out there, including, to help prelicensed and licensed therapists with business issues and marketing. I also recently heard Casey Truffo, creator of Be a Wealthy Therapist, say it’s good to network with other businesses your ideal clients use. For example, I like to work with artists, so it might be good for me to put up a flier at my local art supply store.

    5. Don’t Give Up!

    As one of my now-licensed MFT friends puts it: “Be reasonably humble but don’t short-sell yourself. Lots of interns can be better therapists than people who’ve been licensed for years. They’re inspired, motivated, and have often had the most recent training.”

    If you’re feeling like private practice isn’t for you, please go back to tip No. 1 and see if there might be an internship site that is a better fit. Or if you’re not getting the amount of clients you want, understand that ebb and flow is a normal part of private practice. Look again at tip No. 4 and see if you can ramp up your marketing with the support of your supervisor.

    This is your time to learn and grow, and it’s OK to be unsure or make mistakes. Let your experiences as a prelicensed therapist serve you and allow you to feel more empathy with your clients who may be struggling through similar life transitions.

    Working as a prelicensed therapist in private practice can be scary, exciting, and richly rewarding. Please feel free to comment if you have questions or want to share your experiences. I wish you all the best in your current and future work!

    unnamed (1)Rachel Moore, MA, MFTI, is a registered Marriage & Family Therapist Intern in San Diego who works in hospice and private practice. Rachel was a newspaper copy editor for 14 years in her former life. She now specializes in helping artists, writers, and musicians overcome creative anxiety and increase self-esteem. If you are interested in Rachel’s groups and upcoming events or would like more information about her therapy services, please visit:


    Christine Hammond, MS, LMHC <![CDATA[How to Survive the Holidays with an Addict]]> http://5.418 2015-11-24T14:23:24Z 2015-11-24T14:23:24Z AddictAddicts plus holidays usually equal disaster. This is because addicts have a tendency to divide family at a celebration, not unite. Relatives fall into one of three categories: those who see the addiction and have no tolerance, those who see the addiction and tolerate it, and those who don’t see the addiction at all.

    An addict will take the path of least resistance and be charming with the last two categories while ignoring the first. This divides the parties’ even further causing tension amongst the relatives. When the bickering starts, the addict slips away having made the celebration about them without receiving any direct confrontation. In the end, only the addict is satisfied.

    But it doesn’t have to be that way again. There is a better way of surviving the holidays with an addict.

    Sensible expectations. Review the addict’s past behavior during celebrations. Take notice of any discernable pattern. This is the best estimate as to how the addict will behave in the future. Don’t set expectations that somehow things will be different this year that type of thinking will only lead to disappointment. Rather, see the pattern for what it is and expect the manipulation, excess, arrogance, deceitfulness, and rudeness. Then, determine what will and will not be tolerated.

    Secure consensus. Discuss the expectations with each attendee, including those who follow into the second two categories. The first category will be willing to set boundaries. The second category will go along to keep the peace. But it will not be possible to get the last category to see things differently. Instead, help them to understand that the first two categories have made a decision and everyone would appreciate their silence on the matter.

    State boundaries. Prior to the event, have a discussion with the addict about the expectations. Let them know a consensus has already been reached and there will not be any lenience. This discussion is likely to spark anger in the addict. They will be furious that a conversation about them is happening behind their back. Stay calm, don’t respond with any emotion. Use only logic, simple statements, and limit the dialogue time. They will test what is being said by confronting the last category of relatives, so prepare them ahead of time.

    Snub self-centeredness. During the celebration, the addict will act as if nothing is wrong and attempt the same old pattern again. Pull them aside and gently remind them of the boundaries. Then immediately change the group conversation to something everyone enjoy or suggest a group game. Playing a game together keeps the addict from making the conversation about them or their interests. This simple act can highlight the addictive behavior even further as the addict continues to seek attention. By the end of the event, some of the second category of relatives will have moved to the first group.

    Surviving the holidays with an addict is all about strategy. Don’t allow their addiction to become the center of the celebration again this year.

