Psych Central Professional For mental health, psychiatric and psychological professionals. 2017-05-24T13:16:39Z Bret Moore, Psy.D. <![CDATA[Philanthropy and Innovation May Be Keys to Meeting the Mental Health Needs of Veterans]]> 2017-05-24T02:17:02Z 2017-05-24T13:16:39Z On previous occasions,I have written about the importance of incorporating non-governmental, non-profit and grassroots civilian organizations into the role of addressing the mental health needs of our veterans.  One organization in particular that I have written extensively about is Boulder Crest Retreat, a privately funded, non-profit, and veteran-founded and staffed wellness center in Bluemont, Virginia.  Boulder Crest Retreat was founded from the innovation and generosity of Ken Falke, a former Navy veteran, businessman, and philanthropist.

One of the more recent philanthropic players to make a significant impact on veteran mental health care is billionaire Steven A. Cohen.  Mr. Cohen is a highly successful investor and hedge fund manager who pledged more than $300 million dollars of his own money to address the needs of our Nation’s warriors.

Mr. Cohen has a vested interest in this cause as his son is a Marine who served in Afghanistan.  One of the most notable results from Mr. Cohen’s epic philanthropy is the development of the Cohen Veterans Network.  The Cohen Veterans Network is responsible for standing up free mental health clinics for veterans and their loved ones across the country.  The Network is directed by former Army enlisted Soldier and Air Force officer, Dr. Anthony Hassan.

Dr. Hassan has both a distinguished career in the military as well as academia.  To date, the network has multiple clinics up and running in Texas, New Mexico, Colorado, North Carolina, Philadelphia, and New York. Indeed, Cohen is having an impact on the services aspect of military mental health.  But, as importantly, he is also funding the often overlooked science component of psychological health.

The Cohen Veterans Bioscience is a research group looking to advance the prevention, detection and treatment of traumatic brain injury, post-traumatic stress disorder and related conditions. Overseen by successful clinical researcher and pharmaceutical executive Dr. Magali Haas, Cohen Veterans Bioscience plans to harness the promise of biotechnology for the broad goal of improving brain health.

The generosity of Cohen and the efforts of his teams come at an important time.  Our country has sent nearly three million men and women into harm’s way since the start of the Iraq and Afghanistan wars.  As a result, based on prevalence estimates, it is assumed that hundreds of thousands of veterans and service members struggle with significant psychological, neurological and physical issues.

Sadly, with hundreds of millions of dollars spent developing and refining treatments for PTSD, we have made relatively little progress.  Veterans have a few “good” talk therapies available to them, but they are far from cures. Even after successful treatment, many veterans continue to meet criteria for the PTSD diagnosis. And medications have even less of a successful track record.

As I have said many times before, we must turn to private-sector funding, research and innovation if we are to address the veteran mental health crisis that faces our country. If not, we risk being stuck in “good enough” mode and fail to adequately address the psychiatric needs of our veterans. Our veterans and their loved ones deserve better.

Organizations like Boulder Crest Retreat, Cohen Veterans Network and Cohen Veterans Bioscience are a significant part of our future with regard to improving the quality of life of those who bravely served our country.  And unless we come to terms with the numbers mentioned above and the limitations of our current treatments, the reality is that a generation of warfighters will be known as the ones who were plagued by psychological injury.  This does not honor their sacrifices or their true nature.

To learn more about Cohen Veterans Network and Cohen Veterans Bioscience, visit and


*A previous version of this article was published in Military Times as part of Dr. Moore’s column Kevlar for the Mind.

Jessica Dore <![CDATA[Yoga for Mental Health: Research Round-Up]]> 2017-05-24T02:16:18Z 2017-05-24T02:16:18Z Alternative Treatments for DepressionIt is no secret or surprise that practicing yoga can yield tremendous benefits for the body, mind and spirit. Luckily, the explosion of research supporting mindfulness-based therapies in the healthcare field has meant that more investigators are also looking into the specific benefits of yoga.

If you’re interested in or already actively incorporating yoga into your psychotherapy practice, staying up to speed on the latest evidence that supports the therapeutic applications of yoga is important. Here are some of the most recent studies showing the effectiveness of yoga programs for a range of mental health concerns including anxiety, PTSD, emotion regulation, and addiction.

A yin yoga and mindfulness program helped to decrease stress and worry and boost mindfulness.

 A new study published in this month’s issue of the international journal Anxiety, Stress and Coping found that just five weeks of a yin yoga and mindfulness program yielded significant reductions in stress and worry.

The program used in the study is called YOMI, which combines the words yoga and mindfulness and is a combination of psycho-education and physical practices of mindfulness and yin yoga. Yin yoga is a style of yoga that emphasizes slow and meditative practice as opposed to vigorous or aerobic, like some other styles.

 The study was conducted with a non-clinical sample of participants but found that after five weeks of the YOMI program, participants reported less stress and worry and more mindfulness. The improvements were sustained at a follow-up which took place after five weeks.

 Yoga was found to be effective as an adjuvant therapy for veterans with combat-related PTSD symptoms.

 A study published earlier this month in the journal Australian Psychiatry examined whether once weekly trauma-sensitive yoga sessions would have an impact among participants with combat-related post-traumatic stress disorder symptoms. Twenty-eight of the 30 recruited participants, who were a median age of 63, completed the protocol. 

 The study found a host of benefits including increases in the serum dehydroepiandrosterone concentration, a hormone which when diminished is associated with stress. The study also found decreases in the PCL score, the score from a 17-item self-report measure which assesses symptoms of PTSD according to the DSM-IV definition.

 The findings were consistent with the growing body of research that shows the effectiveness of yoga as a stress-reduction strategy.

 Sixth graders who participated in a yoga program were able to self-regulate, able to better manage stress, and did better in school.

 A dissertation study completed late last year sought to examine whether a school yoga program for sixth graders had had a significant impact on the students’ ability to self-regulate, manage stress and perform in school.

 The investigator surveyed parents and teachers of the 6th grade students in the district and found that students who participated were often able to self-regulate, to manage stress, and to engage academically in a range of settings and situations.

 Yoga was found to be a powerful tool in helping people to quit smoking.

 A study published in the Journal of Thoacic Oncology sought to determine whether yoga would enhance the likelihood of smoking cessation among those who were also receiving behavioral counseling.

 A total of 106 participants were offered behavioral counseling and about half were also offered twice weekly one-hour yoga classes which included meditation, breathing exercises and physical postures. At the completion of the study, participants who had done yoga in addition to counseling showed increased odds of abstaining from smoking over those who did counseling alone. Even after eight weeks, and then again after  12, those from the yoga group continued to show higher rates of abstinence.




The Carlat Psychiatry Report <![CDATA[Psychiatrist Burnout: Q&A with Thomas Skovholt, PhD]]> 2017-05-19T20:24:59Z 2017-05-21T13:24:27Z Burnout: A Primer Q&A with Thomas Skovholt, PhD TCPR: Dr. Skovholt, you’ve done plenty of research and writing on clinician burnout and how to avoid it. What are some of the key concepts that you think psychiatrists should understand?

Dr. Skovholt: One of the great challenges of being a therapist is that we have to form attachments to many clients, and then eventually those relationships often end for various reasons, perhaps because the patient no longer needs treatment or just drops out of treatment. We don’t want to become overly attached to all our clients, because that can be draining. But on the other hand, we don’t want to distance ourselves, because the essence of healing occurs within the caring relationship.

TCPR: You talk about the “cycle of caring.” Can you describe what you mean by that?

Dr. Skovholt: In all the relationship-intense professions, there often follows, for the practitioner, a 4-phase cycle. It starts with an empathic attachment phase, where each of us begins to form a bond with the client. We see our patients, we listen to their stories, and hopefully we empathize. Once that’s established, there’s an active involvement phase. This lasts for many sessions, and it is the main work of treatment—understanding problems, helping with solutions, prescribing medications if you are a prescriber. So far it is all plowed ground for practitioners; these phases are well worn and understood.

TCPR: Yes, these are the phases that probably constitute most of our psychiatric treatment.

Dr. Skovholt: That’s right, but many practitioners don’t pay enough attention to the next 2 phases. The whole goal here is to fiercely protect our capacity to professionally attach with our patients over and over again. So there’s a felt separation phase, in which the therapeutic relationship is ending. When that happens, you have to acknowledge that an important relationship is ending, and you don’t want this to be a negative experience. You might grieve a little if you are very close to the client, and that’s appropriate, but you don’t want to feel depleted. It’s important to reaffirm your own identity as a helper, because you’ll soon be coming up to the next phase, which I call the re-creation phase. You’ve said goodbye to a client, and now you move on to your next client. If you’re very busy, this can lead to a kind of burnout in which you just can’t face beginning the process of forming another intense attachment with a troubled soul. To avoid that kind of exhaustion, you need to consciously re-energize yourself. The felt separation phase and re-creation phase can be expressed in many ways symbolically, and their time duration may vary.

TCPR: It’s true that we often just take ended relationships for granted. What you’re saying is that we should be perhaps more conscious of the fact that when a patient stops coming, that may actually affect the degree to which we are willing to re-engage with a new patient?

Dr. Skovholt: Right, and it’s just really that kind of slow erosion process that can make it challenging over time to re-engage with new patients. As an analogy, consider the simple example of dating: One day you are in a personal relationship with someone, and abruptly that person breaks up with you and essentially disappears from your life. What impact does that have the next time you try to get involved and trust somebody? So what’s the impact on the doctor of the losses, the disappearances? When a client goes away or doesn’t come back, it’s natural to think, “What happened?” “What did I do wrong?” “Did they learn anything?” And, of course, you can’t just go hunt down your former patients to answer these questions. So it’s important to have a thoughtful approach, a strategy if you will, about your investment of time and energy with each new patient.

TCPR: How would you recommend thinking about that?

Dr. Skovholt: For starters, and this is for myself, in a first meeting I would work really hard at not getting ahead of myself in terms of attachment. Because if I get too involved and the patient doesn’t return, then I might start questioning if maybe I came on too strong and scared them away, and then I’m in kind of a depleting mindset.

TCPR: Interesting. Can you give me an example?

Dr. Skovholt: Sure. Say you are doing a first session with a couple. You are trying to ascertain why they are there. One person might be threatening divorce, saying to the other, “You have to go to counseling or I’m not going to stay with you.” The other partner doesn’t want to be in the therapy at all. So you judge what you are hearing and observing, and maybe say at the beginning, “I’m thinking this is one meeting, and then when we’re done at the end we can talk a little bit and you can go home and decide whether you want to come back.”

