Resources

Books, Links, and Articles in Stow, OH

Topic Spotlight

Getting Prepared for College and Life Beyond the Home

We live in an era where college performance is declining for many students while tuition costs are steadily increasing. Over 55% of college students do not graduate within the first six years of college. Eighty percent of college students do not know what their major should be when they enter college, and almost 50% of college students change their majors at least once. Half of those who change majors do so two to three times. Employment rates for college graduates under the age of 25 are less than 50%, with many of those employed being underemployed in jobs that are not well paid and do not utilize the knowledge the students gained in college.


School Place Assessment should be the first step in planning for a successful transition to college, to career success, and to life happiness. It takes a comprehensive look at variables of personality and emotional well-being because personality variables are predictive of career interests. This important information is used to make decisions such as college majors, matching the learning environment to the teenager's learning styles, and emotional preparedness to leave home and go to college. The goal is to assist students in making better decisions so as to complete college in four years and to reduce the frequency of students not completing school/college. This assessment goes far beyond the conventional career interest inventory.


Young adults and their parents will learn from the School Place Assessment customized study strategies based on their personalities, college/career selection, and increased self-awareness related to talents and goals.


The School Place Assessment can be used with students between the ages of 12 to 22. Dr. Whitmore has worked with these age groups for 20+ years. She has been trained and nationally certified to administer and provide valuable feedback to students and their parents.

Books and Links

Books of Interest

Anxiety Disorders

  • Beyond the Relaxation Response (1984) by Herbert Benson, New York: Times Books.
  • Bipolar: The Elements of Bipolar Disorder, A Practical Guide (2002) by Jay Carter, Psy.D., Wyomissing, PA, Unicorn Press
  • Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy (c. 2005) by Steven C. Hayes, Ph.D. with Spencer Smith, Oakland, CA: New Harbinger Publications, Inc.
  • Mastery of Your Anxiety and Panic (2007) by David H. Barlow and Michelle G. Cranske, New York, NY: Oxford University Press
  • Mastery of Your Anxiety and Worry (2006) by Richard E. Zinbarg, Michelle G. Cranske and David H. Barlow, New York, NY: Oxford University Press.
  • The Anxiety and Phobia Workbook (4th ed., 2005) by Edmund J. Bourne Ph.D., Oakland, CA: New Harbinger Publications, Inc.
  • The Mindfulness and Acceptance Workbook for Anxiety (2007) by John P. Forsyth, Ph.D. and Georg H. Eifert, Ph.D., Oakland, CA: New Harbinger Publications Inc.
  • The OCD Workbook, Your Guide to Breaking Free from Obsessive-Compulsive Disorder (c. 2005) by Bruce M. Hyman, Ph.D. and Cherry Pedrick, R.N..Oakland, CA: New Harbinger Publications, Inc.
  • The PTSD Workbook (2002) by Mary Beth Williams, Ph.D., LCSW, CTS and Soili Poijula, Ph.D., Oakland, CA: New Harbinger Publications Inc.
  • S.T.O.P. Obsessing, How to Overcome Your Obsessions and Compulsions (1991) by Edna B. Foa and Reid Wilson, New York: Bantam.
  • When Perfect Isn't Good Enough (1998) by Martin M. Antony, Ph.D. and Richard P. Swinson, M.D., Oakland, CA: New Harbinger Publications, Inc.

Assertiveness

  • Driven to Distraction (1994) by Edward Hallowell, M.D. and John Ratey, M.D. New York: Pantheon Books.
  • The Assertive Woman (3rd ed., 1997) by Stanlee Phelps and Nancy Austin, San Lois Obispa, CA: Impact.
  • You Mean I'm Not Lazy, Stupid or Crazy? (1993) by Kate Kelly and Peggy Ramundo, forward by Larry B. Silver, M.D., Cincinnati, Ohio: Tyrell and Jerem Press.
  • Your Perfect Right: A Guide to Assertive Living (7th ed., 1995) by Robert Albertini and Michael Emmons, San Losi Obispa, CA: Impact.

Autism

  • 100 Day Kit for School Age Children - access here 
  • 100 Day Kit for Young Children - access here
  • Asperkids: An Insider’s Guide to Loving, Understanding, and Teaching Children with Aspergers Syndrome (2012) by Jennifer Cook O’Toole. (Please note that Asperger’s Disorder is now referred to as autism spectrum disorder)

Attention Deficit Disorder

  • Attention Deficit Hyperactivity Disorder- A Handbook for Diagnosis and Treatment (4th ed. 2015) Edited by Russell A. Barkley, Ph.D., ABPP, ABCN. The Guilford Press-Division of Guilford Publications, New York, N.Y. 10012
  • Delivered from Distraction-Getting the Most out of Life with Attention Deficit Disorder (Trade Paperback Edition, 2006) by Edward M. Hallowell, M.D. and John J. Ratey, M.D. Ballantine Books, New York, N.Y.
  • Smart but Scattered-The Revolutionary Executive Skills Approach to Helping Kids Reach Their Potential-(4 to 13 year olds), (2009) by Peg Dawson, Ed.D. and Richard Guare, Ph.D., Guilford Press, New York, N.Y. 10012
  • Smart but Scattered Teens-The Executive Skills Program for Helping Teens reach Their Potential (2013) by Richard Guare, Ph.D., Peg Dawson, Ed.D. and Colin Guare, Guilford Press, New York, N.Y 10012
  • Taking Charge of ADHD-The Complete Authoritative Guide for Parents (3rd Edition, 2013) by Russell A. Barkley, Ph.D., Guilford Press, New York, N.Y. 10012.
  • Taking Charge of Adult ADHD: Proven Strategies to Succeed at Home, at Work, and in Relationships, by Dr. Russell Barkley (2022), also available as audio book
  • The ADHD Workbook for Teens (2010) by Lara Honos-Webb, Ph.D., Instant Help Books- An Imprint of New Harbinger Publications, Inc., Oakland, CA 94609
  • The Parent's Guide to Attention Deficit Disorders 2nd Ed. (1995) by Stephen B. McCarney, Ed.D. and Angela Marie Bauer, M. Ed. Columbia, MO: Hawthorne Educational Services Inc.

Career Development

  • What Color is Your Parachute (30th ed., 1999) by Richard Bolles, Berkeley, CA: Ten Speed.

Child Development/Parenting

  • Adventures in Parenting. A free booklet from the National Institute of Child Health and Human Development (NICHD) can be obtained by calling 1-800-370-2943 or online at www.nichd.nih.gov. It can be downloaded here.
  • Friends Forever: How Parents Can Help Their Kids Make and Keep Good Friends (2010) by Fred Frankel, Ph.D.
  • Good Friends are Hard to Find (1996) by Fred Frankel, Ph.D., Glendale, CA: Perspective Publishing, Inc.
  • How it Feels When Parents Divorce (1984) by Jill Krementz, New York: Knopf
  • Parenting with Love and Logic (1990) by Foster Cline, M.D. and Jim Fay, Colorado Springs, CO: Pinon Press.
  • Teens in Turmoil (2002) by Carol Maxym, Ph.D. and Leslie York, M.A., New York: Penquin Putnam.
  • The Adolescent Self (1991) by David B. Wexler, Ph.D., New York & London: W.W. Norton and Company.
  • The Boys and Girls Book about Divorce (1985) by Richard Gardner, New York: Bantam.
  • The Optimistic Child (1996) by Martin E. Seligman, Ph.D., Harper Perennial.

Chronic Illness

  • Heart Illness and Intimacy: How Caring Relationships Aid Recovery (1992) by Wayne Soctile, Baltimore: Johns Hopkins University Press.
  • Heartmates: A Guide for the Spouse and Family of the Heart Patient (3rd ed., 2002) by Rachel Freed, Minneapolis MN: Fairview Press.

Communication/Negotiation

  • Beyond Reason: Using Emotions as You Negotiate (2005) by Roger Fisher and Daniel Shapiro, USA: Penguin Books.
  • Getting to Yes, Negotiating Agreement Without Giving In (1991) by Roger Fisher and William Ury, USA: Penguin Books.
  • Verbal Judo: The Gentle Art of Persuasion (2004) by George Thompson, Ph.D. and Jerry Jenkins, New York, New York: HarperCollins Publishers, Inc.
  • You Just Don't Understand, Men and Women in Conversation (1990) by Deborah Tannen, New York: Ballantine Books.

Death/Grieving

  • A Broken Heart Still Beats (1998) by Anne McCracken and Mary Semel, Center City, Minnesota, Hazelden.
  • The Bereaved Parent (1978) by Harriet Sarnoff Schiff, New York, NY, Penquin Books, Inc.
  • When Bad Things Happen to Good People (1981) by Harold Kushner, New York: Schocken. (Spiritual help by a Rabbi).

General

  • Authoritative Guide to Self Help Resources in Mental Health (2000) by John Norcross, Ph.D., John Santrock, Ph.D., Linda Campbell, Ph.D., Thomas Smith, PsyD, Robert Sommer, Ph.D., and Edward Zuckerman, Ph.D., New York, New York: The Guilford Press.
  • Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward (1994) by James O. Prochaska, Ph.D., John C. Norcross, Ph.D., and Carlo C. DiClemente, Ph.D., New York, New York, Harper Collins Publisher.
  • The 10 Dumbest Mistakes Smart People Make and How to Avoid Them (1993) by Dr. Arthur Freeman & Rose DeWolf, Preface by Aaron T. Beck, M.D., New York: HarperCollins Publishers, Inc.
  • The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance, by Dr. Matthew McKay, Dr. Jeffrey Wood, and Dr. Jeffrey Brantley (2019)
  • The White Knight Syndrome: Rescuing yourself from your need to rescue others. (2009) by Mary C. Lamia, Ph.D. and Marilyn J. Krieger, Ph.D., Oakland, CA, New Harbinger Publication, Inc.
  •  When Someone You Love has a Mental Illness (Nov. 2003) A Handbook for Family, Friends, and Caregivers by Rebecca Wodis, MFT, Forward by Agnes Hatfield, Ph.D., New York, New York: Penguin Group (USA).

Marital/Relationships

  • After the Affair (1st ed., 1997) by Janis Abrahms Spring, Ph.D. with Michael Spring, HarperCollins Publishers.
  • After the Honeymoon (2008) by Daniel B. Wile, Ph.D., Oakland, CA: Collaborative Couple Therapy Books.
  • The Dance of Anger: A Woman's Guide to Changing the Patterns of Intimate Relationships (1985) by Harriet Lerner, Ph.D., Harper and Row Publishers Inc.
  • The Five Languages of Love (1996) by Dr. Gary Chapman, Northfield Publishing.
  • The Love Dare (2008) by Stephen & Alex Kendrick, Nashville, TN: B&H Publishing Group (Christian).
  • The Seven Principles for Making Marriage Work (1999) by John M. Gottman, Ph.D. and Nan Silver, New York: Three Rivers Press.
  • We Can Work it Out (1993) by Clifford Notarius, Ph.D. and Howard Markman, Ph.D., New York: Berkley Publishing.
  • Why Marriages Succeed or Fail (1994) by John Gottman, Ph.D., New York: Simon & Schuster.