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

    Steve Greenman, MA, LPC, NCC <![CDATA[How to Create Happier Relationships Through Couples Counseling Part Two]]> 2015-11-23T18:57:06Z 2015-11-24T12:56:39Z

    “A happy marriage is a long conversation which always seems too short.”
    Andre Maurois

    The first installment on this topic revolved around creating new principles, goals and objectives that gives the couple a chance for success in finding the underlying causes that create the rift in their relationship.

    We also discussed the primary role for the therapists in guiding the conversation in session to help couples improve communication and review how the couple was progressing in sustaining the new principle, goals and objectives to breathe new life into the relationship.

    In Part 2, we’ll review the importance of the individual behaviors in the relationship and the effort, time and compromises one must be willing to make.

    When an individual reaches out in therapy to upgrade his/her relationship, that person must respect his mate and be honest with himself.

    Time, Trade offs and Compromises

    To create the relationship you really desire, there will be some difficult trade offs and tough choices for each person.

    The first trade off will be time. It simply takes time to create a relationship that flourishes: time to be together, time to be with family, time to play, coordinate, nurture, relax, hang out and plan. This time will encroach on some other valuable areas – your personal or professional time.

    The second compromise is comfort. That means emotional comfort, like going out on a limb to try novel ways of thinking or doing things, listening and being curious instead of butting in, speaking up instead of becoming resentfully compliant or withdrawing

    At the beginning, there will be emotional risk taking action, but you will never explore different worlds if you always keep sight of the shoreline. In addition, few people are emotionally comfortable being confronted with how they don’t live their values or being confronted with the consequences of their actions.

    The other comfort that will be challenged is energy comfort. It simply takes effort to sustain improvement over time: staying conscious of making a difference over time, remembering to be more respectful, more giving, more appreciative etc. It takes effort to remember and act.

    The other effort is even more difficult for some people: that is improving their reaction to problems.

    For example, if one person is hypersensitive to criticism and his/her partner is hypersensitive to feeling ignored, it will take effort to improve their sensitivity instead of hoping the partner will stop ignoring or criticizing.

    In all these areas, there is generally a conflict between short-term gratification and the long-term goal of creating a satisfying relationship.

    The blunt reality is that, in an interdependent relationship, effort is required on the part of each person to make a sustained improvement. It is like pairs figure skating – one person cannot do most of the work and still create an exceptional team.


    • You can’t create a flourishing relationship by only fixing what’s wrong. But it’s a start.
    • Grace under pressure does not spring full-grown even with the best of intentions – practice, practice and more practice. Practice the right things and you will get there.
    • Love is destroyed when self-interest dominates.
    • If you don’t know what you feel in important areas of your relationship, it is like playing high stakes poker when you see only half your cards. You will make a lot of dumb plays.
    • The possibility exists that we choose partners we need but don’t necessarily want.
    • To get to the bottom of a problem often means you first accept its complexity.
    • Trust is the foundational building block of a flourishing relationship.
      You create trust by doing what you say you will do.
    • It’s impossible to be in a highly inter-dependent relationship without ever being judgmental or being judged.
    • If you strive to always feel emotionally safe in your relationship and get it, you will pay the price by becoming dull
    • If neither of you ever rocks the boat, you will end up with a dull relationship
    • Knowledge is not power. Only knowledge that is applied is power.

    Most of the ineffective things we do in relationships fall into just a few categories:

    • Blame or attempt to dominate
    • Disengage/withdraw
    • Resentful compliance
    • Whine
    • Denial or confusion.
    Kelly Higdon, LMFT <![CDATA[Financial Planning in Private Practice with Mary Beth Storjohann]]> http://4.674 2015-11-23T22:17:50Z 2015-11-23T22:17:21Z descarga (14)

    Maybe you have your tax planning, retirement, disability coverage and cash flow all figured out. But if you don’t, this is for you. This is to encourage you to start learning, even in baby steps. I (Kelly) used to find this stuff intimidating. So I’ve reached out for support and every year, it gets better. I don’t feel so fearful and I know what is currently going on in my business while I am reaching new personal and professional financial goals.