TCPR: So my involvement is just at that initial level and no more?

Dr. Skovholt: Right; there is the ambivalence of their wanting help and not wanting it, so I am trying to create engagement and not resistance. Also, I’m focusing on not just them, but also on myself having an ending. Of course, it’s always for the sake of the patient, but it’s also for the sake of me as the practitioner. But if they do come back, then I open up a little bit more and I’m more engaged with them. So during that first meeting, you might want to decide how involved in your patient’s story, in your patient’s life, you want to be while feeling out if this is a patient who would likely benefit from seeing you.

Sharie Stines, Psy.D <![CDATA[The Loyalty Bind of the Narcissist’s Child]]> http://7.1262 2017-05-21T07:23:07Z 2017-05-21T07:23:07Z The loyalty bind with a narcissist is different than other loyalty binds, in that it requires the individual involved with the narc to choose between the narcissist and herself.  And of course, when you’re the child of the narcissist it is no contest. The child will choose her parent’s desires every time.

One woman explained to her therapist when he asked her to visualize her abusive mother as a lion and put her in a cage. The therapist wanted his client to realize she could walk away safely from her mother, whom the client perceived as dangerous. What the therapist failed to comprehend was the plight of a narcissist’s child’s experience with regard to the loyalty bind.  This woman explained to the therapist, “As a child of a narcissist, I will get inside the cage with the lion.”

This grown “child” has been indoctrinated, brainwashed, conditioned, trained, and programmed to do whatever her parent wants – no questions asked.  She has learned well that she is to be loyal to her parent, for the price not to be is too great to pay. She has learned both through experience and observation.

If the parent hates someone, the child must also hate that person, for to have a relationship with the hated person will cause the narcissist great injury and the child knows how hurt her parent will feel if she is to continue to have a relationship with this great “enemy.”

Even if the child is completely befuddled by the war between the two, she must not dare venture anywhere near the “enemy camp.” After all, this would be very injurious to her parent.

The child already realizes she is responsible for her parent’s happiness and she also knows she hasn’t been successful at keeping her parent very happy overall. Why on earth would she add further injury to her already wounded parent?

Loyalty is life blood to a narcissist. While she does not understand or play by common interpersonal relationship rules, such as cooperation, reciprocity, collaboration, mutuality, or partnership, she does play by a set of pseudo-relationship rules; these include loyalty, respect, competition, and position.

These pseudo-relationship rules also include one other dimension – the double standard.  Loyalty and respect belong to the narcissist, as do winning and being in the superior position. The loyalty bind only goes one way as well – from the child to the narcissist.  The narcissist doesn’t have to play by the same set of rules she requires of her children.

Of course, the narcissist’s child doesn’t require her parent to be loyal to her; nor does she gather enemies or people for her parent to hate in order to prove her loyalty.  The narcissist’s child does not require loyalty. She requires nothing. She’s not allowed to have personal wants and needs, let alone requirements.

Nor does the narcissist’s child require her parent to be responsible for her happiness.  In fact, the child doesn’t even think of terms of her “self.” Her vantage point always rests with her parent’s happiness (or lack thereof, which is more the reality.)

The loyalty bind applies to other narcissistic relationships as well. Everything goes swimmingly as long as the family, workplace, church, or otherwise involved system plays by the narcissist’s rules. But, all bets are off when a group member tends to veer off on the independent path, playing by his own set of rules.

In order to remain “safe” in a relationship with a narcissist it is recommended that you make sure you do not commit any loyalty infractions.

But, if you’re reading this article because you want to find a way out of this bind, you must do one thing, which is of utmost importance – you must GIVE YOURSELF PERMISSION to get out of the lion’s cage.


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Jennifer Rollin, MSW, LCSW-C <![CDATA[An Interview on Self Compassion Featuring Dr. Crystal Lee]]> 2017-05-19T20:24:01Z 2017-05-20T13:23:34Z Jennifer: Thanks for taking the time out to talk with me today. So tell me a little bit about yourself.

Crystal: My name is Dr. Crystal Lee, and I’m a psychologist with a concierge therapy private practice in Los Angeles. I help my clients foster self-compassion for themselves. I’ve presented at a few conference about self-compassion, done numerous trainings with psychology students about self-compassion, developed a short-term psychoeducational group based on self-compassion principles and wrote my dissertation about self-compassion in parents of children with Autism Spectrum Disorder.

Jennifer: How do you define self-compassion?

Crystal: According to Kristin Neff, the premiere researcher in self-compassion at UT Austin, self-compassion encompasses three different components; all three are needed to be truly self-compassionate.

The component most people think of is self-kindness, which means reacting with caring and understanding instead of being critical or judgmental.

The second component is belief in a common humanity. This component means that you understand that all human beings are flawed and imperfect and we all struggle with the same feelings.

The third component is mindfulness. I understand mindfulness as being fully present and experiencing the moment with clarity and balance, instead of being swept away by the feelings or ignoring the feelings

Jennifer: What are some ways that you help your clients to practice self-compassion?

Crystal: Initially, if I see clients who are particularly self-critical, are very judgmental of themselves or has feelings of shame, I start with psychoeducation about what self-compassion entails. Then, I usually like to have my clients complete the self-compassion scale to see which components of self-compassion they may need to strengthen. Based on that, I suggest interventions targeted specifically to one of the three components of self-compassion. I might teach them mindfulness techniques (e.g., self-compassion meditations, deep breathing, mindful eating), directly challenge negative self-talk, encourage them to write in a self-compassion journal or help them create a self-compassion mantra.

Jennifer: What might be some reasons why this is difficult for some?

Crystal: Some clients struggle with mindfulness in particular because they are very past- or future-oriented, rather than present-oriented. Sometimes, clients struggle with the mindfulness piece because they’re Christian (and mindfulness has Buddhist roots).

For other clients, being kind to themselves is the biggest struggle because they’ve learned that being self-critical and judging themselves harshly is a way to motivate themselves to change or “be better.”

Jennifer: How do you practice self-compassion personally? 

Crystal: I like to incorporate short mindfulness activities into my daily life–things as simple as eating mindfully when having a snack or tuning into my surroundings. If I’m having a particularly difficult time, I’ll remind myself that everyone struggles and try to normalize my feelings or whatever happened to me.

Jennifer: Are there any ways that practicing self-compassion can be challenging for you?

Crystal: It can still be a struggle for me to let go of using self-criticism as a way to motivate myself to do better and improve myself. I think it’s important to remind ourselves and our clients that self-compassion is a continual journey. You don’t suddenly arrive there and have everything be smooth sailing for the rest of your life.

Jennifer: What is one concrete exercise that you might have a client do who is struggling with being kind to themselves?

Crystal: Something that all people seem to respond to is drawing a parallel between how they treat their best friend or child when they’re struggling versus how they treat themselves when they’re struggling. I have them actually write down the negative self-talk, look at a picture of their best friend or child and then say those same things to them. I have them imagine how the best friend or child would feel and respond to those statements. It’s an eye-opener! No one would dare talk to their best friend or child as harshly as they speak to themselves and they can clearly see how damaging and hurtful that criticism can be.


Jessica Dore <![CDATA[Four Tips for Self-Disclosure in Sessions]]> 2017-05-19T20:23:17Z 2017-05-19T20:23:17Z Depending on who you talk to, sharing personal information about yourself during sessions with clients may be considered somewhere on the spectrum between being a valuable tool and strictly forbidden. Most therapists probably walk the line of being somewhere in the middle; using self-disclosure sparingly but occasionally, when it’s clinically useful.

 When it’s done properly, there can be great clinical value in sharing bits and pieces of your own story with your client. It can remind them that no one is perfect and that in fact, we all struggle at times—even (and maybe even especially) therapists—and it can strengthen the bond of the therapeutic relationship.

It certainly is a fine line and it must be done skillfully.

 Whether you’re already divulging occasionally in sessions, or thinking about beginning to, the following tips may help.

 1.   Be genuine.

 As tempting as it is to remind clients that we are, actually, all in this same boat of being human, be sure that if you take this route you really understand and mean it. Take time to think about what it really means to “be in the same boat” with the client. Put yourself in the client’s shoes with something you personally have struggled with, and remember how difficult it was. 

 Many times, clients will come to therapy with problems that you simply cannot claim to know or understand,and to reduce someone’s individual experience by saying that we are all in the same boat can be invalidating. These are not the times to drop in a personal anecdote or say, “I’ve been there.”

 What being in the same boat with clients actually means is that we are all born with human brains that are subject to the same traps of language, cognition and feelings as well as the behavioral patterns that come from them. We all want to feel good and to avoid pain. This is being human and we can all relate–even therapists.

 2. Drop the expert role.

 Part of validating clients’ experiences is communicating that suffering is a normal part of the human experience and being willing to establish a genuine equal playing field with the client.

 Dropping the expert role doesn’t mean that you throw your techniques to the wind, crack open a beer and start dropping F-bombs or otherwise carrying on in an unprofessional manner. It simply means that you be willing to be human, even in the context of therapy.

 Sometimes being human means being willing to say you made a mistake or that you don’t know the answer to something. It might even mean admitting that something the client said has triggered something in you that you need a moment to process. Both of these things require vulnerability, and they are not easy—particularly if you have been trained to keep a tight lid on your inner experience during sessions.

 But admitting to a client that you, too, have challenging emotional responses, blindspots and hot-buttons can go a long way in establishing lasting trust in the therapeutic relationship.

 3. Be mindful about the reasons behind why you’re sharing.

 If you’re the type of person who has trouble pausing and checking your intentions before you speak, this situation is a great opportunity to practice.

 When bringing up personal disclosures in therapy sessions, you should always be aware of the intention and potential impact of what you’re planning to say before you say it.

 Ask yourself if what you’re sharing is genuinely to help the client or simply to make yourself feel better or less uncomfortable. Ask whether it is aligned with the clinical goals and likely to move the client closer toward them or further away. If you’re not able to answer either of these questions with certainty, perhaps you should hold your tongue this time.

 If you find that you slip and say something that you later wish you hadn’t, you have a valuable opportunity to practice dropping the expert role and being vulnerable. Admit to the client that you made a mistake. You may think this will diminish your credibility, but oftentimes it will do just the opposite.

 4. Don’t make it all about the client.

 Therapy truly is all about the client, so this statement may understandably sound absurd to some. But one of the best ways that you can give the client what they need is by helping them to be comfortable opening up to you. And you can do this by opening up to them.