Mood Disorders

  • Control Your Depression (1996) by Peter Lewinsohn, Ricardo Munoz, Mary Ann Youngren and Antoivette Zeiss, Englewood Cliffs, NJ: Prentice-Hall.
  • Feeling Good, The New Mood Therapy (rev. ed. 1999) by David Burns, New York: Avon.
  • Mind Over Mood: Change How You Feel by Changing the Way You Think (1995) by Dennis Greenberger, Ph.D. and Christine A. Padesky, Ph.D., New York: Guilford Press.
  • Overcoming Depression One Step at a Time (2004) by Michael E. Addis, Ph.D. and Christopher R. Martell, Ph.D., ABPP, Oakland, CA: New Harbinger Publications, Inc.
  • The Feeling Good Handbook (rev. ed. 1999) by David Burns, New York: Plume.
  • The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (2007) by Mark Williams, John Teasdale, Zindel Segal and Jon-Kabt-Zinn, New York: The Guilford Press.

Self Esteem

  • Ten Days to Self-Esteem (1993) BY David D. Burns, M.D., New York, New York: Harper Collins Publishers, Inc.
  • The Self- Esteem Workbook by Glen R. Schiraldi, Ph.D. Oakland, CA New Harbinger Publications, Inc.

Special Education

  • Parent and Educator Resource Guide to Section 504 in Public Elementary and Secondary Schools - a detailed guide published by the US Department of Education (2016).  It can be downloaded here.

Trauma

  • The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Dr. Bessel van der Kolk (2015)
  • The Courage to Heal and The Courage to Heal Workbook (3rd ed. 1994) Childhood Sexual Abuse, by Ellen Bass and Laura Davis, New York, New York: HarperCollins Publishers, Inc.
  • Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, by Dr. Judith Herman (2022)

Article Archive

  • Getting Prepared for College and Life beyond the Home WRPA

    Getting Prepared for College and Life beyond the Home


    We live in an era where college performance is declining for many students while tuition costs are steadily increasing. Over 55% of college students do not graduate within the first six years of college. Eighty percent of college students do not know what their major should be when they enter college, and almost 50% of college students change their majors at least once. Half of those who change majors do so two to three times. Employment rates for college graduates under the age of 25 are less than 50%, with many of those employed being underemployed in jobs that are not well paid and do not utilize the knowledge the students gained in college.


    School Place Assessment should be the first step in planning for a successful transition to college, to career success, and to life happiness. It takes a comprehensive look at variables of personality and emotional well-being because personality variables are predictive of career interests. This important information is used to make decisions such as college major, matching of learning environment to the teenager's learning styles, and emotional preparedness to leave home and go to a college. The goal is to assist students in making better decisions so as to complete college in four years and to reduce the frequency of students not completing school/college. This assessment goes far beyond the conventional career interest inventory.


    Young adults and their parents will learn from the School Place Assessment customized study strategies based upon their personalities, college/career selection, and increased self-awareness related to talents and goals.


    The School Place Assessment can be used with students between the ages of 12 to 22. Dr. Whitmore has worked with these age groups for 20+ years. She has been trained and nationally certified to administer and provide valuable feedback to students and their parents.


    For more information, please contact Western Reserve Psychological Associates, Inc. in Stow, Ohio.


    Western Reserve Psychological Associates

  • Scary Clowns: The Fear of Clowns Eve F. Whitmore, Ph.D.

    Scary Clowns: The Fear of Clowns


    Clowns have been around for ages. Traditional clowns were comic relief in the circus after the thrills and chills of daring circus acts involving acrobatic feats. Even though most clowns are trying to be silly and sweet, many children do not like them. Young children have a fear of strangers, and when they encounter a clown at a birthday party, or even the circus, they can react with fear. Some people develop an extreme fear of clowns, referred to as Coulrophobia, which causes a person to experience mental and physical stress reactions and limits functioning due to anxiety; although this term has not been popular due to the infrequency of actual clown encounters. Interestingly, the classic, sweet, funny clown has been found to have a therapeutic effect on sick children in the hospital, decreasing a child's pre-operative anxiety and decreasing the length of respiratory illness. Sadly, there are fewer professional clowns seen these days because clowns have gone out of fashion.


    So why are some teenagers and adults (only 2% of the adult population) so afraid of clowns? If a parent experiences a specific fear of clowns, this often gets conveyed to a child or teenager, who is then more likely to become afraid. Modern horror movies have portrayed clowns as bad or evil and are not considered sweet or funny at all. In addition, pranks are currently being played by mischievous people dressed in clown costumes. Because one is unable to read a clown's emotions due to their heavy face paint, their display of manic-like behaviors can be terrifying to some, and this increases the idea that clowns are to be feared. In addition, clown fear is being exacerbated by social media. People develop fears by what they read and see in the media, like Facebook, Instagram and YouTube, where information goes `viral,' and rumors of murderous clowns and `clown sightings' spread quickly.


    As Halloween is fast approaching, you need to have your wits about you to enjoy the annual ritual of Trick-or-Treating. If you encounter a clown along the way, do not be intimidated or show fear, especially toward the sweet, nice looking clowns. Use rational thinking: "Clowns are typically good, sweet, soothing figures who make people laugh and feel happy." Consider the source of the viral message on social media, and make sure you note the source providing information about a `clown sighting'. Think logically and rationally before reacting to vague information, and do not let it become an unrealistic fear. If you continue to experience anxiety, then you should consider further consultation with a psychologist in order to better assist with minimizing your fears. Happy Halloween!


    Eve F. Whitmore, Ph.D.

    Staff Psychologist

  • Internalizing versus Externalizing: What are they and what do they mean to you? by E. Thomas Dowd, Ph.D., ABPP

    Internalizing versus Externalizing: What are they and what do they mean to you?


    Broadly speaking, Internalizers are those who tend to blame themselves when something happens or when things go wrong. Their first thought is, "What did I do wrong?" and they go there very quickly, even automatically. Everything is their fault and they tend to feel guilt, shame, and remorse. They tend to feel hurt rather than anger, which they have difficulty expressing. They tend to worry and ruminate and they lack self-confidence. They are afraid to let their feelings show easily.


    By contrast, Externalizers tend to project blame onto others for problems and difficulties. They rarely accept responsibility for anything and are always looking for someone else to blame, even for their own failings. Their first thought is, "Who is at fault for this (along with the corollary thought, `it can't be me!')?" They are easily frustrated and tend to react to frustration with anger. They can have an inflated sense of their own importance and can be insensitive to another's feelings. They often lack a good sense of empathy, or the ability to put themselves in another's situation.


    This is of course a continuum, not a dichotomy, so most of us have both characteristics, tending to one side or the other, depending on the circumstances. Most of us may be externalizers in some situations (such as when a company loses a form they've sent) and internalizers in others (such as when they've forgotten something). But some people are almost pure types and for them life can be very difficult; both for themselves and for those around them and in relationships with them. If you think about it, you've probably known both kinds and perhaps (if you're really honest) you can identify these tendencies in yourself.


    If you're strongly on one side or the other it can cause you problems in relationships with others. Internalizers have a great deal of difficulty handling and accepting even mild criticism. Criticizing their behavior is like attacking their entire self-worth as a person. Sometimes they respond with complete self-loathing and guilt and engage in immediate self-criticism as if to say, "You can't criticize me as much as I can criticize myself!" This often has the effect of causing the other person to withdraw because they don't really want to cause hurt and pain. Paradoxically the Internalizer is then spared further criticism. Externalizers, by contrast, often become angry when criticized and may "lash out" at the criticizer as a way of deflecting blame from themselves. They may say things like, "You do the same thing," "I'm justified in what I do," or even, "I don't do that but you do!"


    Two internalizers in a relationship tend to blame themselves first for any problems and may try to out-do each other in self-blame. Two externalizers in a relationship tend to engage in shouting matches as each tries to blame the other. A relationship consisting of an internalizer and an externalizer may result in an agreement that everything is the internalizer's fault. The externalizer is angry and the internalizer is miserable.


    What to do? In both cases it is helpful to reduce the automatic tendency to respond immediately. Take a deep breath and relax. Second, it is helpful to really listen (for five minutes or more!) to the other person and what he or she is saying. Third, it is helpful for externalizers to ask themselves, "Does the other person have a point?" (even though it may be overstated). Someone once said, "Cherish your enemies — they will tell you things your friends never will." It is helpful for internalizers to ask themselves, "Am I really to blame for all of this? Or can I accept only a little or even none of the responsibility?" Sometimes role reversal can be helpful, in which each party argues from the point of view of the other, although no one really likes doing this.


    The first step, however, is to recognize your own style. A psychologist can help you do this and can suggest additional coping strategies for you. But only when you recognize what you are doing can you begin to change.


    E. Thomas Dowd, Ph.D., ABPP

    Psychologist

  • How to Have a Good Marriage (If that's what you want) E. Thomas Dowd, Ph.D., ABPP, Psychologist

    How to Have a Good Marriage (If that's what you want)


    The noted marriage therapist, Dr. John Gottman, has described what he calls "The Four Horsemen of the Apocalypse" in marriage communications that he says significantly increase the probability of divorce. These are: 1. Criticism of the partner's character rather than the specific behaviors that bother you; 2. Expressions of contempt and disrespect towards the partner; 3. Defensiveness in an argument with the partner; and 4. Stonewalling or refusing to respond at all. While all couples use these tactics occasionally, Dr. Gottman says, repeated use predicts divorce with a high probability.


    As an alternative to telling couples what not to do, I'd like to describe "The Four Horsemen" of a good marriage; attitudes and behaviors that can significantly enhance your marriage satisfaction. If you do these things you can improve your marriage; if you don't like the results you can always return to using Dr. Gottman's "Four Horsemen."


    1. Compassion. Having compassion for other people, including your spouse, has been shown to lead to significant mental, even physical, benefits. Compassion has been defined as an attitude of shared suffering with other people coupled with a desire to reduce that suffering. It is the basis of the Christian Golden Rule and a central teaching in Buddhism. Those who practice compassion tend to have less stress and to be happier. Those who practice meditation often meditate upon compassion. And sometimes we are the most difficult person for whom to have compassion.
    2. Forgiveness. People who readily forgive others (even their spouse!) tend to have better interpersonal relations and to be happier. Such an attitude also encourages others to forgive them. Apologize when you've done something wrong; it is one of the best predictors of forgiveness being granted to you. Research has even shown that forgiveness benefits the forgiver more than the offender. Indeed the "Lord's Prayer" might be reworded to say, "Forgive us our trespasses to the extent that we forgive those who trespass against us."
    3. Understanding. None of us can ever truly understand another person; the motives and developmental history that shaped their behaviors towards us and others. But we can try. To the extent you can begin to understand your spouse, you may be able to see how what (s)he did may say more about him/her than about you. All of us tend to personalize; thinking a spouse's anger towards us is because of us, not them. Sometimes we are just angry or upset in general and take it out on those closest to us because it's safer. You can even link Nos. 2 and 3 because it has been said, "To understand all is to forgive all." So the closer we can come to understanding the closer we can come to forgiving. An aid to understanding is non-judgmental, non-defensive listening. A good marriage therapist can help in this.
    4. Acceptance. There are just some things about our spouse (and other situations too) that we cannot change and therefore must accept. Much as we might like to have it otherwise, they are different people than we are and have different ideas and ways of operating in the world. Often the differences that attracted them to us in the first place are the very things that bother us the most later. The Alcoholics Anonymous slogan says, "Change the things we can, accept the things we cannot change." A wise marriage therapist said, "In marriage you can either be right or you can be happy — but not both." Many things simply are not worth arguing about. Arguing will solve nothing and polarize everything. Acceptance too has been linked to better mental health.