    This podcast is all about the common misteps therapists make in private practice and what they can do to ensure a stable financial future.

    Thanks to Mary Beth Storjohann, CFP, Founder of Workable Wealth for this interview. Mary Beth also provides support in our bootcamp as well and we appreciate her so much!

    Ps. Pardon our appearance – it was super hot!

    Steve Greenman, MA, LPC, NCC <![CDATA[How to Create Happier Relationships Through Couples Counseling Part One]]> 2015-11-23T18:56:07Z 2015-11-23T18:56:07Z Couples are often uncertain what to expect from the process of couples therapy. Most couples approach therapy with the notion that each person will describe their distress and somehow the therapist will assist them to create a happier, more functional relationship.

    However, most people hope their partner will do most of the learning in problem areas.

    What is soon discovered is that the therapist does not have a magic wand and one has to look within themselves to find answers to the problems within the relationship for effective healing.

    Guidelines That Can Make Counseling More Effective

    Experienced therapists have evolved principles, goals and objectives that give them the greatest chance for success in finding the underlying causes of the rift in the couple’s relationship. The primary role for the therapists is to help couples improve communication as well as set goals and objectives for the couple to discuss and ponder:

    • The kind of life they want to build together
    •  The kind of partner they aspire to be in order to build the kind of life and relationship they want to create.
    • Reviewing individual blocks to becoming the kind of partner they aspire to be.
    • The skills and knowledge necessary to do the above tasks.
    • A vision of the life you want to build together
    • To have a life separate from your partner because you are not joined at the hip
    • The appropriate attitudes and skills to work as a team
    • The motivation and patience to persist
    • Time to review progress. To create the relationship you really desire, there will be some difficult tradeoffs and tough choices for each person.

    Important Concepts for Couples Therapy and Relationships

    The following concepts can help couples identify areas of focus to work on outside the sessions. Real healing comes from the amount of work the couple is willing to put in separately and together putting into practice what was shared in session.

    Attitude is Key

    When it comes to improving your relationship, your attitude toward change is more important that what action to take.

    Identifying what to do and how to do it is often easy to identify. The bigger challenge is why you don’t do it.

    How to think differently about a problem is often more effective than just trying to figure out what action to take.

    Your partner is quite limited in his/her ability to respond to you.

    You are quite limited in your ability to respond to your partner.

    Accepting that is a huge step into maturity.

    The definite possibility exists that you have some flawed assumptions about your partner’s motives and that he/she has some flawed assumptions about yours. The problem is most of the time we don’t want to believe our assumptions are flawed.

    Focus on Changing Yourself Rather than Your Partner

    Couples therapy works best if you have more goals for yourself than for your partner. Problems occur when reality departs sharply from our expectations, hopes, desires and concerns. It’s human nature to try and change one’s partner instead of adjusting our expectations. This aspect of human nature is what keeps therapists in business.

    Raj Persaud, FRCPsych, M.Sc M.Phil <![CDATA[Psychology Of How War With Islamic State Becomes A Just War]]> 2015-11-21T19:58:22Z 2015-11-22T12:57:48Z

    Do leaders use psychology when justifying military action to their electorate?

    A leading authority on deciding whether a war can be ‘just’ explains whether the Western fight against Islamic State, is indeed a ‘Just War’ and to what extent psychology is involved in how we get involved in ‘just wars.’

    Is this battle being sold by politicians to the public as ‘just’ or ‘moral’, exploiting the understandably strong emotions in the wake of the Paris atrocities, when, in fact, a more dispassionate analysis might suggest it’s still possible such a conflict could escalate into an unjust war?

    Do we need to understand the psychology of anger and rage about the terrible and murderous attacks in Paris in order to see through the propaganda from both sides, and come to a clear conclusion?

    Does an attempt at a more reasoned analysis about a war against Islamic State seem provocative and unfeeling, when our emotions are understandably heightened following the sorrow and grief of the Paris victims?

    Does the natural need for retaliation and revenge involve a psychological reaction to feeling vulnerable?