 Placing all of the focus on the client is a subtle way of communicating that you are unavailable in the room in any sort of human capacity. The act of coming to therapy itself has put the client in a vulnerable position. The least you can do is meet them with a small bit of vulnerability, as well. If 100 percent of what comes out of your mouth is about the client, you may be missing out on valuable opportunities for authentic connection with the client.

 There is certainly a fine line between clinically useful self-disclosure and self-disclosure done in a way that it is at best distracting, and at worst self-absorbed. But done right, through practice (and yes, trial and error!) it can be a wonderful way to build trust and mutual respect in the therapeutic relationship.




Christine Hammond, MS, LMHC <![CDATA[50 Signs of a Toxic Relationship]]> http://5.1382 2017-05-18T12:31:00Z 2017-05-18T12:31:00Z The phrase “toxic relationship” is thrown around quite a bit in our culture. But what really defines a toxic relationship? And how can a person know they are in the middle of one? Fortunately there are early warning signs. Yet it is unfortunate that are frequently overlooked in exchange for attention, affection, excitement, and the hope of commitment.

Sadly, there were more items than 50 that could have been added to this list, but it needed to stop somewhere. Here are the early warning signs of a toxic relationship.

  1. Won’t take “no” for an answer.
  2. Say you are remembering things wrong.
  3. Never know what you are coming home to.
  4. Are fearful of making them angry.
  5. Find fault with your family and friends.
  6. Doesn’t like you hanging out with your friends.
  7. Seems to know about your private conversations with others.
  8. Says they are the only person you can trust or count on.
  9. Nit-picks your behaviors but won’t modify any of theirs.
  10. Calls you belittling and/or demeaning names.
  11. Demands sex regardless of how you feel.
  12. Talks you into doing sexual things that you don’t like.
  13. Restricts your access to your money.
  14. Threatens to hurt you, themselves, or others.
  15. Expects immediate compliance with their requests without question.
  16. Tells you how you should and do feel.
  17. Refuses to give you any privacy.
  18. Turns your family against you.
  19. Makes it difficult for you to go to work or stay at work.
  20. Puffs themselves up during an argument.
  21. Frequently bullies or intimidates.
  22. Blocks doorways so you can’t leave.
  23. Hides your keys.
  24. Has resorted to physical aggression.
  25. Rages and rants for long periods of time.
  26. Frequently says you have a bad memory.
  27. Has an intense burning stare.
  28. Ignores you as punishment.
  29. Has used weapons such as a gun or knife to make their point.
  30. Threatens to abandon the relationship if you don’t comply.
  31. Says they are the victims in the relationship.
  32. Lies about their actions even after being confronted.
  33. Won’t admit to being wrong.
  34. Is extreme in their emotional responses.
  35. Says they will die without you.
  36. Everything must be done their way.
  37. It feels like you can never win an argument.
  38. Interrupts you but won’t tolerate you interrupting them.
  39. Withholds key information but is furious if you do the same.
  40. Conveniently forgets promises they make.
  41. Is very critical of others.
  42. Blames others for things they do.
  43. Shares your private information with others without consent.
  44. Expects you to drop everything to cheer them up.
  45. You feel rejected by them.
  46. Hides financial resources and/or debt.
  47. Uses religious beliefs to guilt you into submission.
  48. Sends hundreds of text messages.
  49. Is extremely jealous of others.
  50. Refuses to allow you to sleep until they get their way.

If you are in a toxic relationship, it is not too late to get out now. It is better to start over again sooner rather than getting further into an unhealthy relationship that could end in disaster.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Sharie Stines, Psy.D <![CDATA[Watching Our Children Cope with Narcissist Abuse]]> http://7.1254 2017-05-16T18:26:53Z 2017-05-16T18:21:54Z One of the most difficult pains to endure as a parent is to watch our children’s other parent totally abuse, ignore, criticize, abandon, reject or otherwise disappoint our children. We know that our children are innocent in who their parents are. And as we, the adults, learn about emotional abuse and narcissism, we still struggle, even though we possess analytical abilities and some harsh life experience.  Our children are even more poorly equipped than we are to manage the terrain of a narcissistic relationship.

Children have no understanding of the concepts of cognitive dissonance, gas lighting, entitlement, confabulating, triggers, narcissistic wounds, or other complex issues surrounding involvement with an emotional abuser.  Even though we study, seek therapy, and practice new strategies, we are at a loss when it comes to helping our children with these same dynamics.

Many times those in the helping profession, including ministers, priests, pastors, and therapists, do not know how to advise us; or, even worse, provide us with poor guidance that hurts rather than helps the situation.

If this is your circumstance, here are some helpful interventions you can practice in your own life and home with your children:

Be a strong parent.  This includes, having strong energy, not portraying a victim mentality, creating and maintaining solid boundaries with the other parent, and constantly being positive.  This “strong energy” approach will help your children feel stable and secure as they navigate the difficult terrain of having a narcissistic parent. Think of yourself as an anchor; or better yet, think of yourself as a strong, metal, reinforced fortress for your children to find safety in.

Be an honest parent. Do not lie to your children, live in La La Land (or give the appearance that you do,) or bury your head in the sand. Talk to your children, at appropriate age level, regarding the issues of life.

Demonstrate a positive outlook. Help encourage your children to feel positive about their lives. Come across with an attitude that “the glass is half full.”  Help your children look at life from a place of resilience and gratitude. Point out the good things in your own life. Let your children find joy in your home and in their relationship with you. The more you present a positive outlook, the more hopeful your children will feel in general.

Teach your children respect.  Even for the other parent. Tell them that good character involves having integrity and treating all people with dignity, whether or not they deserve it. This will have a boomerang effect in that the children are also being taught the importance of respecting you, as well, without you having to tell them that in so many words.

Play interference when necessary. If you see the other parent (or other narcissistic person) emotionally abuse or neglect your children, step in and confront the situation immediately. Do not walk on eggshells or teach your children to walk on eggshells. Let your children feel your energy (point one above) and rest assured that you do not put up with abuse – either toward yourself or toward your children.

Check your attitude. No matter what you go through, or what your children go through, be sure and demonstrate a healthy attitude, one that resonates with courage, prudence, and good humor. That is to say, be strong, wise, and funny (as opposed to weak, foolish, and gloomy.)

Eliminate drama.  Being in a relationship with a narcissist engenders lots of drama. Have enough self-control to resist the temptation to feed in to it, or to create your own for that matter. While, drama makes life somewhat interesting, when it involves narcissism it can be very toxic. Make an intentional decision to refrain from creating your own drama or being sucked into the vortex of narcissistic drama.

Stay out of the cesspool.  Narcissists always want to invite you to join them in their mire. Do not step into their mess by accepting their invitation to do so.  As much as is physically possible on your end, don’t allow your children to join them there either.  Teach them (and yourself) the concept of “observe, don’t absorb.

Live one day at a time. This is the best advice ever. This gives you permission to start each day with a clean slate. You can wake up in the morning and remind yourself that today is all you have. There are no guarantees for tomorrow. Live this day well. Don’t dwell on the mistakes of the past, nor” future trip” about the worries of tomorrow. Take this day as it comes and live it fully.

No matter what interventions you use, be sensible and realize you are your child’s most consistent role-model. As you show them how to be around a narcissist, they will emulate you. Be a difference maker in their lives, teaching them how to cope with all types of circumstances and personalities.  Remember, it isn’t what happens to us that defines us, it’s what we do with what happens to us that makes all the difference in the world.


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Christine Hammond, MS, LMHC <![CDATA[The Bridge to Recovery in 12 Steps]]> http://5.1377 2017-05-16T14:25:21Z 2017-05-16T14:25:21Z The road to recovery is paved first with good intentions then morphs into hard work, determination, resolve, and commitment. Good intentions can start the process but it is not enough to complete it. Imagine a stretch of highway on a flat road which is far easier to pave then it is to engineer a bridge which spans across a large body of water.

The process of recovery is more like constructing a bridge over troubled waters. The waters could be anything: an addiction (drugs, alcohol, sex), situational experience (death, abuse, divorce), emotional disorder (panic attacks, depression, anxiety), mental disorder (eating disorders, PTSD, OCD) or personality disorder (narcissism, borderline, obsessive-compulsive). Just like a bridge, there are some parts that are consistent, yet still characteristically unique.

Having a rough outline of the consistent parts is similar to starting with a blueprint prior to construction. While the blueprint is designed to be accurate, sometimes life happens and things need to be changed along the way. Here is a rough first draft of recovery:

  1. Acknowledge there is a problem. Unless there is an admittance of an issue, there can be no recovery. There could actually be several problems at once. For instance, a person who is addicted to alcohol might also have PTSD from a sexual assault, anxiety from work related stress, and a pending divorce. The idea here is to pick the problem that is causing the greatest amount of damage and work on it first.
  2. Seek wise counsel. This is where wise counsel from a person who is qualified to work with these issues is so important. Frequently the person described above is not capable of discerning which issue needs to be addressed first. Nor do they know how to begin and subsequently work through recovery. Wise counsel is like hiring an architect to design the bridge. The better the architect, the more a person has to pay, yet the better the results.
  3. Make a decision to change. A person who wants to change will openly admit they are willing to do what is required, almost without question. Those who constantly argue as to how to proceed might not want desire the change as much. Discovering the reason for the resistance early on is like working with a difficult planning board. If their hindrance is not immediately addressed, the project could be delayed for years.
  4. Take first steps. There is an old saying that the first steps are the hardest. But not in the case of recovery. Strangely enough, the early phase of process is the easiest because the pilings are driven into shallow waters. The difficult part happens when they have to be driven into the deepest part of the water. In the case of the addict, there are obvious initial reasons for the addiction and then there are the hidden ones that silently solidify the addiction.
  5. Solicit accountability partners. Putting together a team of accountability partners is like having project and construction managers who has built bridges before. These people must have previous experience with the issue in order to be effective. It is not best to utilize family or spouses as they have their own personal motives at stake.
  6. Set timelines. Every journey needs to have a start and finish date in mind that is reasonable. A bridge is not built in a day. Recovery is at least a 6 month process and can be longer depending on the issue. At the end of 6 months, there are three possible decisions: proceed as planned with a new deadline, stop completely and start again, or stop because the work is complete.
  7. Focus on the journey. When building a bridge, it is not a good idea to also be constructing a building. Recovery requires myopic focus. This is not the time to begin a new relationships, change jobs, move, or work on marital issues. Rather, all energy, time, and resources should be directed towards the recovery process. This ensures the greatest possibility of success.
  8. Modify process as needed. As hard as a person might try, not everything is predictable. Even blueprints need to be revised during the construction process as new information is gathered. So does the recovery process. This is where having an experienced person guiding the process is helpful as they can best redirect the new path. Google cannot help with this.
  9. Reset expectations. As the bridge is being constructed, it may look a bit different from what was envisioned at first. So new expectations and adjustments need to be made. From a recovery standpoint, this might mean the alcoholic needs to leave their bartending job and find a new vocation. Or a person might find it necessary to move after a divorce. These expectations should be discussed with the accountability partners.
  10. Develop new boundaries. Think of boundaries as railings on a bridge designed to keep everyone safe and in their own lane. This is not about boxing someone in so they lose their freedom. Rather, it is a safety issue designed to protect a person from falling into the same problem in the future. A good recovery process establishes new boundaries.
  11. Reorganize life. Once the bridge is built, traffic is rerouted to utilize the new structure. So it is true with recovery. Life is reorganized with new expectations, priorities, boundaries, purpose, relationships, and goals. This is the time to enjoy and celebrate the accomplishments of completing recovery.
  12. Cultivate new growth. As the years progress after recovery, new growth in areas that was not foreseen often develops. Just like a bridge can generate economic growth in areas that previously struggled, so can recovery. Many who have successfully completed the process find that giving back to others who are struggling is an immensely satisfying experience.