    So try these suggestions on an intimate partner and watch the results. You can also investigate each topic in more depth to enrich your life.


    E. Thomas Dowd, Ph.D., ABPP

    Psychologist

  • Forgiveness and Reconciliation: What they are and what they aren't E. Thomas Dowd, Ph.D., ABPP, Psychologist

    Forgiveness and Reconciliation: What they are and what they aren’t


    There has been much misunderstanding about forgiveness and its companion, reconciliation. In this article I’d like to describe the benefits and pitfalls of forgiveness and to dispel some misconceptions about it. Definition of forgiveness:


    It is both intra-personal (an attitude change) and interpersonal (a change in relations between people). In genuine forgiveness, one who has suffered an injury chooses to abandon rights to resentment and retaliation and instead offers mercy and understanding. It is voluntary and unconditional and does not depend on the offender’s response, although the offender’s response may help.


    What forgiveness is not:


    1. It is not pardoning (sparing legal penalties), condoning (which implies a justified offense), excusing (implying the offender has a defensible reason), or forgetting (denying existence of injury).
    2. It is not necessarily reconciliation. This implies the continuation or re-establishment of a previous relationship and is based on the trustworthiness of the offender. And sometimes the offender is not even present, as in death.
    3. Forgiveness does not necessarily demonstrate the moral superiority of injured party.

    What do people do when they forgive?


    1. They feel empathy for the transgressor, trying to understand the reasons behind the injury.
    2. They have more generous feelings about the transgressor.
    3. They stop ruminating about the transgression. The more people ruminate about an offense, the more difficulty they have forgiving the offense.

    Dimensions of forgiveness


    It involves both internal and interpersonal activities. The former changes cognitive appraisals and interpretations such as anger and hostility; the latter changes the relationship with the offender and implies no further revenge or reparations. But the fear often is that the offender may then not have to feel as guilty or change future behavior.


    There are several types of forgiveness:


    1. Hollow forgiveness. The injured party expresses forgiveness but does not really feel it. He/she may continue to harbor resentments but the perpetrator may feel the matter is over and “back to normal.” But expressing forgiveness may be the first step to making the commitment to forgive – changed behavior really can change attitudes. Hollow forgiveness is better than nothing.
    2. Silent forgiveness. The injured party changes his/her attitude but does not express it; this allows the perpetrator to continue to feel guilty but reduces the negative feelings of the injured party. It seems manipulative but has several advantages. First, it has many of the advantages of forgiveness (reduction of negative feelings) without the disadvantages (loss of the perpetrator’s concessions and restitutions). Second, it may provide safety in certain situations, e.g. with an abusive spouse. Third, it may work well in exchange relationships where we need resources from other people. You can use the, “After all I’ve sacrificed for you...” model.
    3. Total forgiveness. The injured party ceases to feel resentful or upset about the offense and the perpetrator is released from further obligation and guilt. There may indeed be a total reconciliation here.
    4. No forgiveness (“total grudge”). “My father hated your father; my grandfather hated your grandfather, etc., so I hate you. And I’ll teach my children to hate your children!” This is obviously bad for everyone!

    There are several advantages of forgiveness:


    A continuation of negative emotions may undermine one’s mental (and even physical) health. Anger can, in the short run, feel empowering but it doesn’t last. If you have a disposition to forgive it may reduce your interpersonal hostility in general.

    It can restore needed close and caring relationships; a lack of forgiveness tends to undermine all relationships and can lead to having few friends or intimates. It promotes relationship harmony.

    A refusal to forgive invariably hurts the injured party more than the offender. A famous Rabbi once said that a refusal to forgive if genuinely asked for is as great as the original offense. The victim role is associated with misfortune and passivity and identifying with it can undermine one’s functioning.

    Forgiving is transformational rather than conservational. It changes one’s motivation from self-protection to self-enhancement. It changes one’s goal from avoiding pain to pursuing peace; peace of mind and peace with others. It is empowering because it eliminates the victim role which is disempowering. It encourages empathy. But dropping our self-protective stance is difficult indeed for all of us.

    Disadvantages of forgiveness (advantages of holding grudges):


    1. Forgiveness involves relinquishing future claims for restitution; in other words, the offender no longer OWES. In economic terms, it reduces the injured party’s future resources. There are tangible and material benefits to be gained by holding grudges.
    2. Not forgiving helps one to retain a sense of moral superiority (righteous indignation); forgiving renounces it. But in many religions, forgiving itself has been seen as morally commendable.
    3. Forgiving may increase the possibility that the transgression will recur; not forgiving may result in greater power in the victim that may reduce the chances of reoccurrence. Not forgiving means the injured party can continually remind the perpetrator of the offense. In that sense, not forgiving can feel empowering because forgiveness reduces one’s options.
    4. Forgiving can be risky if the perpetrator denies wrongdoing. Forgiveness may remove the last obstacle to a repeat. An apology involves the implicit assumption that the transgression will not be repeated. One study showed that the perpetrator‘s response was the best predictor of forgiveness and an apology correlated with high forgiveness. Apologies also helped people feel more empathic towards perpetrators.
    5. Transgressions may hurt the injured party’s pride or self-esteem and forgiving may feel like accepting a loss of face or self-esteem. This may account for “silent forgiveness;” it avoids a public loss of face. Forgiveness may be misinterpreted as weakness.
    6. Forgiveness means relinquishing a claim on revenge. Revenge can be a positive, empowering feeling - at least in the short run.
    7. Non-forgiveness may arise from principles or moral standards; forgiving may feel like condoning immorality. Strong adherence to standards of justice may imply that some acts should not be forgiven.

    But note this! You are the primary beneficiary when you forgive others because it reduces your own negative emotions. You also bear the costs of not forgiving (holding a grudge) because you get to keep your negative emotions. This hurts you but generally it doesn’t hurt the perpetrator at all. So do yourself a favor: forgive. If you have difficulty forgiving someone important to you please see a psychologist to help you with the process.


    E. Thomas Dowd, Ph.D., ABPP

    Psychologist

  • Gratitude: What is it, what are the benefits, how can you get it? E. Thomas Dowd, Ph.D., ABPP, Psychologist

    Gratitude: What is it, what are the benefits, how can you get it?


    "Gratitude is not only the greatest of virtues but the parent of all the others" (Cicero)


    "Act with kindness but do not expect gratitude" (Confucius)


    Gratitude is a most misunderstood concept. It can provide numerous mental, even physical, health benefits. But most people don't practice it and some even think it's unnecessary and unhelpful. "I shouldn't have to be grateful," they may think. "I'm only getting what I deserve and I really deserve more. Other people should be grateful to me."


    What is gratitude and why is it so difficult to express? It is an acknowledgement of the goodness in your life. It is also a recognition that the source of this goodness lies at least partially outside of yourself. To that extent it is unearned or undeserved merit. To really express gratitude it is helpful to adopt the attitude of wanting what you have rather than having what you want. In a culture where a strong tacit message is, "You deserve it!" it can be difficult to feel gratitude. It is much easier and less countercultural to feel non-gratitude (failing to recognize the benefit) or even ingratitude (finding fault with the benefit). Ask yourself: How often have you ignored another person (a spouse, parent, or friend) who gave you a benefit or a compliment (non-gratitude) or even questioned their motives in doing so (ingratitude)? And what has been the result?


    Gratitude is really more of a choice and an action than a feeling. While we may indeed feel grateful, we will enhance it if we choose to act gratefully. Furthermore it will benefit you more than the person to whom you express gratitude and it will enhance your relationship with that person. You will feel better and your wellbeing and relationships will improve. Who would not want that? But like everything else in life you must work at it. Fortunately the more you do the easier it will get.


    What can gratitude do for you? It can reduce depression and increase pleasant memories. It can reduce what has been called "the poverty of affluence." It can strengthen your relationships with others. People who keep "gratitude journals" report feeling more connected to others. It can improve your marriages and other intimate relationships by increasing the "positivity ratio," the ratio of positive to negative messages we give our partners. Good relationships have a ratio as high as 5:1 while distressed relationships have a ratio as low as .7. Some relationships are even in negative territory where there are more negative than positive messages given.


    There are several obstacles to expressing gratitude, however. One is "negativity bias;" the human tendency to respond negatively to significant events. Another is narcissism, or excessive self-regard; sometimes expressed as, "Thank God I'm not a sinner like everyone else!" A third is adaptation; "It's just my due; I deserve it." While a new car or a new spouse may make us feel better about ourselves for a while, the feeling will not last. We adapt quickly to what we have and then want more. And sometimes expressing gratitude just feels like too much work!


    What can you do to express more gratitude in your life? Here's how.


    1. Keep a Gratitude Journal; a list of all the things for which you are grateful. Be specific; don't just say, 'I'm grateful for my spouse." Update it regularly. If you always write the same things it will become stale and you will likely quit. Think about it before writing.
    2. Write a Gratitude Letter to someone who has provided you with something important in your life. It is not necessary that the other person even know what they have provided. Simply tell them in your own words how they have been important to you. It might be a professor, a parent, an intimate partner, a friend, a co-worker. Do it now before they die because many people have regretted not doing this while they still could. You may even wish to bring the letter to them and discuss it. And be prepared for a powerful experience.
    3. Ask yourself several questions:

    • "What have I received from ... ?" (Recognize all the gifts we have received from others).
    • "What have I given to ... ?" (Focus on the gifts you give to others).
    • "What troubles and difficulties have I caused ... ? (Acknowledge how we cause pain and suffering in the lives of others).
    • "What advantages have I been given in life" (Recognize your gifts).
    • "Which allies and supporters have helped me get where I am?" (Recognize your dependence on others).
    • "What do I take for granted in life?" (Recognize what you normally don't see).

    If you do at least some of these activities you will begin to cultivate a habit of gratitude in your life. You will begin to develop and exercise your gratitude muscles. And like everything else it becomes easier with practice.


    E. Thomas Dowd, Ph.D., ABPP

    Psychologist

  • Seasonal Affective Disorder Catherine Cherpas, Ph.D. Counseling Psychologist

    Seasonal Affective Disorder


    Seasonal Affective Disorder (SAD) is a type of depression that occurs around the same time each year. For many people, symptoms begin in the fall and may continue into the winter months. However, some people report an opposite pattern with symptoms beginning in spring or summer. Symptoms of fall/winter SAD may include depression, anxiety, loss of energy, hopelessness, excessive sleep, social withdrawal, appetite changes, weight gain, concentration difficulties, and loss of interest in activities you enjoy.