    Do we seek military solutions to re-establish a sense of power and control? But might the craving for a temporary ‘psychological fix’ end up causing more problems, and yet even more innocent victims, on both sides, in the longer term?

    Who Decides a War is Just?

    Nicholas Fotion, professor of philosophy at Emory University in Atlanta has published a book entitled, “War and Ethics – a New Just War Theory,” published by Bloomsbury Atlantic and a chapter entitled ‘Just War Theory’ in the ‘Encyclopaedia of Applied Ethics.’

    Professor Fotion points out arguments over whether a war is just seem to have existed perhaps as long as wars have endured.

    In a sense, both sides always believe their fight is ‘moral’ or just, but who, in fact, is right when it comes to deciding that a war is ‘just’, and how can we work this out definitively for ourselves?

    Professor Fotion argues that attempts to define a ‘just war’ date back to Confucius (552–479 BC). In a surprisingly prophetic analysis, which appears to have anticipated current parts of the Middle East conflict, when asked what to do if a rebellion break outs in a province of a country, Confucius declared that an emperor should dispatch virtue rather than soldiers.

    The ancient Chinese philosopher was arguing that a ‘just’ response to a conflict requires a coherent analysis as to causes.

    Confucius was contending that as rebellion most likely was triggered by exploitation and brutality from local leaders, the remedy then was not to inflict even more harm by crushing the rebellion, but rather, to replace bad rulers with virtuous ones.

    Deciding whether Western military intervention in the Middle East is just, partly hinges on your view of whether the West installs one bad leader after another, with little concern on the impact on local populations. Or whether in the long run, corrupt governance is replaced with better.

    This outcome of such warfare crucially determines whether battles like this are ‘just.’

    Joseph R. Sanok, MA, LLP, LPC, NCC <![CDATA[How to Handle a No Show]]> 2015-11-21T00:37:06Z 2015-11-21T11:36:35Z

    We’ve all had no shows or late cancellations. How should you handle this?

    At the heart of a no show is the question “What are we worth?”

    Whether you have a full private practice or a struggling one, ultimately, that time that you set aside for that person you didn’t take on new clients. Even if you’re not busy, you had the potential to take someone on during that time. What’s the standard you want to set for yourself?

    I charge my full rate if someone no-shows, unless there is a car accident or someone’s really sick.  I have the 24-hour notice clause that they have to give me at least 24-hour notice so that I can try to fill it.  At the heart of it is that I could have filled that counseling session with somebody else and so why would I get $20 for showing up, for being here or for keeping that spot open if I could have filled it with a full rate client?

    Accountability of a Counseling No Show

    I found that I have a very low no show rate when someone does have to pay for their no show or their late cancellation. Now, there are times where someone calls the morning of. You can choose whether you’re going to be completely rigid and completely consistent or not. I don’t do it like based on client. “Oh, I like that person or not.” That’d be obviously unethical.

    I think that there are situations when people say the week before, “Oh, my daughter might have volleyball that night. We’re going to have to let know.” Then you know ahead of time, “Okay, they might cancel the last minute or they might not.”

    You then take on that risk, as well. I think charging the full rate really helps the client realize that you are busy or you have the potential to be busy and that someone else could have had that session.

    Logistics of a No Show Policy

    The way the logistics work is within my intake, I mention it. I also have it in my intake paperwork that they sign off that they’ll be charged the full rate. I don’t keep a credit card on file. Some people do that, but overall it’s seen as a best-practice to not keep it on file.

    If someone then no shows, then in the next session, I charge. I may also email them ahead of time. If it’s a brand-new client, though, I don’t charge them for that because if you think of it from a sales perspective, you don’t want to start that therapeutic relationship or that business relationship on the wrong foot. 

    I may mention that I just wanted to let you know that typically with that no show or in the first session you need to cancel the hour before, I will have to charge you that full rate in future sessions. I just wanted to remind you of that and I’ll waive that this first time because you just don’t want to start that therapeutic relationship on the wrong foot and you don’t want to start them being double out-of-pocket even though you could have filled that session.