Again, these steps are just a rough draft. A good recovery process needs to be intentional, supported, and followed. Once it is complete, it is time to savor the new view.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Marie Hartwell-Walker, EdD <![CDATA[Advantages of Part-Time Private Practice]]> 2017-05-16T01:56:36Z 2017-05-16T11:56:19Z This Month’s Expert: Rebecca W. Brendel, M.D., J.D. HIPAA and Psychiatric PracticeWorking at a salaried job in a clinic certainly has advantages. Your salary is stable. You probably have a benefits package. Your hours are predictable. But at some point, most clinicians entertain the idea of going into private practice. The clinic salary may be small and the benefits package not beneficial enough. The clients may be too similar to each other or seemingly unwilling or unable to improve. The schedule may be predictable but it may not be flexible enough to accommodate family needs. Vacation time is minimal. What at one time seemed like a great job starts to feel restrictive and unrewarding.

Those are all good reasons to think about cutting ties and launching your own practice. But doing so full time can be scary. Unless you have substantial savings, start up can seem impossible. For that reason, many clinicians wade into private work instead of jumping in. Some even find that a balance of part time salaried work and part time private practice balances the need for security with the desire for flexibility and variety. Let’s look at the clear advantages of going into private practice only part time – at least to start.

You have a financial base: By keeping your salaried job, you have the security of a financial base. Although the per hour pay is usually much less than what you can earn privately, it is steady. That can reduce some of the anxiety that goes with starting out on your own.

You retain some or all of your sick time, personal time and vacation time. Until a private practice is well established, it’s difficult to take time off. Your salaried job provides some paid leave while you build your own practice to the point that you feel able to give yourself days off.

You retain your retirement account. Even if it isn’t generous, clinic retirement programs offer a base from which to work. Often, the employer provides some matching funds to your contributions. Being in private work means doing that for yourself. It’s too easy to put it off or to not take care of yourself by creating and maintaining a retirement plan when retirement feels like it is in a distant future.

You don’t have to spend much to capitalize your business: Launching into full time work means investing in a lease, furniture, office equipment and perhaps a commitment to a billing service. Part time work lets you start slow with a minimal cash investment.

You don’t have to commit to renting an office full time. Many successful private practitioners are happy to rent some hours or days to the part-timer. Ideally, you should establish hours on at least a couple of days or evenings each week to ensure that you will be able to reschedule someone who has to cancel or to see a client on an emergency basis.

You don’t have to set up an office: Renting someone else’s space has its advantages. You don’t have to buy furniture. You may be able to negotiate use of a computer and a copier. You probably won’t be expected to do major cleaning. The trade-off, of course, is that you need to accept the style and taste of the renter. The office may not be set up or decorated in ways that are an expression of you.

You can see a different clientele: If your salaried job is in a specialized clinic or setting (substance abuse clinic, inpatient hospital, college counseling services, etc.), your private practice gives you the opportunity to see people with different presenting problems. If you decide to work during the evenings and on weekends, you are more able to see people who have full time jobs, couples, and families.

There’s time to learn the paperwork: Although the quantity of paperwork is the most common complaint of therapists who work for clinics, they usually do have a billing department and office manager who are managing most of it. Once in private practice, you will be on your own to develop the forms, apply to insurance company panels, learn the vagaries of those panels and get into the rhythm of submitting billing and keeping accurate accounts. It can be daunting. Even if you hire a billing company, you will still be required to learn how to use the company’s services well. Part time work lets you ease in and get comfortable with it.

Part time work gives you the time to develop your business skills. To be successful as a full time practice, you will need to become an entrepreneur. That means learning skills in marketing and networking as well as bookkeeping and office management. A part time practice lets you begin to do these things without the pressure that comes with being immediately dependent on getting and keeping enough clients and making enough money to support yourself.

Burn out prevention: If your clinic job requires a “productivity rate” of 35 clients or more a week, in order to earn your salary, it can feel relentless. You schedule 40 or more a week to make sure you make your quota. Sometimes, they all show up which is stressful. More often, not enough show up which is also stressful. By cutting back on the full time job in favor of developing a part time private practice, you can give yourself a break. Since private clients generally pay more than your clinic hourly rate, you can afford to see fewer clients but still make the same income.


Dorlee Michaeli, MBA, LMSW <![CDATA[Stress: Is it Your Friend or Foe?]]> 2017-05-15T13:51:32Z 2017-05-15T13:51:32Z There are different ways to view stress. When looking at it as something harmful to our bodies and health, we operate as if we must minimize the pressures we face in our daily lives. With this perspective, coping measures may include meditation, journaling, deep breathing, and other techniques for self-care that reduce stress.

However, not all stress is bad and it is our perception of it that plays a key role in whether it will have a detrimental effect on us or not. This post will provide you with some of the key take-aways from George Faller, LMFT’s “Befriending Stress” workshop at the 2017 Psychotherapy Networker Symposium.

As per Faller and Hans Selye (the father of stress), there are two types of stress: eustress (positive stress) and distress (negative stress).  Faller explains how stress is crucial for our growth; without any stress, people don’t change and literally wither. Conversely, if people are at the other extreme and are under chronic stress, it is very harmful to their health and overall wellbeing.

The sweet spot of eustress stress is what is needed to enable you to achieve your goals. This amount helps you focus and do your best to succeed or surmount a challenge.

There are two primary ways of responding to stress:

  • Fight or flight response – this is a helpful response when you are being attacked but not when you want to perform your best (you are more likely to choke under pressure).
  • Challenge response – this is a physically different response than the fight or flight response when threatened by a situation. While as in the fight or flight response, your brain is giving you more blood flow, you are smarter because it is paying more attention to your environment and all your senses are open to all the information available.

To shift from a threat to a challenge response, Faller suggests we view our stress response as a resource. For example, when stressed, consider saying to yourself: “Ok, I’m feeling stressed out and that’s a good thing – this stress will help me do a better job.”

Research has shown that when people shift their perspective on stress in this positive way, it changes both their physical stress response and helps them perform better in many different situations such as taking an exam, giving a speech etc.

While we all need cortisol (the catabolic function stress hormone) and DHEA (the anabolic anti-stress hormone) in our system, we feel and operate at our best with a low level of cortisol and high level of DHEA. When you respond with a fight or flight response, you have high levels of cortisol and low levels of DHEA. This is because in the anticipation of physical harm and wanting to minimize blood loss, the body constricts blood vessels and mobilizes immune cells to foster fast healing. In light of the primary goal being self-protection, attention to negative signs increases and typical emotions felt are fear, anger, self-doubt and shame.

However, when taking the recommended challenge response approach, you experience low cortisol levels and high levels of DHEA. This is because the body is not anticipating any harm to achieve its desired goal and it may relax blood vessels. It increases blood flow and energy to meet the objective with feelings such as excitement, anxiety, enthusiasm and confidence. Attention to positive signs increase and fear is suppressed.

  • To obtain the optimal ratio of cortisol to DHEA, choose the challenge response over the fight or flight response.

Why Your Stress Mindset Matters

According to a study that tracked 30,000 adults in the United States for eight years and was cited by Kelly McGonigal in her book “The Upside of Stress,” you have a 43% increased chance of dying if you thought you were stressed out. Conversely, if you thought stress was a normal part of life, you have less the normal rates of mortality.

Mini-Exercise (to complete with a partner)

For a simple illustration of how influential your mindset can be, Faller suggested taking turns with a partner in which one of you are thinking negatively for a couple of minutes as in how you might feel if you woke up tired were stressed and had too much to do. After doing this, hold out your arm and ask your partner to push down as you push back and notice how much effort this took.

Next, repeat this exercise, thinking about stress using the challenge response – i.e., acknowledging the stress and its power to help you perform your best. Then use that extra energy to hold out your arm and ask your partner to push down as you push back and notice how much effort this took.

Below are two possible ways to take the challenge approach or transform distress to eustress (positive stress).

  • Name it – Reframe it – First, recognize and acknowledge your stress – notice the signs such as racing thoughts, worries and physical symptoms. Second, reframe your stress to include challenge and opportunity.
  • Embrace it – Embrace the emotion(s) – Look at your emotions (such as anger, fear, sadness, shame and surprise) as a signal or compass telling you what’s important or what you need. Next, search for a good solution; embedded within any problem is the solution or response to the fear of the problem.

For example, when feeling sad or full of shame, notice this emotion and reach out to someone you trust for connection and comfort. Connection is the best antidote to sadness and shame.

Post Traumatic Growth Is An Example of a Challenge Response to Stress!

Drs. Richard Tedeschi and Lawrence Calhoun coined the term Post Traumatic Growth (PTG) as referring to the “positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning.” It is not about feeling or returning to the state of being prior to the period of trauma, but rather “it is about undergoing significant “life changing” psychological shifts in thinking and relating to the world, that contribute to a personal process of change, that is deeply meaningful.”