    The specific cause of Seasonal Affective Disorder remains unknown. Like many mental health conditions, your age, genetics, as well as your body's natural chemical make-up, may play a role in developing the condition. The reduced level of sunlight in fall and winter may disrupt your body's internal clock, which lets you know when you should sleep or be awake. This disruption of your circadian rhythm may lead to feelings of depression. Also a drop in serotonin, a brain chemical that affects mood, may play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression. In addition, the change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.


    Some lifestyle remedies that may help reduce symptoms of SAD include making your environment brighter and sunnier, spending more time outdoors, and exercising on a regular basis.


    If your seasonal depression symptoms become severe, you may want to see your family physician or a psychologist. Treatments for SAD include light therapy, medication, and/or psychotherapy. Although SAD is thought to be related to brain chemistry, your mood and behavior can also contribute to your symptoms. Psychotherapy can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthier ways to cope with SAD and manage stress with psychotherapy.


    Catherine Cherpas, Ph.D.

    Counseling Psychologist

  • Motivation — What is it? Bonnie L. Fraser, Ph.D. Clinical Psychologist

    Motivation—What is it?


    "I want to exercise, but I just don't have the motivation." We hear that a lot and we say it ourselves. Whether the behavioral goal is to exercise, pay the bills, study, do the taxes or just get to work on time. So what is this quality of "motivation" that we are lacking?


    For most of us motivation is the incentive or inducement to move. It may be maintained by an inner excitement about achieving a goal and it can also be maintained by an external incentive. External incentives can either be rewards for performance or fear of the consequences of non-performance. Sometimes when we say, "I'm just not motivated" we mean, "I'm just not anxious enough about it yet." Other times it may mean "I'm too anxious about it to start."


    What the psychologist can do in cognitive therapy is help you explore your own motivation or barriers to it. We can't inject you with motivation. You will have to do your homework. These factors are necessary:


    • A clear awareness of the benefits of change.
    • Awareness of all factors that maintain the status quo.
    • An honest log of your current behavior and accompanying thoughts.
    • A willingness to change any external factors that maintain the status quo.
    • Remembering that anything you do often can reinforce what you do less often.
    • Willingness to experiment, fail, and then revise your experiment. (e.g. if 20 minutes is too much, try for ten minutes).

    Changing what you say to yourself-"I can make choices".


    Willingness to make a significant commitment of time to supervising yourself.


    One thing that does not work to improve behavior is punishment for non-performance. It does help, though, to write down what you are doing instead of what you planned to do.


    This may sound like even more work than just doing "it"! And it may be, but at least you will learn some things about yourself.


    Bonnie L. Fraser, Ph.D.

    Clinical Psychologist

  • HAPPINESS---What is it? How to get it? How to keep it? E. Thomas Dowd, Ph.D. Psychologist

    Happiness—What is it? How to get it? How to keep it?


    Has there ever been a parent who never said to their child, "I don't care what you do; I only want you to be happy." Indeed it seems that what everyone wants is continuous and genuine happiness. Even the US Constitution refers to "Life, liberty and the pursuit of happiness". However, happiness cannot simply be reduced to nothing more than having a good time.


    What is happiness?


    Happiness is an activity. Helen Keller said, "True happiness is not attained through self-gratification, but through fidelity to a worthy purpose." In other words, we become happy by doing things that make us happy, whether in our work or in our play.


    Happiness is an attitude. Abraham Lincoln said, "Most people are about as happy as they make up their minds to be." In other words, if we decide to be happy, we are more likely to be happy. And we now know that Lincoln suffered from depression throughout his life. But they didn't call him a Depressive; they called him Mr. President.


    Happiness is a feeling that is the result of our attitudes and actions. But notice that the feeling of happiness is the result, not the cause, of attitudes and actions.


    What determines happiness?


    Believe it or not, studies have found that a large part of the variance (about 50%) in whether we are happy or not depends on our genetic makeup. Happiness just seems to come more naturally to some people than to others. If your parents and other relatives were happy, it is more likely that you will be too. But if they weren't, well, it doesn't mean you are doomed to unhappiness forever. Because research has also found that your intentional activity accounts for about 40% of the variance in whether or not you are happy. Surprisingly, only about 10% of your happiness is determined by your individual circumstances. Therefore, if you are unhappy today, you'll probably be unhappy tomorrow - unless you decide to do something about it.


    To what is happiness related?

    1. What is very important to happiness: Your personality, work, self-esteem, optimism, and a sense of control over your life. Those who work in meaningful occupations and have control over large aspects of their lives are more likely to be happy. Surprisingly, perhaps, spending money on other people rather than yourself is very important! But most parents know that.
    2. What is somewhat important to happiness: Good health, religion (religious people are happier than non-religious people), and relationship harmony. For example, while a bad marriage may make you miserable, a good marriage can make you happy.
    3. What is not important to happiness: Money, age, gender, intelligence, attractiveness, and parenthood. This is very surprising to people because they tend to assume that they'd be happier if only they had more - money, beauty, etc. Likewise, we often assume older people are unhappy because they're, well, old and full of aches and pains. But some of the unhappiest people are the young who are insecure about relationships and practically everything else. Therefore, you don't need to be rich and beautiful to be happy, and you don't need children. Indeed, research has discovered that marital satisfaction actually declines during the child rearing years and increases after they leave! So much for the myth of the "empty nest" unhappiness. And changing your life circumstances (for example, your spouse or your place of residence) won't help make you happier either. If you are unhappy in Ohio with your old spouse, you'll likely be unhappy in Florida with a new spouse because you take yourself with you wherever you go!

    What are the primary sources of happiness in life?

    They include the quality of your family relationships, your employment, your community and friends, the state of your health, your sense of self-control or autonomy, the quality of your personal ethical and moral values, and the quality of your environment. Fundamentally, things won't make you happy - relationships will.


    What are some happiness-enhancing activities in which you might engage?

    1. Practice expressing gratitude for what you have. Interestingly, many people constantly moan and complain about what they don't have, which is a good recipe for unhappiness. Each evening write down three specific things that happened that day for which you are grateful. Think small!! Write down different things each evening.
    2. Cultivate optimism. Express faith in yourself, other people, the world, and God. A sense of optimism is a good predictor of mental health.
    3. Ambrose Bierce once said, "Happiness is an agreeable sensation arising from contemplating the misery of another." Psychologists call this downward social comparison comparing ourselves to others who are worse off than we are. It really will make us happier than upward social comparison which is comparing ourselves to those who are better off than we are. For example, research has shown that if we look at and admire attractive members of the opposite sex, we are unhappier with our spouses. If we look at others who are more attractive than we are and then envy them, we will feel worse about ourselves. Spending too much time watching television can make us unhappy because all the people in the sitcoms are younger, thinner, more attractive, and have better spouses and sex lives than we do. But remember the saying, "I felt bad because I had no shoes until I met a man who had not feet."
    4. Practice random acts of kindness, such as letting someone cut in front of you in traffic. It's catching! Mark Twain once said, "Always do the right thing. It will impress some people and astonish the rest." The same goes for kindness and generosity.
    5. Put more effort into building and enhancing your social connections with others. Social relationships are a buffer against negative life events. Ask yourself, "How many people would come to my funeral? Who would they be and why should they?" In Charles Dickens' A Christmas Carol, no one came to Ebenezer Scrooge's funeral in the scenario posed by the Ghost of Christmas Future. Remember also, no one ever says on their deathbed, "Gee, I wish I'd spent more time at the office!"
    6. Learn to forgive others and yourself. A lack of forgiveness hurts you, not the other party. Forgiving primarily benefits you. This is another complete topic for another time.
    7. Commit to your goals and follow through with actions. Remember, "When all is said and done, some people have said it and some people have done it - and they aren't the same people!"
    8. Savor and think about life's joys. Relish the mundane and the ordinary. Have fun in small activities. Do outrageous things-outrageously... Remember, happiness is not something that just happens to you. Like love, it's a decision, and deciding you want to be happier is the first step. Then foster it by planned activities. But don't try to force it; let it come to you. For in the words of the 1960's saying, "If you want something let it go. If it comes back to you it's yours. If it doesn't, you never had it."

    E. Thomas Dowd, Ph.D.

    Psychologist

  • Dementia is Not Just Alzheimer's! Catherine C. Cherpas, Ph.D., Counseling Psychologist

    Dementia is Not Just Alzheimer's!


    Dementia is a condition caused by a number of different diseases. Many people equate dementia with Alzheimer's disease, but they are not synonymous. It is true however, that Alzheimer's is one of dementia's major causes.


    Dementia is a global impairment of cognitive ability that interferes with normal activities of daily living. Loss of memory is the hallmark of dementia. Impaired executive functioning (i.e., inability to plan, organize and implement a task) is another prime characteristic of dementia. Other characteristics include problems with language, spatial orientation, and changes in behavior.


    Dementia is what we once called senility. It is not a normal part of aging though the diseases that produce it are much more common in the elderly.


    Statistics for the causes of dementia vary depending on the population surveyed and the criteria used for the diagnosis of different types. At times, causes may not be clear-cut, and in many cases, more than one pathologic process may be at work. The prevalence of different forms of dementia varies in different countries. Dementia also seems to occur more frequently in urban environments.


    Overall, it is estimated that Alzheimer's pathology is present in about 50-75% of all dementias. Major symptoms of Alzheimer's disease are memory impairment, language dysfunction, visual-spatial deficits, impaired executive function, and behavior disturbance.


    Fronto-temporal dementia (or Pick's disease) may represent 5-10% of cases. Unlike many dementias, memory ability remains fairly intact until the disease is advanced. There are felt to be two major clinical subdivisions of this dementia, frontal lobe variant and temporal lobe variant. In the frontal lobe variant, behavioral abnormalities predominate along with changes in personality and social conduct. These persons may show poor impulse control, rudeness and use foul language in situations where it is uncalled for. In the temporal lobe variant, language function and speech are affected with behavioral problems less prominent. Initially, these persons may have difficulty finding words, naming objects and have difficulty expressing themselves as well as understanding what has been said to them. Sometimes only nonsensical phrases are spoken. In most cases, verbal output is progressively reduced, and eventually the affected individuals become mute.


    Dementia with Lewy bodies and Parkinson's disease dementia represent about 15-20% of cases. These two conditions have similar disease processes though different parts of the brain are predominantly affected by each entity. Lewy bodies are present in the neurons in both illnesses and the clinical pictures include the motor finding of Parkinson's disease and cognitive decline. However, in Dementia with Lewy bodies, intellectual impairment is evident early on, whereas in Parkinson's it occurs later.