    Why it Works

    I found that when someone has to pay for that no show, it really reminds them, especially the teenagers with whom I work. I’ve had teenagers that just totally flaked out and their parents say, “You have to pay the full rate. I’m not going to pay it.”

    Then, maybe that teenager had to work for a number of hours–it might even equal a full day’s work that they are paying. As a result, they take counseling a lot more seriously. I mean, if you no show on a doctor, you no show on a plumber or you no show on your furnace person, you have to pay him.

    Here are some quick tips to improve your no show/late cancellation policies:

    • Have your policy in your welcome email
    • Have a written policy on the intake
    • Charge your full rate
    • Make it easy to pay via online payment
    • Practice your explanation
    • Tell yourself, “Every medical professional does this.”

    Why would we change and change our expectations for people that are coming to us that want to reach their goals? Why would we be less holding them accountable? Those are my thoughts on no shows.

    Man looking at his watch photo available from Shutterstock

    Sharie Stines, Psy.D <![CDATA[Attachment Trauma]]> http://7.84 2015-11-21T07:26:45Z 2015-11-21T07:26:45Z teddybearDuring the early developmental years of an infant and young child’s interpersonal life is the need for intersubjectivity.  Intersubjectivity involves the infant and parent’s discovery of each other, and the development of the self in relationship with the other.  The intersubjectivity experience in a securely attached child is what creates an integrated self.  Without a secure attachment relationship with a parent then a person develops a fragmented self, incapable of properly engaging in healthy interpersonal relationships.  Primary intersubjectivity involves a here-and-now person-to-person relationship.

    Affect (emotional) attunement is shared affect and is one component of intersubjectivity between two persons.  Two other components of intersubjectivity are shared attention and shared intentions.  Both parent and child are involved in a congruent state of experience.  Attunement creates connection between the two individuals by ensuring that each person feels a co-occurring experience of acceptance, value, and enjoyment.  In order for a child to develop well, he needs to have a positive impact on the important people in his world.

    When a child is neglected, ignored, and not attuned with in some way then he/she feels and concludes that “I am not interesting, not special, and not lovable.”  This is the end result of attachment trauma.  When this experience recurs over and over again the child develops a deep sense of shame and rage.  Over time, when a child does not have sufficient restorative or correcting experiences with the parent, the shame never gets resolved and the child develops neither the ability to experience guilt nor empathy.

    When a child has been subject to attachment disruption, neglect, or abuse, then he has not learned how to trust others, how to love, and how to develop an integrated self.  He has deep seated shame that permeates his sense of self, which if not corrected, can develop into psychopathology.  Children and adults who do not have healthy intersubjectivity with a parent, particularly a mother, as a young child, are incapable of experiencing remorse when they hurt others.  Guilt and empathy emerge only within the context of attachment security.

    If you are a foster parent, therapist, step-parent, or some other significant person in a child or adult’s life who suffers with attachment trauma, be prepared to understand that your life will be difficult.  The person suffering with attachment trauma cannot have a healthy relationship with anyone, particularly someone in a close, intimate context.  Be prepared to realize that the suffering person will display the following behaviors:

    • Have a strong need to be in control at all times
    • Will resist comforting, affection, and experiences of mutual enjoyment
    • Will be highly manipulative causing others (and yourself) to doubt your good intentions
    • Will use people like objects and will use people for what they can give to them (are very utilitarian in relationships)
    • Can be extremely oppositional
    • Have no sense of guilt, remorse, or regret for wrongdoing
    • Will sabotage all or most events involving enjoyment with others or between others
    • Will steal, lie, bully, hurt, and destroy
    • Cannot connect to others emotionally and can easily walk away from significant relationships
    • Have no insight
    • Cannot feel sadness, but rather, feels self-pity and pouts
    • Is very manipulative

    If you are involved with a person exhibiting the above listed traits, then be warned to educate yourself and arm yourself with knowledge and personal therapy so that you will not personalize or react to this person in ways that will cause you to lose your own sense of self.  Make sure you have resolved all of your own childhood attachment issues with your own parents.