Studies show that more than 50 percent of people who experience traumatic episodes grow from those experiences. Only a minority experience PTSD (post traumatic stress disorder) or end their life by suicide. The people who experience post traumatic growth often see new possibilities in their life, experience increased strength (tapping into something they didn’t know was there before), have more meaningful relationships, exhibit greater appreciation and gratitude for what they have and develop spiritually and/or find meaning in the something bad that happened.

In sum, choosing to befriend your stress may help you feel happier and healthier perform better and live longer. It may also aid you in having stronger relationships and be more attuned with your clients.

What are your thoughts about Faller’s approach to managing stress?

Stress: Friend or Foe?



Faller, G. (2017, March 23). Befriending Stress. 2017 Networker Symposium Session# 7170-118.


Susan Gonsalves <![CDATA[Our Ethical Obligation to Practice Outcome Monitoring]]> 2017-05-13T21:27:27Z 2017-05-13T21:27:27Z Why Did You Become a Therapist?

 Many people say that they went into therapy in order to help people, yet despite this initial goal, they report that they actually spend most of their “office time” writing notes and completing paperwork. With complicated EHRs, large caseloads, and increasing administrative responsibilities, some of these duties are inevitable. Fortunately, however, new tools and technologies are emerging to help clinicians to not only fulfill their job duties, but also more effectively treat their patients and ensure that they are providing quality care and utilizing best practices.

One of the best practices that has been demonstrated repeatedly to improve outcomes is using Measurement-Based Care. Measurement-Based Care is a system that utilizes patient-reported symptom rating scales to inform clinical decisions about patient care.[1] Similar to Measurement-Based Care, outcomes monitoring or progress monitoring, is the routine collection of self-report data from patients to evaluate their progress in treatment and perception of the therapeutic alliance.

In both Measurement-Based Care and outcomes monitoring, clinicians use the self-report data provided by their clients to objectively assess their progress and make adjustments to their treatment plan or therapeutic approach in accord. Therapists have been slow to adopt routine progress monitoring or Measurement-Based Care[2], but the time has come for that to change.

In addition to standard measures of symptoms (e.g. PHQ-9, GAD-7), there are several published measures that can effectively provide feedback to the clinician (e.g. OQ, ROM, PCOMS). With a wide variety of validated measures available to assess one’s patients, there is little reason not to develop a thoughtful plan for evaluating one’s practice.

Improved Communication

Providers’ desire to offer the highest quality of care possible is not the only reason to practice outcomes monitoring or Measurement-Based Care.

Monitoring can help patients to stay more engaged in their treatment and more participatory, both in sessions and with between-session assignments. They are less likely to stop treatment if they feel heard by their clinician.

Structured measures provide another opportunity for the therapist to listen to the client and get a better understanding of his/her emotions, experiences and feelings about therapy itself. Therapists often report having a strong desire to meet their clients where their clients are ready to be met. Providing an additional channel for communication (i.e. other than informal queries in session) will help them move towards this goal.

Some patients may feel more comfortable disclosing a symptom or therapeutic rupture on a form than directly to the clinician; the use of objective, validated measures can allow therapists to be aware of these issues without requiring the client to bring them up on their own.

Clients are also less likely to drop out of treatment if they feel that their therapist is responsive to their needs. This factor means it’s important to be aware of both the client’s symptoms and the degree to which he or she is suffering, and being cognizant of the therapeutic relationship and ensuring that it is productive.

Studies have repeatedly demonstrated that there is often a disconnect between how the client feels and how the provider thinks the client feels[3], and therapists who are able to minimize this gap and flexibly respond will find that their clients stay in therapy longer and get well more quickly.

The Time is Now

Advances in technology have led to the development of a number of different methods for administering, scoring and integrating clients’ responses to both symptoms and outcomes measures into the EHR, to minimize the burden on providers and administrative staff. Patients are increasingly interested in using technology tools to manage their health care, and the use of such devices and programs to monitor treatment progress is an excellent application of such technology.

Many clinicians have been proactive and excited about implementing empirically-supported treatments and have been outspoken advocates for the use of proven therapies.

Why are we so resistant to outcome monitoring and Measurement-Based Care? While behavior change is never easy, as healthcare providers, we are obligated to do it when we know there are effective, proven strategies we can implement to improve our care delivery. This process includes doing progress monitoring and adjusting treatment plans and interventions based on our clients’ feedback.

Mental health providers are also health care consumers, and I challenge them to imagine seeing a physician who does not routinely make objective measurements such as blood tests and weights while crafting and managing a treatment plan. Why should mental health be any different when it comes to tracking progress?





Christine Moberg, Ph.D. is a licensed clinical psychologist and head of psychology at Pacifica Labs ( and blogs regularly at

Christine Hammond, MS, LMHC <![CDATA[The Best of Moms]]> http://5.1372 2017-05-13T10:34:34Z 2017-05-13T10:34:34Z There is a lot of talk about dysfunctional moms: those who harm their children, fail to parent, or even over parent. But not so much attention is paid to those moms who are excellent. Some are capable by instinct, others have good modeling from other moms, and others learn from the mistakes of others.

These moms pay attention to the developmental stages of their children and mold their parenting to meet their child’s needs. They successfully navigate through joy and sadness as their child passes to another stage in life. Most importantly, these moms know how to care for their child without depleting their own emotional resources. It is a delicate balance and one worth striving to achieve.

Erik Erkson’s Eight Stages of Psychosocial Development serves as a parenting guideline. Please note that these stages will be discussed from a maternal perspective due to the nature of the article. It is not meant to diminish the value of fathers or other caregivers.

  • Trust vs. Mistrust (Birth to 1 year). During this year, the mother forms a strong positive attachment to their child through meeting the child’s physical, mental, and emotional needs. A child is unable to care for themselves so it is extremely important that the mother meet all of their needs. This instills a sense of hope in the years to come.
  • Autonomy vs. Shame/Doubt (1 – 3 years). These years are marked by a child’s desire to experiment and try new things such as walking, talking, potty training, and eating solid foods. A mother who allows a child to progress without over protecting develops resolve in the child. Stage one and two are a sharp contrast from meeting all of the child’s needs to allowing the child to meet some of their own needs.
  • Initiative vs. Guilt (3 – 5 years). The pre-school years are ones of learning large motor skills such as riding a tricycle, getting dressed without assistance, and throwing a ball. There is a quite of bit of imaginative play where the child makes up the rules and purpose of the activity. Mothers who delight in the child’s imagination help to foster creativity. Trying to coddle the child, as was possible in previous stages, frustrates them.
  • Industry vs. Inferiority (5 – 12 years). These are the best years for education as a child’s brain is similar to a sponge. They are able to take in volumes of information and regurgitate it when questioned. Mothers who stimulate learning develop competent children who are unafraid of their abilities. While answering all of the “why” questions may be exhausting, these moms realize the value of poring information into their child.
  • Identity vs. Confusion (12 – 18 years). At the beginning of this stage is the development of critical thinking skills. This is usually a difficult adjustment for most moms as they are no longer one of the greatest influences in their child’s life. But the best of moms appreciate and encourage their child to challenge their beliefs knowing that this process leads to a fully formed sense of self and fidelity. This is why the teen years are so troubling for many families who do not work toward this goal.
  • Intimacy vs. Isolation (18 – 30 years). Without a strong sense of identity, it is impossible to achieve intimacy with another person. As the now adult child matures, it is natural for them to pull away even further. Unfortunately, in the American culture today, the previous stage is often extended unnaturally well into the twenties. Mothers who focus on proper development find ways to encourage their adult child to leave the nest.
  • Generativity vs. Stagnation (30 – 60 years). This stage and the next cannot be taught; rather they are modeled by their mother. These moms live a life of individual development, professional advancement, and community generosity. They demonstrate a strong work ethic while striving to understand their adult child’s vocation. There is no comparing between siblings, just an appreciation for each adult child’s unique path.
  • Integrity vs. Despair (60 – death). With age comes wisdom and these moms are willing to share their kernels of truth and insight. They are available to their adult child providing guidance only when asked. They are not judgmental of their adult child’s choices but find areas of pride and joy in their accomplishments.

The best of moms master these skills and help to rise up another successful generation. They deserve appreciation and thanks for their efforts.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Robyn Brickel, MA, LMFT <![CDATA[PTSD: Using New Knowledge to Help Survivors Heal]]> 2017-05-11T16:32:39Z 2017-05-11T16:32:39Z No one is prepared to deal with a traumatic event. The experience leaves the mind and body in a state of overwhelm. Survivors may have nightmares, feel jumpy or find themselves re-playing the event in their minds. They may even feel disconnected from the world. What happened was traumatic and any person would feel shaken up. This response is natural and human.

 For people who have enough resilience and support, the intense state of alarm will go away over time. They can sort out their thoughts and feelings, process what happened and move on. It may take days or weeks, but the symptoms gradually decrease.

With post-traumatic stress disorder (PTSD) the feelings don’t go away. People with PTSD don’t experience getting a little bit better every day. In fact, trying to cope with the after-effects of severe trauma can be very difficult. New brain research and the hard work of survivors provides important insights for treatment and hope.

Recognizing PTSD and How People Experience It

 We often think of PTSD as a risk for soldiers, for people fighting in war or those doing military service. Although it is a risk for them, PTSD can develop from any event that feels overwhelmingly threatening or scary to the person involved. It can happen to anyone, at any age, at home or anywhere.

We know extreme events can lead to PTSD symptoms. Domestic violence, rape, child abuse and neglect, terrorist attacks, natural disasters, car accidents — these are just a few of the traumas that can lead to PTSD.

However, It can also come from events that appear far less dramatic — such as ongoing bullying, a playground accident, emotional neglect or a medical procedure during childhood. It is important to recognize the myth that only obviously life-threatening events carry the risk of PTSD. Rather, PTSD is the result of the reactions, perceptions and biology of the person traumatized.

Women are twice as likely to develop PTSD than men.  Experts estimate that just under two in 25 people, or 7.8 percent of people in the US will experience PTSD during their lifetime.

The Neurobiology of PTSD

 PTSD is a specific kind of stress-related disorder, with biological and behavioral changes. Mental health care professionals diagnose it according DSM criteria.

 No words can describe the debilitating impact of severe trauma on survivors. But a diagnosis can help people with PTSD seek appropriate treatment.

Brain research is shedding light on changes in the brain’s structure and function following the aftermath of trauma. This information helps explain why emotions and other symptoms occur the way they do. It also leads to therapeutic approaches to help PTSD survivors manage symptoms and even strengthen brain structures that support recovery.