    Fluctuation in cognitive ability with variation in attention and alertness, recurrent visual hallucinations, and motor features of Parkinson's disease are the signal features of Dementia with Lewy bodies. The same pattern of cognitive impairment seen in Dementia with Lewy bodies also occurs in Parkinson's disease dementia though hallucinations may be less frequent. Difficulties with memory and executive functions are prominent. Speech impairment is often a major feature and usually because of motor dysfunction. Visuo-spatial problems are also seen frequently.


    Vascular dementia may represent about 20-25% of cases. Most older people have some vascular changes in the brain though the degree of involvement varies. When dementia from any cause occurs in the elderly, it is likely that cerebrovascular disease is playing some role. A more accurate label for many cases may be mixed dementia.


    Vascular dementia has also been called multi-infarct dementia and post-stroke dementia. The classic description is of a stepwise deterioration in cognitive function following stroke, but this is not always the case. There may be a slow progressive decline in cognitive ability. Strokes may be silent and without sudden changes in the individual. Also, the parameters of cognitive dysfunction depend on the location and severity of strokes.


    There are many other different disease processes that produce dementia. Some of these less common conditions include normal pressure hydrocephalus, Creutzfeldt-Jakob disease, progressive supranuclear palsy and Huntington's disease. Infectious causes of dementia include syphilis, Lyme's disease, and AIDS. A metabolic problem like thyroid deficiency (hypothyroidism) is a reversible cause of dementia that is important to rule out in persons who have cognitive impairment. Autoimmune diseases like multiple sclerosis and lupus can also progress to dementia.


    To summarize, dementia is a condition caused by a number of different diseases or pathological conditions, and many times there may be multiple causes or explanations for cognitive declines observed. When dementia is suspected, see your primary care physician who can refer you to a geriatrician or a neurologist to assist with diagnosis and treatment of symptoms. Your physician may also refer you to a psychologist who specializes in neuropsychological testing. Information obtained from neuropsychological testing can help to determine if impairment exists, its severity, whether the pattern of impairment within the context of the individual's history suggests a diagnosis, and what are the real life consequences of this impairment. Through education and psychological counseling, the individual and his/her family can learn to cope more effectively with losses in cognitive and physical functioning and with emotional and behavioral changes.


    Catherine C. Cherpas, Ph.D.

    Counseling Psychologist

  • Help....I Don't Like My Therapist! Suzanne Hetrick, Ph.D.

    Help....I Don't Like My Therapist!


    When you first call our office to ask to see a therapist, our staff members do their best to match you with the best professional for the type of problem or need that is presented. Usually the matching process takes into account insurance coverage and the schedule availability of you and your therapist. We hope that you are a good fit with the therapist selected for you. It usually works out just fine, and you feel good about who you see. At a large group practice, such as Western Reserve Psychological Associates, we have fourteen psychologists who are available at various times to see people. The psychologists all have differing strengths and expertise.


    There are times that your therapist may notice, after a session or two, that he or she is not the best qualified for your particular situation or presenting problem. In these instances, your therapist may recommend a colleague see you. You should not feel badly about changing therapists. You are not being rejected or abandoned. Rather you are being re-directed to someone who has specialty credentials to work with your issues or problems. Hopefully, the transition is a smooth one, and you are soon working with the therapist who is best able to meet your needs.


    There are some times that the fit is not a good match. Perhaps the therapist's style or therapeutic orientation and expertise are not conducive to a good working alliance. You don't have to "love" your therapist to get better, but it helps if you feel that you have a compatible working relationship. You need to feel understood and valued. You need to know that your treatment goals are being addressed and that you are making positive progress. If you don't think you are getting the help you need, what do you do?


    First, talk to your therapist directly about your concerns. You may be able to work through the problems that are getting in the way of progress. On the other hand, it may be that your therapist will agree to refer you to someone else.


    Secondly, if you cannot work things out with your therapist, you can initiate a change to another therapist on your own. Just inform the office personnel at WRPA that you need to see a different therapist. It is important that you give feedback to your therapist if things did not work well. It helps to be very open about your reasons for a change. Therapists learn from failures as well as successes.


    In situations where a couple is being seen for counseling, or the whole family is involved in sessions, one or more of the people being seen may not like the therapist or may feel things are not moving forward. In those instances, talk with the therapist about options. There are times that two therapists work as a team with couples or families, especially when issues are complex. Or it may be helpful to have people see different therapists for some individual work and then return for couples or family work. Again, be honest in acknowledging when therapy is not working for you.


    Problematic situations do not happen often, but when they do, they need to be talked about honestly and openly with the goal of making therapy a success. You really should like your therapist!


    Suzanne Hetrick, Ph.D.

  • Teen Dating Violence: The Need for a Safety Plan Janet E. Dix, Ph.D., Psychologist

    Teen Dating Violence: The Need for a Safety Plan


    Unfortunately, teen-dating violence is more prevalent in our society than most people realize. According to the Domestic Violence Advocacy Program of Family Resources, Inc. (www.acadv.org/dating.html), about one in three high school students have been or will be involved in an abusive relationship. Forty percent of teenage girls from the ages of 14 to 17 say they know someone their age that has been hit or beaten by a boyfriend. Though teens try to hide the fact that they are being abused, their parents, siblings, teachers and friends often notice signs that are indicative of dating abuse. For example, a change in personality, failing grades, use of drugs or alcohol, pregnancy, emotional outburst, moodiness, or isolation are signs that the teenager is in distress and needs help. A trained counselor, therapist or professional who specializes in working with adolescents would be able to offer guidance and help change the direction the teenage is headed. Teenagers should be aware of how to keep themselves safe from harm and know the warning signs of an abusive partner.


    Why would 14 to 17 year olds hide the fact that a boyfriend or girlfriend is abusing them? First, teenagers are inexperienced with dating relationships and find it difficult to confront the abuser. Secondly, teenagers who have low self-esteem and fear being rejected and alone will often tolerate negative behavior so as not to alienate or end the relationship. Low self-image influences how one views others and what one is willing to put up with by a date. Thirdly, teens often fear being rejected by their peers, want to be independent from their parents, deny that the abuse will happen again and therefore, suppress their feelings of hurt, betrayal, and fear. Many kids don't know who to tell, what to do, how to stop the abuse, or how to get out of a controlling and abusive relationship. Some young women believe that their boyfriend's jealousy, possessiveness and even physical abuse, is "romantic".


    Teenagers need to recognize Early Warning Signs that your date may eventually become abusive. Some of the signs include:


     Extreme jealousy

     Controlling behavior

     Quick involvement

     Unpredictable mood swings

     Alcohol and drug use

     Explosive anger

     Isolates you from friends and family

     Verbally abusive

     Threatens violence


    Teenagers need to think through Dating Safety. For example:


    • Double date the few first times you go out with a person.
    • Before leaving on a date give parents the exact details of the date.
    • Let your date know you are expected to call home.
    • If you leave a party with someone you don't know well, tell a friend; ask him/her to call and make sure that you arrived home safely.
    • Trust your instincts. If a situation makes you uncomfortable, try to be calm and figure out a way to remove yourself from the situation.

    Teenagers should think ahead of potentially dangerous situations and have an Individualized Safety Plan. Some things to consider in designing your plan are:


    • Who could you tell about the violence and abuse? Which adults? Who would keep you safe at school? Teachers, principal, counselors, security?
    • Consider changing your locker and/or lock.
    • Use a buddy system for going to school, walking to classes, and after school, walking to classes, and after school activities.
    • If stranded, whom could you call?
    • Which friends would help you be safe?
    • Get rid of or change the cell phone numbers you gave the abuser or the abuser gave you.
    • Where could you go quickly to get away from the abusive person?
    • Keep spare change and your emergency numbers with you as well as a copy of the restraining order if you have one.

    In the training seminar on Dating Violence and Sexual Assault in Teen Relationships sponsored by Summit county Children Services and Akron Children's Hospital, a bookmark titled Respect: The Teen Dating Bill of Rights was handed out to all the participants. It reminds teens that they have the right to:


     Not be abused

     Live without fear

     Say no to sex

     Set your own limits

     Change your mind

     Choose your own friends

     Refuse a date

     End a relationship

     Your opinion

     Be respected

     Spend time alone

     Be heard

     Set goals for yourself

     Ask for help


    Everyone has a right to ask for a date and refuse a date. All of us have a right to refuse to lend money and to refuse sex any time and for any reason. We all have a right to have friends and space aside from our partner. Sometimes relationships become mostly emotional and only slightly rational. If you or someone you love is struggling with violence in a relationship, please seek help. Take action. Sometimes just talking through a situation with an objective party can help with the decision to stop the abuse.


    Janet E. Dix, Ph.D.

    Psychologist

  • Post Traumatic Stress Disorder — A normal reaction to an abnormal situation John Lowenfeld, Ph.D., ABPP, Clinical Psychologist

    Post Traumatic Stress Disorder — A normal reaction to an abnormal situation


    We have heard a lot about Post Traumatic Stress Disorder, or PTSD, one of a group of Anxiety Disorders. It is at the same time over-diagnosed and often misunderstood. PTSD is a reaction to an extreme stressor that can affect anyone, given the right stressful situation.


    People react differently to various stressors, but no one is immune to stress. In order for a diagnosis of PTSD to be made, a stressor that is outside the range of normal human experience must be identified. This can include extreme experiences such as active combat, rape, involvement in severe accidents, experiencing natural disasters such as earthquakes or tsunamis, severe personal abuse, etc. In all instances the stressor must be personally experienced and be severe, and the response to it involved fear, helplessness or horror.


    In order for a diagnosis of PTSD to be made, symptoms must include the following:


    • Re-experiencing the traumatic stressful event, such as in recurrent distressing recollections or dreams, acting or feeling as if the event were recurring including a sense of reliving the experience, illusions, hallucinations and "flashbacks" to the event, intense distress at exposure to cues that symbolize or resemble an aspect of the event, and physiological reactivity (such as sweating) when exposed to such cues.
    • Persistent avoidance of stimuli that are associated with the traumatic stressful event such as avoiding talking or thinking about it, avoiding activities, places or people associated with it, inability to recall some important part of the event, diminished interest and participation in activities, feeling detached or estranged from others and a restriction in the range of affect or feeling such as experiencing joy or love.
    • Persistent symptoms of increased arousal (autonomic activity) such as insomnia, irritability or anger, difficulty concentrating, increased "jumpiness" or startle response, and hypervigilance or guardedness.

    PTSD is a treatable disorder, affecting about 8% of the U.S. population at some time in their life. While the disorder is occasionally self-limiting, the most effective treatments have been the Cognitive Behavioral Therapies (CBT). Some antidepressant medications (Selective Serotonin Reuptakes Inhibitors or SSRI's) have been used, as have a combination of CBT and SSRI's. Group Therapy interventions have also been effective.


    John Lowenfeld, Ph.D., ABPP

    Clinical Psychologist

  • Worry Bonnie L. Fraser, Ph.D., Clinical Psychologist

    Worry


    "What if"? So much misery is caused by those two words. Especially now, with so much uncertainty in the world, it is easy to become consumed with worries and alarms.