    When raising a child with attachment trauma, it is important that you run a tight ship and keep the child in close proximity to you at all times, always providing empathy, strength, humor, kindness, and firmness.  Be aware that other people will not understand the continual manipulation strategies the child uses and will most likely question your parenting.  It is important for you to be strong enough to understand that other people just have no idea about the nature of the work you must constantly accomplish in order to raise a child with attachment trauma, and you must realize that in many ways you stand alone.  In fact, others may openly challenge you, believing that you are too hard on the child; this happens because of the masterful manipulators these individuals are.

    To help these children (and adults), you must provide the attachment experiences that they did not have in those early developmental years.  You do this by holding them accountable, mirroring (reflecting) their words and behaviors consistently, and by not allowing them to manipulate you or others.  You must be willing to call them on their manipulations and behaviors and teach them how to interact in a family in a healthy way.  This job is tough and requires consistent love.  Never yell at them or look at them without empathy.  If you are unable to do this momentarily then remove yourself from the situation until you are ready to do so.

    Steve Greenman, MA, LPC, NCC <![CDATA[Recognizing Symptoms Leading to Relapse]]> 2015-11-18T00:12:22Z 2015-11-19T12:27:19Z Even though it is up to the individual to maintain the disciplines that insure sobriety, other people can help.

    Nearly every person close to an alcoholic is able to recognize behavior changes that indicate a return to old thinking.

    Often these individuals and fellow A.A. members have tried to warn the subject, who by now, may not be willing to listen. He/she may consider it nagging or a violation of his/her privacy.

    Warning signs abound. Most alcoholics, if approached properly, are willing to go over an inventory of symptoms periodically with a spouse or other confidante.

    If the symptoms are caught early enough and recognized, the alcoholic will usually try to change his/her thinking, to get “back on the beam” again.

    A weekly inventory could prevent some relapses. This added discipline is one, which many alcoholics seem willing to try.

    Following is a list of common symptoms leading to “dry-drunk,” to possible relapse or, to what A.A. commonly calls “stinking thinking.”

    • Exhaustion – Some people allow themselves to become overly tired or in poor health. Some alcoholics are also prone to work addictions; perhaps they are in a hurry to make up for lost time. Good health and enough rest are important. If you feel good, you are more apt to think well. Feel poor and your thinking is apt to deteriorate. Feel bad enough and you might begin thinking drinking couldn’t make it any worse.
    • Dishonesty – This behavior begins with a pattern of unnecessary little lies and deceits with fellow workers, friends and family. This symptom is called rationalizing – making excuses for not doing what you do not want to do, or for doing what you know you should not do.
    • Impatience – The individual thinks that things are not happening fast enough or others are not doing what the alcoholic wants them to do.
    • Argumentativeness – Arguing small and ridiculous points of view indicates a need to always be right. “Why don’t you be reasonable and agree with me?” It could be looking for an excuse to drink?
    • Depression – Unreasonable and unacceptable despair may occur in cycles and should be dealt with and talked about.
    • Frustration – This reaction is directed at people and also because things may not be going the person’s way. Remember – everything is not going to be just the way you want it.
    • Self-Pity – “Why do these things happen to me?” “Why must I be alcoholic?” Nobody appreciates all I am doing (for them)!”
    • Cockiness – A feeling of “I’ve got it made and no longer fear alcoholism”–could lead to going into drinking situations to prove to others they have no problem. Do this often enough and it will wear down defenses
    • Complacency – “Drinking was the farthest thing from my mind.” Not drinking is no longer a conscious thought. It is dangerous to let up on disciplines because everything is going well. To have a little fear is always a good thing. More relapses occur when things are going well than otherwise
    • Expecting too much from others – “I’ve changed; why hasn’t everyone else?” It’s a plus if they do, but still your problem if they do not. They may not trust you yet and may be still looking for further proof. You cannot expect others to change their lifestyles just because you have.
    • Letting up on disciplines – Prayer, meditation, daily inventory, A.A. attendance. Either complacency or boredom can be a cause. An alcoholic cannot afford to get bored with the program. The cost of relapse is always too great.
    • Use of mood-altering chemicals – The person may feel the need to ease things with a pill and the doctor may go along with it. Chemicals other than alcohol may not have been a problem in the past, but people can easily lose sobriety starting this way. It is about the most subtle way to have relapse. The reverse of this situation is true for drug-dependent people who start to drink.
    • Wanting too much – It’s important not to set goals too high and to take one step at a time and keep long distance goals flexible.