 PTSD and the Brain

 Neuroimaging studies have revealed important structural and functional differences between the brains of people with PTSD and the brains of individuals without PTSD. Research has studied changes in three particular parts of the brain and their role in the stress response: the hippocampus, ventromedial prefrontal cortex (ventromedial PFC) and amygdala. 

 The Hippocampus In PTSD Survivors

 The hippocampus may change the most after severe traumatic stress. It regulates memory and the ability to distinguish past from present. It stores and re-activates memories in response to certain stimuli. The hippocampus of PTSD survivors is measurably smaller and does not separate past and present or read cues from one’s surroundings as it otherwise would. This change may explain the experience of flashbacks or sudden panic attacks. Fortunately new ways to cope can be learned.

 The Amygdala and Ventromedial PFC in PTSD Survivors

 The amygdala interacts with ventromedial PFC — the part of the brain involved in response to emotions and self-awareness. This latter area becomes smaller and less able to regulate the amygdala’s “fight-or-flight” signals. This situation may explain feelings of panic or terror with PTSD in response to seemingly harmless everyday events.

 These findings help all of us understand why PTSD survivors respond so differently to stress and stimuli than people who do not experience PTSD. The findings guide new medical treatments and behavioral therapies to help rebuild other strengths in the brain and better coping skills.

 What Does Treatment and Recovery Look Like?

 Therapy and recovery for PTSD is about calming the brain. It is a careful journey tailored to the needs of each person, so only general ideas can be outlined here.

 Just as the experience of trauma changes the brain, therapeutic experiences can promote the growth of new connections in the brain, help resolve traumas and help repair the brain’s abilities to function. These therapeutic and healing experiences can be learned in mindfulness training or mindsight, a term coined by Dr. Daniel Siegel.

 Mindfulness or Mindsight

 “The brain changes physically in response to experience, and new mental skills can be acquired with intentional effort,” says psychologist Dr. Daniel Siegel in the book, “Mindsight: the New Science of Personal Transformation. “ Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds. It helps us be aware of our mental processes without being swept away by them, enables us to get off the autopilot of ingrained behaviors.”

 Siegel has found that for PTSD survivors, understanding something about how the brain works often demystifies the experience of symptoms and can make survivors feel less alarmed or “crazy” by what is happening. It also creates a framework for developing new calming and self-regulatory skills that enable survivors to live more fully.

 Goals for Therapy

 Psychiatrist and researcher specializing in treating PTSD Bessel van der Kolk sees the goal of treatment as helping people with PTSD resolve the disconnect caused by the trauma. “If we can help our patients tolerate their own bodily sensations, they’ll be able to process the trauma themselves,” he says. He supports the use of a number of therapies that help survivors become more mindful of their own physiological states, including

  •  Trauma-informed yoga, or restorative yoga
  • EMDR, or Eye Movement Desensitization and Reprocessing
  • Sensorimotor therapy (developed by Pat Ogden, using neuroscience and other therapies to incorporate body awareness as a resource in psychotherapy)

 The therapist’s work is to help clients maintain a sense of being allied together in therapy in the present, safely address a traumatic experience and begin to leave it in the past. It is possible to spend time with friends, family and loved ones and remain in the present. PTSD survivors can develop new strengths and learn how to live more fully and peacefully in the present.

 More resources to help calm and quiet mind and body are in the links below:


The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
by Bessel van der Kolk

 Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society
by Bessel A. van der Kolk and Alexander C. McFarlane

 Sensorimotor Psychotherapy: Interventions for Trauma and Attachment (Norton Series on Interpersonal Neurobiology) by Pat Ogden and Janina Fisher

 Trauma and the Body: A Sensorimotor Approach to Psychotherapy (Norton Series on Interpersonal Neurobiologyby Pat Ogden and Kekuni Minton

 The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment (Norton Professional Book) by Babette Rothschild

 8 Keys to Safe Trauma Recovery: Take-Charge Strategies to Empower Your Healing (8 Keys to Mental Health) by Babette Rothschild

 Mindsight: The New Science of Personal Transformation by Daniel J. Siegel

 Organizations and Approaches to Therapy

 EMDRIA – EMDR International Association

 Self-Care Resources

 Smartphone Applications

 Other Self-Care Resources


Christine Hammond, MS, LMHC <![CDATA[5 Environments that Distinguish Narcissists from Borderlines]]> http://5.1364 2017-05-12T10:03:41Z 2017-05-11T11:04:07Z 5 Environments that Distinguish Narcissists from BorderlinesThere is a lot of crossover between Narcissistic Personality Disorder (NPD) and Borderline Personality Disorder (BPD). They share some of the same characteristics yet the underlying needs and motivations are extremely different. For a person unfamiliar with the subtitles, this can be quite confusing.

Without an accurate understanding of the two, it is easy to misinterpret their behaviors and make a situation worse. Fortunately, NPDs and BPDs want to be appreciated for who they are and therefore make it clear in these five environments just which personality they are.

  • Walking into a relationship. At the start of any relationship, NPDs and BPDs are highly attentive. They have an ability to immediately connect with another person and draw them into their world. They act as if the other person is the most important person in their whole life.
    • At the heart of a narcissist is a deep rooted insecurity that they cover with a perfect exterior. So while the relationship begins fast and quick, it only goes so deep because the NPD is fearful of revealing their secret. This is confusing for the other person who thought the relationship would continue to progress.
    • At the heart of borderlines is an intense fear of abandonment. Any indication that the BPD will be discarded is met with intense anxiety and a desperate need to get the other person back. Many times, they come across as needy, demanding, or extreme. This is exhausting for the other person who is confused by the dramatic shift in the relationship.
  • Walking into work. Unless the NPD or BPD is the boss, they are likely to be dissatisfied at work. This may result in frequent job changes or an inability to maintain a job for long periods of time. However, when they are their own boss, they are likely to remain in a position longer.
    • NPDs believe they are right and won’t take criticism from a boss well. They tend to see everything as a power struggle for control, influence, money, or dominance. They can also satisfy their need for not working for someone too long by rising to the top of the ladder quickly. Their ability to see opportunities for gaining influence is amazing. Unfortunately, they have no problem taking advantage of others in the process.
    • BPDs can sense the dissatisfaction of a boss when they enter the room. This is traumatizing for them and in an effort to defend themselves, they react emotionally inappropriate. The key to their success lies in finding a mentor as soon as possible (preferably not a narcissist). Having a go-to person that is on their side can make all the difference.
  • Walking in the bedroom. Sex and intimacy tend to be the same thing for NPDs and BPDs. Their idea of emotionally connecting is the physical act of sex. Generally speaking, they tend to be very engaging during sex and see their ability to meet their partner’s needs as evidence of their love.
    • Unfortunately, this is the only environment that most NPDs are able to express intimacy. The idea that they would disclose inner feelings or insecurities is terrifying. So they frequently use sex as proof that they love their partner.
    • BPDs feel intimacy extremely deeply. They have a desperate need to express just how passionate they are about someone and words frequently feel inadequate in expressing their desire. They engage in sex as an extension of the intimacy they feel.
  • Walking into a party. NPDs and BPDs love to be the center of attention at a party. When they walk in a room, many times all eyes turn towards them. They are generally charming, energetic, tell fascinating stories, and absorb all of the energy in a room. They naturally draw a crowd around them.
    • Part of the definition of narcissism is an insatiable desire to have constant attention and affirmation. A party is the perfect environment to meet the needs of their ego. They can get small amounts of admiration from a large number of people without exhausting one person. At the end of the party, they tend to feel emotionally elevated.
    • One of the characteristics of a borderline is the ability to sense the emotional energy from others and mirror it. So when the party is a happy celebration, they naturally shine with jubilance. However, this process is exhausting and by the end of the party, they become drained and want to isolate.
  • Walking into therapy. Both NPDs and BPDs walk into therapy with their own agenda. They have something pressing on their brains and hearts that they want discuss immediately. However, the motivation is quite different.
    • NPDs want to control every aspect of the session. They like to focus on other people and avoid their contribution to a situation. When working with a NPD it is important that the therapist maintain control of the session, not the patient. This is the only way any real change can occur.
    • BPDs have pressing emotions that must be discussed immediately. If they are not released, the emotions will intensify and a blow up towards the end of session is highly likely. This is not about control, it is about emotion management. The therapist should allow the BPD to discuss their concern so the rest of session can be more productive.

These five environments provide an opportunity to differentiate between the two similar personality disorders. Observe the person in the surroundings and they will reveal who they are.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Susan Gonsalves <![CDATA[The Case for Mothers and Mothering]]> 2017-05-09T18:48:52Z 2017-05-10T11:48:33Z It is curious it was not until the early part of the 20th century that it took a woman by the name of Anna Jarvis1 to create a day that honors and officially acknowledges the importance of mothers. Mother’s Day will be celebrated this year on Sunday, May 14.

But ‘the times they-are-a-changin’,’ and what may have applied in her time doesn’t go far enough in our present society. A distinction should be made between the mother and the act of ‘mothering’- one is a noun, the other a verb. Historically and biologically driven, the role of mothering has been, and to a large extent still is, primarily fulfilled by the biological mother. But with changes in family structures and shifts in values and priorities, this role is now often carried out by a variety of mother substitutes such as fathers, grandparents, adoptive, foster, step-parents or paid caregivers.

Selma Fraiberg, in Every Child’s Birthright: In Defense of Mothering’ (1977),2 was prescient when she wrote that, “mothering…is the nurturing of the human potential of every baby to love, to trust and to bind himself to human partnerships in a lifetime of love.”

Mothering, whoever takes on the responsibility of raising the child, requires a strong and prolonged commitment towards the goal of maximizing his human potential. Fraiberg notes the evidence from various sources converges in the consensus that the human capacity to love is formed in infancy and this bond should not only be considered as a ‘gift’ of love to the baby, but a right – ‘a birthright for every child.’

John Bowlby, a British psychoanalyst, and the father of attachment theory, emphasized the significance of our first bond with the mother (or substitute) in an historic study in “Attachment and Loss” (1969). 3 Attachment is essential in developing trust and empathy and is the root for establishing meaningful relationships with others. It is a necessary prerequisite to a successful learner and develops within a safe, secure and stable home with a consistent, nurturing and empathic caregiver.

Unfortunately, the recognition and awareness of the crucial role of mothering in a child’s healthy development, and consequently, to future generations, is gradually being eroded. It is often seen as a secondary role in the scheme of our busy lives.