    May people ask us "So, has the economic crisis increased your business"? Actually, it hasn't. Some people are too afraid to spend any money (even $20 for a co-pay) and others lose their insurance when they lose their job. But mainly, people keep their "what if'" and "if only's" at home, where they keep them to themselves or inflict them on the family. It doesn't help much that other people have the same problems; actually, that just makes it scarier. Anxiety is one of the most infectious emotions.


    Psychologists are not immune to anxiety, either. But for the record, here are some things we have learned about managing it so worry doesn't run your life:


    1. Stay away from other people who are talking about "what if". You don't need broadcasting from the anxiety radio network.
    2. Give your mind some time just to worry. You are going to do it anyway and you don't want to be doing it at two a.m. So actually schedule some time each day to sit down with a pad and paper and give your mind over to your worries. Actually write them down. That way you don't have your brains alarm system going off at unexpected times with helpful little reminding (e.g. "Your savings is already down 50%" or "You should have had that little mole looked at before I lost my health insurance", or "You'll have to lay off three more people if things don't pick up).
    3. Find anxiety clusters and ask yourself, "How likely is this to really happen"? If you don't really know the answer, find someone who might.
    4. From your worry list, pick the things you can do something about right now and do it. Procrastination really fuels anxiety.
    5. Make a "prediction record". Column 1 is for the date you make your negative thought/prediction. Column 2 is the thought itself. Column 3 is for the outcome in 1 month. Column 4 is for later updates. Include everything from "It will probably rain on graduation day" to "The government of Pakistan is going to jail". See how many of these worries actually come to pass. We usually remember our few accurate predictions and forget all the catastrophes that did not happen.
    6. For really persistent worries, follow your catastrophe spiral down to it's end. e.g.
    • I'm going to get laid-off.
    • We'll lose the house.
    • The kids will hate me.

    Everyone will know and I'll be mortified.

    Note how this particular downward spiral goes from a possible actual event to a worst outcome to what others will think about it. Many worries are made worse by undeserved guilt and shame.

    If you find this technique just scares you more, there is a helpful workbook: Mastery of Your Anxiety and Worry (New York: Oxford University Press) 2006.

    7. Focus on this moment.

    8. Exercise. Feeling physically fit helps emotional resilience.

    9. Get a reality check from a wise friend.

    10. If you are really stuck and making yourself miserable, see a psychologist!


    Bonnie L. Fraser, Ph.D.

    Clinical Psychologist

  • Post Holiday Blahs Barbara A. Buchanan, Ph.D. Clinical Psychologist.

    Post Holiday Blahs


    Thanksgiving through New Years is a whirlwind of shopping, wrapping, decorating, arranging and socializing. For the religious there are also services filled with meaning and reflections.


    January and February can be so blah after all that busyness. It's cold and snowy in Ohio. The day is mostly gray and light, when it's there, is filtered through clouds and reflected off snowfall. It's just not inspiring.


    In fact, there are seasons for a reason. In temperate zones, like the Midwest, fields are fallow in winter. They receive moisture as snow, sleet and rain and they rest. In spring, the earth blooms because of the rest during winter.


    It's not a great stretch to imagine that human beings could benefit from a season of rest. After the winter holidays seems a good time for that. Do things, but make them small scale and simple to contrast with the over-the-top November-December holidays.


    For example:


    • Invite a friend to lunch. Get caught up with each other.
    • Find your old knitting project and work on it.
    • Fill up the photo albums you bought years ago.
    • Play cards with your kids.
    • Bake something with your kids.
    • Plan a golf outing for April or May.
    • Watch old movies and eat popcorn.
    • Read good books. Go to the library — it's free.
    • Plant seeds. Watch them grow. Spring is coming.

    There are big times and there are small times: January and February don't have to be blah. They can be times of quiet enjoyment in small, simple and meaningful ways.


    Barbara A. Buchanan, Ph.D.

    Clinical Psychologist

  • Disability and the Family Virginia Fowkes Clark, Ph.D.Virginia Fowkes Clark, Ph.D.

    Disability and the Family


    Having a family member with a medical or psychiatric disability places unusual stresses on the family. Family members who provide care giving more than 36 hours weekly are at increased risk for anxiety, depression, sleeplessness, and back pain. For elderly caregivers with a chronic illness themselves, there is a high mortality rate than for those who are not in a care giving role.


    When the disability first occurs, extended family, friends and community members tend to flock to help the family. However, as disabilities become more chronic, people fall away and distance themselves from the family and the person with the disability. The resources of the family become stretched.


    Financial stress often arises. Sometimes a two-income family has to cut back to one income either because an earner has to stop work due to the disability or with an elderly parent or a child one earner has to stay home to care for the one with the disability. Sometimes a stay at home mother has to return to work so her disabled husband can stay home. The changes in finances also change the roles taken in the family.


    When a child becomes disabled or is born with a disability, if there are other children, they often receive less attention. Sometimes this can lead to behavioral or emotional problems in the child without the disability.


    Strain on the marriage is common among parents of a child with a disability. Often the mother becomes very involved with the child and pays less attention to the husband and the marriage. As mentioned above, finances can be strained which is a source for common arguments.


    Often it is difficult to admit one is angry with a family member for having a disability and its impact on the family. Acknowledging the possible or inevitable future losses is important but it is also important to not overemphasize the loss. A shift needs to be made toward strengths, interests, and abilities. One needs to find meaning and hope beyond the physical progression of the disease. Challenges can be viewed as opportunities for learning and change. Furthermore one needs to be flexible and adjust future major goals.


    Community support and psychotherapy can help. Support groups sometimes exist for families with certain disabilities, although more are needed. Respite services are available for families in some cases. Psychotherapy focusing on stress management and support can provide both an outlet for frustrations but also can improve coping.


    References:


    1. John S. Rolland, M.D. "Mastering Family Challenges with Illness & Disability: An Integrative Model" 3rd Annual Ortho Summer Symposium, 2008.
    2. Froma Walsh, Ph.D. "Spiritual Wellsprings for Resilience: Living and Loving Fully with Disabilities." 3rd Annual Ortho Summer Symposium, 2008.

    Virginia Fowkes Clark, Ph.D.

  • What is a Health Psychologist? Gerald J. Strauss, Ph.D. Section Chief, Clinical Health Psychology, Cleveland VA Medical Center, Assistant Clinical Professor of Medicine, Case Western Reserve School of Medicine.

    What is a Health Psychologist?


    Health Psychologists are licensed psychologists who have doctorial degrees in Clinical, Counseling, or Educational Psychology who go on to do specialized post-doctoral training in Health Psychology. Health Psychologists generally work in medial settings such as hospitals. However, they can also work in other settings such as private practice settings, performing more traditional mental health work.


    If working within hospitals Health Psychologists may be found providing clinical care for patients in General Internal Medicine and Family Practice Clinics, Spinal Cord Injury Units, Pain Management Centers, Geriatric Clinics and Nursing homes, Sleep Clinics, Cardiology Clinics, Infections Disease Clinics, and many more. Additionally, Health Psychologists also direct obesity treatment clinics, perform pre-bariatric surgery evaluations, pre-organ transplant evaluations, and function as team members in the treatment of various chronic health diseases such as diabetes, hypertension, heart failure, and pulmonary issues.


    Finally, Health Psychologists are often found in academic medical settings (like medical and nursing schools) providing education to various medical disciplines, engaging in research, and holding academic appointments (e.g., Assistant, Associate, and Full Professorships) within those Institutions).


    Gerald J. Strauss, Ph.D.

    Section Chief, Clinical Health Psychology

    Cleveland VA Medical Center

    Assistant Clinical Professor of Medicine

    Case Western Reserve School of Medicine

  • How to Help a Friend with Panic Disorder Bonnie Lee Fraser, Ph.D. Clinical Psychologist

    How to Help a Friend with Panic Disorder


    Panic attacks are almost as frightening to an observer as they are to the person experiencing them. People experiencing panic may suddenly look pale and complain of feeling dizzy or faint or "weird." They may feel their heart racing, and may insist that they are having a heart attack. They may sweat, flush, shake, pant, and look ill. A person in a panic state may get angry or start crying or just look dazed. They may insist on leaving where you are now and going home or to the hospital. Of course the first few times the panic sufferer will probably be taken to a doctor or emergency room. This is entirely appropriate. A thorough medical evaluation is important to rule out dangerous medical conditions that can cause these symptoms.


    After medical clearance, a patient is told he or she is having panic attacks. A panic attack is essentially a communication problem. In a panic attack the brain apparently misreads physical sensations and turns on all its alarms at once. It feels as if you were crossing the road and you suddenly saw a semi-truck driving straight for you. You run and you trip. You cannot hear anything but the blasting of the horn, you cannot see anything but the headlights, and you cannot escape.


    The problem for the people with panic disorder is that, despite repeated assurances by the doctor that they are not ill or dying; they are having miserable, but harmless and treatable panic attacks, they may still fear and avoid the experience. At this point reassurance is useless. People prone to panic attacks may want to avoid all places where panic episodes have occurred in the past. The panic attack sufferers may get alarmed at the first twinge of anxiety and go to elaborate lengths to prevent the next attack. Ultimately these avoidance strategies do not work and over time they will seriously restrict the person's life. They may come to see themselves as ill or weak or disabled and unable to ever have a normal life.


    It is important for you not to minimize the intensity of the experience. Panic does feel overwhelming. What both of you need to remember is that it is temporary. The best advice for both of you is to: FLOW with it.


          Face it


         Let the feelings come


         Observe the sensations


         Wait


    This advice applies to you as well as to your friend. You can help best by staying calm. Face it that you are going to be there for a while. Most attacks last from ten to twenty minutes with after-effects of lesser anxiety that last for several hours. Find an out-of- the- way spot where both of you can wait for the anxiety to subside. If your friend wants to talk, listen. If he or she wants to keep silent, don't ask questions. If your friend is in counseling, he or she will have been instructed not to fight the feelings. This is the most helpful advice you can give. Mention it only if the friend seems to be struggling or if wants to leave immediately. (Patients are told that it is best to stay where they are until the panic has passed). Help him or her do that.


    You may be tempted to try to figure out what is "causing" the anxiety. This is pointless. They don't know what caused it. You don't know what caused it. Doctors don't know what causes it. Often the attack just comes out of the blue. All we know is the tendency to have panic attacks runs in families. We think it has something to do with breathing. We know it is more prevalent in people who have mitrovalve prolapse. We also know that exploring origins is not a useful coping strategy. Staying put, accepting the feelings, and waiting is helpful. Some patients are able to practice slow breathing during that attack. Some people feel better if they keep walking. If that is helpful, fine. Other quick fixes, such as reaching for a pill, running for an exit, or calling their husband, their mother or the doctor again, are not likely to be helpful, and are likely to be problematic in the long run. So, stay in the Flow yourself!


    After the attack has subsided some people may be ashamed, embarrassed, apologetic, or even angry that you witnessed their distress. This is the time for reassurance. Tell them that it is not their fault and that you do not think less of them. If they have not tried cognitive therapy, suggest it. They are not alone. Anxiety disorders are the most common group of emotional disorders. There is a lot of information available. Take a look at the website for The Anxiety Disorders Association of America, www.adaa.organd for the American Psychological Association, www.apa.org. The more informed you both are, the less scary the occasional panic attack will be.