      ]]> 0 Christine Hammond, MS, LMHC <![CDATA[Having a Nervous Breakdown?]]> http://5.412 2015-11-19T10:36:37Z 2015-11-19T10:36:37Z Nervous BreakdownOne minute everything seems fine. Then in a flood of intense emotion and erratic thoughts, it all changes. Life becomes a distorted kaleidoscope, with nothing familiar from before. Even speaking is difficult. It is impossible to explain what is happening because the event is so unlike anything experienced prior.

      In the past, the term nervous breakdowns described such an event. But this is not a diagnosable disorder; rather it is a cultural euphemism. Instead there are three main possibilities for the condition described above. Each has unique characteristics and very different treatments.

      Panic Attack. One possibility is a panic or anxiety attack. For a person never experiencing this event, it can seem similar to the symptoms of a heart attack. The sudden onset of intense fear usually reaches a peak within minutes. Initially, most are unable to identify the fear that caused the event. It is only after some counseling that the trigger can be recognized and properly addressed. Other symptoms include:

      • Pounding heart
      • Sweating
      • Trembling or shaking
      • Shortness of breath
      • Feelings of choking
      • Chest pain
      • Nausea
      • Dizziness
      • Chills or heat sensations
      • Numbness or tinging sensations
      • De-realization or depersonalization
      • Fear of losing control
      • Fear of dying

      It is important to rule out a medical condition first, so see the help of a physician immediately. Once the physical symptoms have subsided and there is no finding other than a panic attack, seek the help of a counselor to discover the cause. Untreated attacks can lead to an increase in the duration, frequency and intensity.

      Manic Episode. Another possibility is a manic episode which may or may not be part of Bi-Polar Disorder or another type of depression. Unlike a panic attack, periods of mania tend to be longer lasting and have less panicky physical symptoms. Rather, the episode creates a larger than life impression. For a person experiencing this for the first time, it can increase anxiety so some of the symptoms of a panic attack could also be present. The main characteristics of mania are:

      • Intense feelings of euphoria
      • Fast speech, talkative
      • Racing thoughts
      • Impulsive and “high-risk” behaviors: shopping, gambling, sex
      • Insomnia or feels rested after three hours of sleep
      • Ideas of grandeur: can do anything
      • Easily distracted
      • Increase in goal-directed activity
      • Discernable pattern of episodes

      It is best to see a psychiatrist to get a proper diagnosis of manic depression. The good news is that this condition is can be successfully treated with medication. This is a brain chemistry issue and not a manifestation of intense fear or anxiety.

      Brief Psychotic Episode. The last possibility is a brief psychotic episode. While the name may sound a bit intimidating, the condition is more common than realized. This does not mean a person has a psychotic disorder, although it might be an indicator of one. Usually this lasts for a couple of hours to several days but not longer than a month. It has the following symptoms:

      • Delusions (beliefs without any basis in reality)
      • Hallucinations (hearing voices or seeing things that are not actually present)
      • Disorganized speech
      • Severely disorganized or catatonic behavior
      • No discernable pattern of episodes

      To receive the best diagnosis, it is good to be treated in a mental facility for this condition. A combination of medication and rest might be just what is needed. Anyone can have a one-time episode; it is not a sign of weakness in any way.