It was 40 years ago when Fraiberg wrote we are seeing a devaluation of parental nurturing and commitment to babies and young children in our society, which may affect the quality and stability of the child’s human attachments in ways that cannot yet be predicted. She warned deprivation of a mother or mother substitute will diminish the child’s capacity for life. Her cautionary notice is eerily apparent in the ever-growing numbers of young children and troubled youth as reflected in mental health issues and criminal behaviors.

For example, a Report in Canadian Bullying Statistics (2012)4 from the Canadian Institutes of Health Research, indicates 47% of Canadian parents have had a child victim of bullying; Canada has the ninth-highest rate of bullying in the 13-year-old category on a scale of 35 countries; and at least one in three adolescents have reported being bullied recently. Any participation in bullying increases risk of suicidal ideas in youth. Amanda Todd,5 for example, who committed suicide by hanging herself in October, 2012, left flash cards to tell of her experience. It went viral after her death raising worldwide attention (See follow-up of her story).6

The explosion of neuroscience research over the past few decades is providing a meteoric rise in neurobiological literature with findings that support their predecessors’ observations and predictions. Louis Cozolino, professor of psychology at Pepperdine University, writes in The Neuroscience of Human Attachments (2014),7 there is… “a causal link between interpersonal experiences and biological growth. These links are of particular interest in their impact on early caretaking relationships when the neural infrastructure of the social brain is forming.

And, Linda Graham, a marriage and family therapist (2017),8 says  “experiences in those early relationships encode in the neural circuitry of our brains by 12-18 months of age, entirely in implicit memory outside of awareness; these patterns of attachment become the “rules”, templates, schemas, for relating that operate lifelong, the “known but not remembered” givens of our relational lives.

Fraiberg’s words are as true today as they were in her time. The basic needs of children have not changed – our values have. Our priorities have been rearranged as advertisers shape our wants into needs. We did not invent childhood. We are only discovering what has likely existed since the beginning of time. Doris Lessing (1986), 9 British novelist and poet, pointed out in the CBC Massey Lectures in Canada, “… what we have, we take for granted. What we are used to, we cease to value.”

As Lloyd de Mause (2006)  says, mothering is essential to humanity

            because ‘mothering’ is a labor of love

            because ‘mothering’ is an investment in the future of the next generation

             because ‘mothering’ is an investment in the future of civilization and

            because psychic structure must always be passed from generation to

             generation through the narrow funnel of childhood…”10

So, to all the mothers and mother substitutes, who have taken on the loving and arduous tasks of mothering with all the pleasures and perils of parenting, we honor you May 14 and every day.


  2. Fraiberg, Selma, Every Child’s Birthright: In Defense of Mothering, Basic Books, Inc. (1977) (xi).
  3. Bowlby, J. (1969). Attachment and Loss, Volume 1. (Second edition.) New York: Basic Books
  4. Canadian Bullying Statistics, Date modified:   2012-09-28
  6. Todd, Amanda, Counting victories against bullies, Winnipeg Free Press, Winnipeg, MB. Saturday, March 18, 2017 (B1).
  7. Cozolino, Louis, The Neuroscience of Human Attachments,Second Edition, W.W. Norton & Company, New York, London (2014) (xviii)
  8. Graham, Linda, Marriage & Family Therapist (2017), Resources for Recovering Resilience,
  9. Lessing, Doris, Prisons We Choose To Live Inside, CBC Massey Lectures, CBC Enterprises, Toronto (1986).
  10. deMause, Lloyd, The Evolution of Childhood, First Rowman & Littlefield, Inc., 2006, Lanham, Maryland 20706, p 3.5.








The Carlat Psychiatry Report <![CDATA[Research Updates in Psychiatry: A New Treatment Program Effective for First-Episode Psychosis]]> 2017-05-08T19:12:02Z 2017-05-09T11:11:43Z Psychosis Psychiatry ResearchPSYCHOSIS

A New Treatment Program Effective for First-Episode Psychosis

(Kane JM et al, Am J Psychiatry 2015; Oct 20 [Epub ahead of print];

Catching patients early in the course of their psychotic disorders may improve outcomes. A new NIMH-funded study compared a very comprehensive treatment program with treatment as usual, and the results were promising.


The study is the first multisite, randomized controlled trial in the U.S. that compares outcomes of comprehensive, team-based coordinated care in early psychosis to usual care. Called RAISE-ETP (Recovery After an Initial Schizophrenia Episode—Early Treatment Program), the study tests an experimental treatment called NAVIGATE, which is assisted by a Web-based system called COMPASS. While the study contains many acronyms (perhaps too many), the term NAVIGATE itself is not an acronym—it’s just a good verb description of the goal of the program, which is to help patients “navigate” their way from that first episode of psychosis to recovery.

Researchers enrolled 404 patients with a first episode of psychosis and randomly assigned them to one of two treatment groups. Patients in the experimental arm (n=223) received the NAVIGATE package of treatments, which included personalized medication management, family psychoeducation, individual therapy focusing on resilience, case management, and employment and education support for at least 2 years. The control group (n=181) received treatment as usual, which in community mental health centers is mostly medication.

Actually, the study’s methods were a little more interesting than this. Instead of randomly assigning individual patients to these treatments, researchers randomly assigned clinics. Thus, of 34 community mental health centers enrolled, 17 were assigned to NAVIGATE and 17 were assigned to usual care. The advantage is that this confers a real-world flavor to the study. It’s more practical to train a clinic’s entire staff on how to provide a comprehensive suite of treatments than it is to pluck individual patients out of the clinic for specialized treatment at an academic center. The disadvantage is that it’s harder to make sure patients in the two groups are truly comparable because they weren’t randomly assigned individually.

All the patients were between 15 and 40 years of age (mean was 23), with a history of only one episode of psychosis and a diagnosis of schizophrenia, schizoaffective, schizophreniform, or brief psychotic disorder (more than 50% had schizophrenia). Patients in the study had taken no more than 6 months of antipsychotic medications, and the average time between the onset of symptoms and first treatment was 74 weeks— nearly 1 and 1/2 years. The patients in the NAVIGATE group were more likely to be male than those in usual care (77% vs 66%), had worse PANNS scores (78 vs 74), were less likely to have had a prior hospitalization (76% vs 82%), and were less likely to be in school at baseline (16% vs 26%). Whether these group differences affected the results of the study is unclear.

The NAVIGATE treatment technique

So what were some of the specifics of the NAVIGATE treatment? While the paper didn’t get into details, the NAVIGATE website provides more information ( Each patient is assigned 4 different clinicians: a prescriber, a therapist, a family education clinician, and a “supported employment and education” (SEE) specialist. There’s also an overall case manager who may be one of the existing team members. Patients have sessions with one or more team members weekly for the first 6–12 months, then less frequently (usually monthly) during months 12–18.

There’s a detailed manual for each of the 4 treatments on the website available for free download. As a psychiatrist who doesn’t really specialize in psychosis, but who still sees plenty of psychotic patients, I found scanning these manuals to be quite helpful. I learned useful information on how to do cognitive restructuring with severely ill patients, on what supported employment actually means, and on how family education can be helpful.


Patients were assessed every 6 months over 2 years. Those assigned to NAVIGATE had significantly greater improvement on the primary outcome measure—the Quality of Life Scale score. The largest improvements were seen in interpersonal relations, sense of purpose, motivation, curiosity, emotional engagement, and engagement in activities. A significantly larger proportion of NAVIGATE patients were either working or going to school during the study. In terms of core symptoms, NAVIGATE patients showed more improvement on psychotic and depressive symptoms in the Positive and Negative Syndrome Scale (PANSS). NAVIGATE patients stayed in treatment significantly longer than the usual treatment patients (median of 23 months vs 17 months). There was no significant difference in hospitalization rates between the two groups (relatively low rates in both groups of about 3%–4% per month or 34%–37% of patients hospitalized over two years).

Finally, catching patients earlier helped their outcome. Patients who received NAVIGATE and who had a duration of illness less than 74 weeks had significantly greater improvement in quality of life and psychotic symptoms than those patients who went longer than 74 weeks before getting treated (effect sizes of 0.54 vs 0.07 for QLS and 0.42 vs 0.13 for PANSS—the larger the effect size, the greater the effect was of that intervention).

Carlat’s Take: A comprehensive care program for first episode psychosis patients appears to help more than treatment as usual, at least over a 2-year period. The authors say they are continuing their assessments for 5 years and will someday publish those results. A limitation of the study is that it’s not clear if the NAVIGATE program produced its benefits via its specific components or more non-specifically, by exposing patients to visits and more time with clinicians. A more systemic issue is whether community mental health centers can afford to implement NAVIGATE. That’s not clear, though the authors are optimistic, for two reasons: First, insurance covers many of the NAVIGATE services, such as medications, individual therapy, and family therapy; second, the federal government has allocated money to support programs targeting first-episode psychosis. Let’s hope that money helps.

Susan Gonsalves <![CDATA[Death: The Flip Side]]> 2017-05-08T01:35:48Z 2017-05-08T01:35:48Z Death Has an Ugly Side—But Also an Optimistic Side

Death is all around us. It permeates almost every aspect of our life showcasing its omnipresence.

Death, as symbolized by the proverbial Grim Reaper, is actually personified in infinite ways. Large scale wars, suicide bombers, endless famines, chronic illnesses, accidental fatalities and natural disasters—among many others—unveil the reality of death. Experiencing the loss of a loved one can bring us to the brink of a colossal folding: the collapse of the fragile truce, maintained in our psyche, between death anxiety and death acceptance.

Indeed, death is painful to those left mourning. It can be incomparable, incomprehensible and inconceivable. Death has no true words, feelings or ways to describe it. Death is that part of life which is scary, taboo and reserved for way later in life. However, death is also Janus-faced. One side of the mask unveils hurt, shock, terror, trauma and suffering. The opposite side unveils moments of personal rebuilding, positive transformation and self-actualization.

Thus, within a positive psychology framework, death has the capacity to be the matrix for an increasingly engaging and fulfilling life.

Death Allows Us to Rebuild Ourselves and Our Relationships

Our awareness and acceptance of death can lead to our salvation. Through death, we view life with a different purpose and observe changes or details that may have previously gone unnoticed. A major obstacle to a heightened awareness of death is denial. Denial, an elementary defence mechanism, allows us to erect barriers—blocking our true awareness of death from consciousness.