    Bonnie Lee Fraser, Ph.D.

    Clinical Psychologist

  • Diaphragmatic Breathing: A Technique for Managing Stress, Anxiety and Panic Richard C. Rynearson, Ph.D., Clinical Psychologist

    Diaphragmatic Breathing: A Technique for Managing Stress, Anxiety and Panic


    All relaxation and self-calming procedures for managing stress and anxiety have breathing control and training as a common and necessary factor.


    Thoracic breathing (chest breathing), shallow breathing, sighing and hyperventilation are common dysfunctional breathing patterns when we are tense, anxious or angry.


    Hyperventilation (over breathing) decreases the level of CO2 (carbon dioxide) in the blood, which causes the blood to become less acidic. When the acidity of the blood decreases, oxygen is bound more tightly to the hemoglobin in the blood, and oxygen has more difficulty passing to the tissues of the body, thus reducing the amount of oxygen available for adequate physiological functioning.


    Acute hyperventilation occurs when we are suddenly confronted with increased physical activity or frightening or stressful events that resolve quickly. Chronic hyperventilation affects every system in the body and causes significant physical symptoms and complaints. Among these are:


    • Headaches - Increased Muscle Tension and Cramps
    • Dizziness - Irregular and Rapid Heart Rate
    • Faintness - Tightness in the Chest
    • Anxiety/Panic - Non-cardiac Chest Pain
    • Feelings of Unreality - Sweating
    • Cold Hands or Feet - Blurred Vision
    • Shivering - Tingling in the Limbs
    • Irritability - Muscle Weakness, Fatigue

    Those experiencing these symptoms often lie down, go to bed and passively wait to feel better, or take medication. Some may go to the Emergency Room only to be told that there is nothing wrong with them. With this reassurance, the symptoms may recede, and they typically feel better until the symptoms return at another time.


    Hyperventilation can be controlled by learning Diaphragmatic Breathing! Try the following basic steps and enjoy the results!


    1. Lie or sit in a comfortable, quiet place where you won’t be disturbed.
    2. Put one hand on your chest and the other hand over your navel.
    3. Exhale all your air until your belly pulls in.
    4. Now imagine you have a balloon underneath your navel that inflates as you inhale and deflates as you exhale.
    5. Breathe in through your nose and pull the air deeply into your lungs. Feel your belly expanding – like a balloon blowing up. Exhale slowly through your mouth and feel your belly go down, like a balloon deflating. Softly say “haa” on your exhale.
    6. Breathe in slowly – inhale to a count of 3 and exhale to a count of 6 – taking twice as long to exhale as you did to inhale.
    7. Keep your shoulders as relaxed as possible - they should not rise as you inhale.

    After taking 4 deep breaths as described above, continue breathing naturally and rhythmically through your nose, with a hand on your belly, letting it rise and fall gently as you inhale and exhale. Note the natural calming and relaxation that accompanies each exhalation. Now just continue to practice for 10-15 minutes, enjoying the calming effects of Diaphragmatic Breathing.


    If you have found this calming, try and practice breathing for a few minutes each day and/or in response to specific stressors.


    References:


    Harvey, John (1998). Total Relaxation – Healing Practices for Body, Mind and Spirit. New York. Kodansha International.


    Kabat-Zinn, Jon (1990). Full Catastrophe Living-Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York. Delta.


    Richard C. Rynearson, Ph.D.

    Clinical Psychologist

  • Relationships and "the New Infidelity" John S. Schell, Ph.D., Clinical Psychologist

    Relationships and "the New Infidelity"


    Dating back to biblical times, infidelity has been a threat to committed relationships and is certainly one of the issues that bring couples into therapy. Today, infidelity does not have to involve a sexual indescretion to destroy the very nature of trust that holds two people together. "The new infidelity is between people who unwittingly form deep, passionate connections before realizing that they've crossed the line from platonic friendship into romantic love." According to Dr. Shirley Glass, a psychologist and renowned expert on infidelity, "infidelity is any emotional or sexual intimacy that violates trust."


    Of course, Dr. Glass is describing what we have come to know as an emotional affair, an affair that excludes sexual intimacy but involves primarily emotional intimacy. In reality, to call this a new form of infidelity is a bit of a misnomer. Evidence of these types of emotionally charged relationships date back in history as well, but it seems safe to say that the frequency with which people are having emotional affairs is certainly on the rise. Dr. Glass identified this trend in her 2003 book, Not Just Friends, citing her data which suggested that approximately 60% of the men and women she had counseled had been involved in an emotionally unfaithful relationship. Furthermore, 82% of sexually unfaithful partners had had an affair with someone who was at first "just a friend."


    David Moultrup (1990), author of Husbands, Wives, and Lovers, has broadly defined an extramarital affair as "a relationship between a person and someone other than (the person's) spouse or lover that has an impact on the level of intimacy, emotional distance, and overall dynamic balance in the marriage-the role of the affair is to create emotional distance in the marriage." By this definition, sexual involvement is neither a necessary ingredient in defining the presence of an affair, nor in understanding its impact on the committed relationship. Of course, for the emotionally unfaithful partner, citing the absence of sexual activity may be a way to neutralize the sense of extramarital wrongdoing. "But we didn't have sex" is somehow supposed to make the betrayal of an emotional affair less painful. In fact, because infidelity means different things to different people, those involved in an emotional affair might not even consider their behavior as inappropriate or hurtful. Men in particular often seem to hold this view, but for women who stereotypically put more emphasis on emotional rather than sexual intimacy, an emotional affair may prove to be even more destructive to a relationship than a one night stand or casual sexual encounter.


    It's important also to remember that most people who become involved in an emotional affair were not intending to be unfaithful, were not looking to have an affair, and in many cases did not think they were vulnerable to such behavior. Sharing your deepest thoughts and feelings in an ongoing interaction with someone will typically generate a feeling of closeness that then stimulates even more disclosure and more intimacy. Eventually this type of relationship can become extremely close causing an emotional attachment to develop thereby potentially causing serious damage to a marriage or committed relationship, regardless of whether or not the affair ever becomes sexual in nature.


    It's important also to remember that most people who become involved in an emotional affair were not intending to be unfaithful, were not looking to have an affair, and in many cases did not think they were vulnerable to such behavior. Sharing your deepest thoughts and feelings in an ongoing interaction with someone will typically generate a feeling of closeness that then stimulates even more disclosure and more intimacy. Eventually this type of relationship can become extremely close causing an emotional attachment to develop thereby potentially causing serious damage to a marriage or committed relationship, regardless of whether or not the affair ever becomes sexual in nature.


    Signs that a close friendship may really be an emotional affair include: Inappropriate emotional intimacy: Are you sharing more with your friend than you are with your partner? Do you think your friend understands you better than your partner? Do you look forward to being with your friend more than your partner? Sexual and emotional chemistry: Are you sexually attracted to your friend? Is it more exciting to be with your friend than your partner? Deception and secrecy: Does your partner know about your friendship or is it a secret? Are you saying and doing things with your friend that you wouldn't do with you partner present? Denial and minimization: Is the phrase "we're just friends" your way of rationalizing your close friendship?


    In general, infidelity happens for a variety of reasons, but emotional affairs seem to be on the rise because of increased opportunities, both in the workplace and online. What may start out innocently enough, may quickly spiral out of control, and result in a relationship that is inappropriate in terms of the emotional intimacy involved. Individuals involved in these types of relationships may experience the same biochemical rush that occurs when two people fall in love, creating a "high that becomes almost addictive" according to Dr. Frank Pittman (1990), psychiatrist and author of Private Lies: Infidelity and the Betrayal of Intimacy. This makes the developing pattern of inappropriate intimacy all the harder to break.


    Over the past few years, I have seen more and more couples who are struggling with trust issues and a sense of betrayal that has come from one of the partners having had an emotional affair. In many of these cases, the lack of sexual involvement has not mitigated the negative effects of the affair, and the deception involved was clearly destructive to trust and the relationship in general. Of course, friendships are important and can provide us things that we sometimes cannot find in our relationships, but allowing them to fulfill important needs at the expense of your partner and your relationship can certainly be destructive and is a sure sign of an emotional affair.


    John S. Schell, Ph.D.

    Clinical Psychologist

  • Boundaries Barbara A. Buchanan, Ph.D., Clinical Psychologist

    Boundaries


    There are all kinds of boundaries; map boundaries, property boundaries, and personal boundaries. Ohio has a boundary with Indiana. I can't come into your house without your knowledge and consent. We all understand those kinds of boundaries; it is the personal boundaries that are harder to comprehend.


    Personal boundaries involve different physical and emotional space. In the USA, we generally like about three feet of personal space. In other countries personal space is different. Even we drop the three-foot boundary on entering an elevator. There we ignore the closeness by detaching strategies, staring at the ceiling or the floor numbers, but not at fellow passengers.


    Emotional boundaries are the trickiest to get. Let's discuss some examples and see what we can learn about emotional boundaries.


    Example 1. At the end of dinner while the ladies are clearing up, the granddaughter (23 years old) said, "I hate my Dad, he never cared about me". The grandmother said, "No, you don't. That's not a nice thing to say".


    Example 2. The wife is upset, frustrated and crying. The husband shouts, "You have no right to be upset"!


    Example 3. The former girlfriend receives a threatening E-mail saying she will be sued if she doesn't return the former boyfriends "stuff". The only things she has from him are gifts from last Christmas.


    Comment on example 1. The grandmother has just violated her granddaughter's emotional boundary by negating her granddaughter's feelings. She further interferes by criticizing the granddaughter's opinion. Anyone may have an opinion that doesn't agree with our opinion.


    Comment on example 2. The husband also negates the wife's feelings but does so more aggressively than Grandma did. Rule 2. Everyone has a right to his/her feelings.


    Comment on example 3. The former boyfriend is not recognizing the separateness of his former girlfriend. He's treating her like a "thing", which cancels her right to be treated like any other gift receiver. This is a more severe boundary violation than example 2 because it negates her. Were this to continue in an intact relationship, it could go to violence*. Rule 3. People may not be treated like "things".


    Boundaries tell us who we are and who we are separate from. An emotional boundary is how we respect and protect ourselves as well as respect and acknowledge others.


    Here are some clues that your boundaries are being violated and you are being emotionally abused.


    1. You are expected to go along with other peoples' plans for you. Once you are no longer a child, this should stop. You should be a part of planning group or couple events.
    2. Someone who claims to love you tells you what to think, do or say.
    3. Someone who claims to love you is very critical or may swear at you when you disagree with that person even in small ways.
    4. If there is a history of the above, notice that physical limitation's or isolation may occur. (e.g.... "Don't go to the game with your brothers").

    There are things to do to help you deal with boundary violations.