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

      Rev Sheri Heller, LCSW <![CDATA[Geopolitics and the Psychopath]]> 2015-11-18T00:11:39Z 2015-11-18T12:11:11Z

      “A small proportion of people who suffer from psychologically abnormal personalities have, throughout history, had an immeasurable detrimental impact on our societies, our politics and our world. Enabled by their ruthlessness to readily acquire positions of power, they have long dominated the psychologically normal majority of the world’s population.”
      Ian Hughes

      In the aftermath of the Paris massacre, I find myself pondering the surreal state of the world and the myriad humanitarian disasters and violations of international law infiltrating the globe.

      War crimes in Iraq, Gaza, Syria and Libya accompanied by air strikes, bombing raids and regime changes have become routine.

      The genocide in Yemen, albeit a humanitarian catastrophe, receives little media attention.

      U.S. led propaganda and harsh sanctions have economically destabilized Venezuela, conceivably as a prelude to invasion.

      Governmental looting of pensions and savings has begun, devastating retirees and their surviving spouses while corporate moguls earn 380x more than the average wage earner.

      It has always been this way irrespective of ideology, theology, or philosophy. The brutality of war and suffering are historical realities.

      Human Evil

      In distress I turn to my chosen field of psychology for answers. I am led to realize that in this geopolitical landscape, driven by the quest for political domination and exploitation of world resources, it is increasingly imperative that the layperson acquires a basic psychological comprehension of human evil, in order for any of this to make a modicum of sense.

      In “Religion Within the Boundaries of Mere Reason” philosopher Immanuel Kant makes the claim that evil is innate to the human species. According to Kant, self-conceit is the designated egoistic trait responsible for moral corruption.

      An extreme propensity for evil has been referred to by psychiatrist Hervey Cleckley, in his seminal book “The Mask of Sanity,” as a neuropsychiatric defect that fuels the need to destroy. Cleckley’s psychological perspective identifies a measure for evil as psychopathology.

      Wikipedia defines psychopathy as a personality disorder characterized by enduring antisocial behavior, diminished empathy and remorse and disinhibited or bold behavior.

      They are conscienceless and calculating and ruthlessly driven to acquire power and control. Psychopaths command compliance and obedience so as to actualize their agendas.

      Accordingly, they are encouraged by the absence of critical thought, and the reliance on primitive psychological defenses of those they seek to control. Moreover, research using positron emission tomography (PET) indicates that one of the primary causes of psychopathic behavior is believed to be neurological abnormalities in the frontal lobe of the brain.

      Cleckley purports that psychopaths present with a visage of normalcy.

      According to Cleckley the psychopath has the uncanny ability to conceal this ‘neuropsychiatric defect,’ stating, “they are disarming not only to those unfamiliar with such patients but often to people who know well from experience their convincing outer aspect of honesty.”

      We are deceived, even deluded by, the psychopath’s disguise of virtue, his glibness, ostensible calm, status and charm. The psychopath’s veneer of normality can be so seamless it becomes implausible to consider the malevolence behind the mask, even for trained clinicians.

      Political Ponerology

      Political Ponerology, coined by psychiatrist Andrzej Łobaczewski, is the study of institutional and government systems comprised of high-ranking officials presenting with psychopathic traits.

      Łobaczewski’s investigations focus on government in which absolute political power is held by a psychopathic elite and explains how an entire society can be ruled and motivated by purely pathological values.

      Łobaczewski emphasizes how psychopathic leaders’ “special psychological knowledge” of normal people enables them to manipulate and assert a hypnotic power over the masses. He explains, psychopaths have studied us and their ability to use our emotions against us deteriorates our cognitive abilities.

      B.F. Skinner’s work with operant conditioning tells us that what we learn is impacted by reinforcement and punishment/unpleasant consequence.

      A pattern of intermittent reinforcement establishes unpredictability and confusion. The psychopath capitalizes on this phenomenon. The victim’s mind scrambles in an effort to mitigate the distress and return to internal consistency.

      Eventually, cognitive dissonance sets in and the desperate urgency to discern a rhyme or reason becomes a driving force. At this point, the duped masses are caught up in an addictive cycle and come to view the psychopathic tormentor as the redeemer. Lobaczewski contends, the psychopath’s evil motivations masked by a humane ideology, further exacerbate confusion.