Denial allows us to keep the reality of our mortality submerged in our unconsciousness—avoiding an almost unbearable volcano of anxiety, depression and anger from overwhelming our psyches. Thus, death is left occupying seldom traversed territory—shrouded in a cloud of mystery. Whereas famous thinker Max Weber characterized modern society as progressing towards a state of disenchantment, where rationalization and scientific reasoning threaten to obsolesce notions of mystery and mysticism, death stands unweathered by the siege.

Even with increased scientific understanding in the field of death and dying, death lies beneath a blanket of enchantment—full of mysteries and secrets. Humans search for explanations, reasons and an understanding of death.  We do not have a great understanding of death. This mysterious thing that threatens our existence can be terrifying.

How can we increase our awareness and acceptance of death while avoiding the anxiety it causes?

The idea of death really intensifies when we lose a loved one or experience a crushing loss in our lives. Through the process of grief, this period is when we can learn to grow from death.

We have to accept the reality that death makes us uncomfortable. We have to acknowledge that it causes anxiety. While grieving, we may go through several states of grieving as championed by Kubler-Ross; however, death can also be a time to rebuild ourselves and our identities.

Through grief, we learn to detach (but not forget) a past relationship and identity in relation to the loved one and learn how to reconstruct new identities through new or re-invigorated relationships. Our energies are sublimated—that is, channeled and re-directed in a way that positively reconstructs our lives. This channeling could include, volunteer work, finding a new passion in life or making new friendships.

When we learn to detach, we create new room and space  or better yet, opportunities for us to form new social attachments and build from previous social experiences and attachments.

Death Creates New Meaning and Purpose

Death has the power to re-create meaning and purpose in life. Psychologist Paul Wong proclaims that in order to know and appreciate life, we must know what it means to die. To die also means to live.

Therefore, it is through our recognition and acceptance of death that we can truly live a fulfilling and flourishing life.

Death is not just something on television or on the daily news; death is in our own lives and touches us on a personal level. When a loved one dies, we are grounded in the reality and realization of our own mortality. Death is not supposed to be foreign. It is a part of our personal fabric—our personal story.

Death affords us the opportunity to view life in a temporal dimension. The idea that life is finite adds a layer of meaning to life. We must have a high level of respect for death in order to resourcefully, as well as humbly, use the time we have left in this world to give our lives a sense of meaning and purpose. It is death that motivates us to really indulge in and experience the various types of moments and instances. Without a finite timeline, life could be afforded very little or no meaning.

We may notice the constant smile on a once unfamiliar face in the workplace, spend extra time with our loved ones or even let go of past grudges against friends or family. On one extreme, we may engage in death defying activities such bungee jumping, skydiving or mountain climbing.

Death Inspires Self-Actualization

Death has the capacity to allow us to be the very best we can be in the slotted amount of time we have. Abraham Maslow saw this stage in life as self-actualization: where we reach our full potential and cultivate our meaning and purpose in life. From the depths of sorrow and grief experienced after the death of a loved one, an increased confidence and resiliency levels may arise while grieving.

The ability to get through such a painful and incomprehensible event portrays how resilient we can be and may prepare us in facing future losses. As mysterious and scary as death can be, an awareness and acceptance of death allows us to confidently face unknown and unfamiliar circumstances in life. In order to really reach the highest levels of self-actualization we must remember that life is not perfect. Life is not linear and does not always travel down the path we want. Death helps us build a certain level of tolerance and awareness to the reality that we do not always get what we want. We learn to compromise and settle—realizing that not every situation, problem, or battle can be won.

We also learn that death can strike at any time. We may never be ready for it. However, it is possible for us to come out of a death experience stronger and more resilient.


Wong, P., Tomer, A. (2011). Beyond Terror and Denial: The Positive Psychology of Death

Acceptance. Death Studies, 35(2), 99-106. Retrieved from



Christine Hammond, MS, LMHC <![CDATA[The Basics of Borderline Personality Disorder]]> http://5.1360 2017-05-06T13:11:53Z 2017-05-06T13:11:53Z A person with Borderline Personality Disorder (BPD) has an intense fear of abandonment, demonstrates dangerous and impulsive behaviors, has unstable personal relationships, and experiences extreme emotions. They can have severe depression, anger, anxiety or rage followed by substance abuse and self-harming behaviors. Yet, they can be the most passionate loving people who are highly sensitive to their moods and the moods of others.

Unfortunately there are some basic misperceptions about BPD which contribute to misinformation and inaccurate diagnosis. Here are some basic concepts.

Misdiagnosing: Sadly, many people with BPD are often misdiagnosed as bi-polar which can be successfully treated with medication. However, if a person actually has BPD and is given bi-polar medication, the result can be disastrous. After a period of time, mood swings are more not less exaggerated, self-harming behavior might increase, and even thoughts of suicide escalate.

Similarities: The reason for the confusion between the two disorders is because they do share some distinguishing characteristics. The mood swings tend to oscillate between the two extremes of manic and depressed or love and hate. However, bi-polar mood swings seem to be unrelated to circumstances and can often be charted. Whereas a BPD mood swing seems to be very much related to present circumstances. Other similarities include self-harming behavior, addictive tendencies, and heightened anxiety.

Differences: One of the best tools for determining the difference between BPD and bi-polar is the sleep patterns. People with bi-polar have very erratic sleep behavior. During the manic phase of bi-polar, some are able to stay up for days. While during the depression phase, they sleep for 10-15 hours per day. A person with BPD may have poor sleep habits but they are not consistent with the mood swings.

Accurate diagnosis: Generally speaking, people with BPD tend to be highly self-aware. A simple read of the signs and symptoms of BPD in the DSM-5 is often evidence enough. Most are open about their self-harming tendencies and have a genuine desire not to continue to engage in that behavior. However, they usually don’t talk openly about the dissociative symptoms until it is identified. Many with BPD are unaware that this is a key indicator in diagnosing.

Underlying fear: The fear of abandonment is pervasive in people with BPD. This is frequently the driving force in their intense reactions. Vincent Van Gogh who is known for his post-impressionistic paintings in the late 1800’s was believed to have BPD. His most famous painting is “Starry Night” which he painted while in an asylum in France. He was hospitalized after he cut off part of his left ear because he was distraught over the abandonment of his housemate and fellow painter, Paul Gaugin. They had only been living together for about nine months.

Treatment: People with BPD respond well to therapy when they find the right person and treatment. Unfortunately it often takes several different therapists and approaches before the right combination can be found. The reason therapy works is mostly because of the client. A person with BPD doesn’t enjoy losing relationships and is open to trying new techniques in order to improve their connection with others.

Hospitalization: It is not unusual for a person with BPD to have been hospitalized several times due to self-harming behavior. However, short-term hospitalization is about stability, not treatment. Often the best type of treatment is an in-patient facility that specializes in BPD. Within this environment, techniques for managing life on the outside can be learned, practiced and developed in a safe accepting atmosphere.

Passion: A quick glance at the 900 paintings Vincent Van Gogh generated in his short 11 year career reveals a person with a deep zealousness for beauty, expression, and creativity. While his personal and professional life was a mess, his paintings now hang in the best museums around the world. His ability to magnificently express his emotions and thoughts through art are now legendary.

Too many times, the negative characteristics of BPD are pointed out without bringing to light the positive traits. Understanding the basics of the disorder helps to keep things in a better balance.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.

Christine Hammond, MS, LMHC <![CDATA[The Confusion of the Millennial Narcissist]]> http://5.1355 2017-05-05T16:13:48Z 2017-05-05T16:13:48Z It’s a toss-up between who is more confused: millennials because the world does not work the way they envision it should or other generations because they don’t understand how millennials think. All of the extra attention, special treatment, and emotional support that parents gave their kids have not resulted in a more productive generation but rather one that seems apathetic. This is why the subtext to the title of millennial is often the most narcissistic generation.

How did this happen? Some research has suggested that the lack of severe economic downturn during the childhood of millennials is to blame. Others, point the finger at parents who reinforced the idea that their child was so special they didn’t have to adhere to the standards of society. And some believe society is responsible because every child received an award even when they came in last place. Whatever the cause, the traits of narcissism seem to apply.

But millennials are not the standard grandiose narcissists. Rather, there are more subtleties in their characteristics. It is important to note that every millennial is not narcissistic, nor should they be considered as such. The purpose of this article is to highlight how narcissism manifests within this generation, not to diagnosis everyone as a narcissist. Here are the symptoms of narcissism re-interrupted by millennials.

  • Grandiose sense of self-importance – This sometimes manifests in an attitude that they don’t have to work hard to prove themselves. Rather, they believe they can achieve anything without having actually accomplished even a basic level. The result is they don’t even begin.
  • Fantasies of unlimited success – This maybe a consequence of substituting video game fantasy or media idolatry for harsh reality. In the gaming and media world, there are unlimited possibilities of achievement. But real life takes into account talent, determination, motivation, persistence, environment, and timing. Millennials prefer the fantasy over the reality.
  • Believes they are special – It is not unusual for a millennial to tote their non-judgmental attitude as evidence of how they are set apart from other generations. Ironically, by stating that other generations are judgmental, they are making a judgment. But this argument is frequently lost on them.
  • Needs excessive admiration – It is shocking how millennials expect praise for normal responsibilities of adulthood (known by millennials as “adulting”) such as paying bills and cooking basic meals. Instead of viewing this as a customary part of being an adult, many of them expect admiration for standard practices.
  • Sense of entitlement – There is an attitude amongst the millennials that the ultimate goal in life is to maintain a constant state of happiness. They believe that they deserve to be happy and should not do activities in which don’t bring happiness.
  • Exploitative of others – While millennials are excellent at not taking advantage of each other, they seem to have no difficulty in taking advantage of their parents. It is almost as if only those in their generation deserve respect.
  • Lack of empathy – The inability to feel empathetic with others translates into relationships that lack true intimacy. This in turn brings about a limited desire for making or maintaining a long-term commitment to a partner.
  • Envious of others – Hidden beneath the surface of many millennials is a jealousy of other’s success. Some even believe they should have success without any effort or that success comes without struggle, time, persistence, sacrifice, and even pain.
  • Arrogant attitude – Sadly, many millennials mock other generations and their subsequent decisions believing they could do a better job. This arrogance prevents them from learning from the mistakes of others and even growing from their own errors.

Not all millennials fit this profile, but when narcissism is added to the mix, this is frequently how it manifests. As with every generation, there is a learning curve and hopefully they will see their error and self-correct before they make a negative impact on the next generation.

Christine Hammond is a Licensed Mental Health Counselor and a National Certified Counselor who lives in Orlando and is the award-winning author of The Exhausted Woman’s Handbook.