    • Use I statements. "I feel uncomfortable when you speak for me. I am fully capable of speaking for myself".
    • Read — There are lots of books about boundaries and relationships. In June '02, there was a good article in Oprah Magazine about, The Emotionally Abusive Relationship in the magazine interview with the young actress/singer Brandy.
    • Go to therapy — Strengthen yourself, learn how to set limits and why you didn't. Some boundary violators are really clever about it and put all blame off onto us. You can't be more than half of the problem.
    • Improve your self care — Find out what you like: foods, clothing, bathing, places to walk. Then do what you like.

    There is every reason to believe that you can have good boundaries. First, recognize when your boundaries are violated by others. Second, refuse to violate the boundaries of others. Three, build a life with people who treat you well.


    * If you are intimidated, restrained, prevented from leaving, "bumped" into a wall, etc. you are being physically abused.


    Barbara A. Buchanan, Ph.D.

    Clinical Psychologist

  • Having Trouble Sleeping? Karen Desmarais, Ph.D. Staff Psychologist

    Having Trouble Sleeping?


    Do you find that you have difficulty falling asleep at night, often laying awake for hours after going to bed? Are you restless throughout the night and have trouble staying asleep?


    There are many reasons that individuals experience disrupted sleep patterns. For instance, worrying about the day's events, or experiencing stress or depression can contribute to sleep difficulties. Certain medical conditions can impact sleep patterns as well. It is important to see your medical provider to rule out any medical condition that may be contributing to the problem. In addition to these factors contributing to disrupted sleep, excessive alcohol consumption, the use of illicit substances, and/or the use of stimulants (i.e., nicotine found in cigarettes; stimulants contained in some cold medicines) can also lead to sleep impairment.


    Fortunately, there are several things that may help improve your sleep:


    • Establish a regular sleep schedule. Go to bed at the same time each night and get up at the same time each morning.
    • Decrease/eliminate alcohol use and/or illicit substance use.
    • Avoid exercising in the evening. This tends to increase your body temperature and can negatively impact the sleep cycle.
    • Avoid napping.
    • Avoid consuming caffeine after 6pm, or even 4pm if you go to bed early. For instance, avoid such things as caffeinated coffee, caffeinated soda, and chocolate since these are stimulants.
    • Take a warm bath or shower a few hours before bedtime
    • Sleep in a room set at a comfortable temperature. A room that is too hot or too cold may interfere with sleep.
    • If you're unable to sleep, don't remain in bed for more than 20-30 minutes. Laying in bed tossing and turning can make it even more difficult to sleep due to the frustration of trying to force yourself to get to sleep. Instead, get up, engage in a relaxing activity, such as watching TV or reading, then return to bed. You may need to do this repeatedly throughout the night.
    • Avoid eating heavy meals before bedtime. However, eating a light carbohydrate (i.e., a few crackers or a piece of bread) might help improve sleep.

    Chronic sleep problems can be extremely disruptive to one's life and one's ability to cope with stressors. If your sleep problems are interfering with your daily life in any way, it may be beneficial to seek help from a qualified mental health or medical professional.


    Karen Desmarais, Ph.D.

    Staff Psychologist

  • Oppositional Behavior in Children Virginia Fowkes Clark, Ph.D.

    Oppositional Behavior in Children


    Every year thousands of children are evaluated and treated by clinicians because their parents or teachers complain that these children frequently disobey, argue, lose their temper, deliberately annoy others or in other ways are disruptive. Some research suggests that psychosocial factors such as family conflict and parent mental health problems are related to oppositional behavior in children. Treatment hinges on assessing both the child and the family setting.


    How do you know if your child has Oppositional Defiant Disorder? According to the DSM-IV-TR, to meet the criteria a child must have four of the eight symptoms more frequently than is typical for the child’s age and developmental level and lasting at least six months. These symptoms are: often loses temper, often argues with adults, often actively defies or refuses to comply with adults’ requests or rules, often deliberately annoys people, often blames other for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful and is often spiteful or vindictive.


    A good clinician will help clarify whether your child has these symptoms in addition to another set of symptoms which may better explain why your child is oppositional. For example, many children with Attention Deficit Hyperactivity Disorder have these symptoms but when both are treated, the prognosis is much better. It is important to recognize that sometimes children develop these symptoms in reaction to some stress in their life. Some children with depression develop many of these symptoms. In that case, the depression needs to be treated as well as the oppositional behavior in order for your child to get better. Some children with autism spectrum disorders develop these symptoms and treatment has to be tailored with that in mind otherwise there will be little progress. Sometimes these symptoms can be stemming from a bipolar disorder.


    Assessing factors in the family are especially important. When parents are under stress due to their own mental health problems, financial stress or marital conflict, it is more difficult to be an effective parent. Helping parents be the best that they can is an important component of treating oppositional behavior. Parent training should be a vital part of the treatment. Furthermore, treatment of oppositional behavior in a child may lead to the detection of mental health problems in a parent or serious marital problems. In these situations, when all the problems in the family are addressed, the outcome is the best.


    Virginia Fowkes Clark, Ph.D.

  • Psychology's Role in an Outpatient Primary Care Medical Clinic Gerald J. Strauss, Ph.D. Section Chief, Health Psychology, Louis Stokes, Cleveland, Department of Veterans Affairs Medical Center, and Clinical Assistant Professor of Medicine, School of Medicine, Case Western Reserve University.

    Psychology's Role in an Outpatient Primary Care Medical Clinic


    Richard Suinn, a former president of the American Psycho­logical Association has stated that "it is past time for psycho­logists to expand their services into primary health care". Currently, Health Psycho­logists at the Cleveland VA Medical Center provide professional services in an array of clinical settings including cardiology, organ transplants, spinal cord injury, infectious diseases, oncology, geriatrics, pain management, and primary care medicine, among others.


    In primary care medicine the Health Psycho­logist works with an interdisciplinary team including physicians, nurse practitioners, clinical pharmacists, nurses, and social workers. This innovative team approach to patient care has been in place at the Cleveland VA since 1994. Referrals to the psycho­logist can come from any team member and may include the following questions: depression/anxiety, obesity, pain, post traumatic stress, sexual dysfunction, coping with physical health problems, smoking cessation, and treatment nonadherence to name a few.


    Within the last two years the Health Psycho­logist has facilitated Shared Medical Appointments (SMAs) for Diabetes and Hypertension. The SMAs are interdisciplinary group meetings for patients with those specific diagnoses. Generally 8-18 patients meet together with the team members to discuss problems associated with the diabetes or high blood pressure. Information about the diseases is offered to the patients such as what is a hemoglobin A1c (an average of one's blood sugars over the past three months), what is a normal blood pressure, what are normal cholesterol levels, etc. However, the major thrust of the SMA is to foster discussion among the patients about how they cope with the disease, what works (and doesn't work) in improving their blood sugars and blood pressures, and how they solve problems in self-management of the diseases. Patients learn and take advice better from their peers than from providers. This is evident in our study of outcomes in the SMAs. We found that patients whose hemoglobin A1c and blood pressures had been elevated for months, if not years, while following with their primary care providers had statistically significant reductions in A1cs and blood pressures after only 1-4 visits in the SMA. These improvements clearly reduce the risk for heart disease, stroke, blindness, kidney disease, and amputation.


    The evidence suggests that Clinical Health Psycho­logists play an important role in prevention and treatment of physical as well as mental health problems. Although Western Reserve Psychological Associates is a psychology based practice we can certainly help our patients with more physically challenging concerns, as cited above, in addition to their mental health needs.


    Gerald J. Strauss, Ph.D.

    Section Chief, Health Psychology

    Louis Stokes, Cleveland, Department of Veterans Affairs Medical Center

    and

    Clinical Assistant Professor of Medicine

    School of Medicine

    Case Western Reserve University

  • Techniques for Handling Emotional Outbursts in The Classroom in The Primary Years Janet Dix, Ph.D. Psychologist

    Techniques for Handling Emotional Outbursts in The Classroom

    in The Primary Years


    Parents dread the call from the school that their son or daughter had an emotional meltdown that took a while to get under control. In therapy, parents who are seeking help will say, "My child's teacher is open to any suggestions you might have as to how to handle my child in those situations." The following are suggestions and tips for the teachers to use during those emotional episodes.


    First of all, the teachers are dealing with a variety of children who approach school and stress in different ways. Parents who have a child with any type of special needs should communicate to the teacher the nature of the special needs and not assume that he/she knows and understands your child. Some common diagnoses include learning disabilities, Attention Deficit Hyperactivity Disorder, Asperger's Syndrome, and Obsessive Compulsive Disorder, to name a few. The classroom teacher deals with children who are anxious and are worriers, others who are obsessive about their work and become emotional when it is not perfect, others who get easily frustrated which quickly escalates to anger and others who interpret situations as a one-sided interaction.


    The following are some techniques for dealing with anxiety/tempers in the classroom with primary/elementary school-age children as presented in the book, Asperger Syndrome: What Teachers Need to Know, written by Matt Winter, copyright 2003. These techniques are winners and can be used for all children but are especially effective for children with Asperger Syndrome. Because so many children get confused by the intensity of their emotions, the following tips are useful for teachers helping any child control ones emotions.


    Manage your emotions-The adult's response will have a direct effect on the situation. If the teacher gets angry it is like throwing fuel on the fire. If you stay calm and speak in a calm soothing voice you will have a positive influence. Once both of you are calm then try to sort out the conflict, not while emotions are running high.


    Stress ball---Some children feel better if they have something to do with their hands especially if they are feeling emotional. A "Koosh ball" or other soft ball that the child can repetitively squeeze can serve to calm the child down. Some children feel better having something to fiddle with in their hands when they are upset or nervous. Rather than thinking of it as a distraction, think of it as a self-soothing tool. Teach anger management---Talk through the physical and emotional cues that let us (as human beings) know that we are getting angry. This can be taught to individual students or to the class as a whole.


    1. Stop, Think, Do---Talk the child (or the whole class) through this technique to use when getting angry. Stop what you are doing, think about what you could do and what might happen, choose the option that will keep you safe and do it.
    2. Teach the child and/or class how to stop and slowly count to ten when getting angry.
    3. Teach deep breathing techniques.
    4. Give safe alternatives to hitting---if there is a need to destroy, make it productive. Pupils can crush cans for recycling, tear up cardboard boxes so they can be laid flat for the recycling bin, etc.

    Safe place---Discuss with the child a safe place in the classroom or the school to go to if stressed. The place should be nearby and safe. If the child cannot leave the classroom, a reading corner or bean bag chair can serve the purpose (be creative). Establish some rules for the amount of time and number of times it can be used. If possible, the child should let you know that he/she is going there. In some cases, it may be useful to schedule a regular time for the child to visit this place to rest and recharge batteries. The author explains that the children with Asperger Syndrome need this time out from the stress of dealing with busy classrooms.


    The list continues but for purposes of wrapping up this piece, I will mention them but not describe them. Additional strategies for de-escalating anxiety and temper tantrums include: Deep pressure therapy, Security item, Burning off anxiety, Divert attention, Notebook of things not understood, Regular check-ins, Relevant consequences, Pick your battle, and Reward systems.


    Winter's 98 page paperback book I found to be a handy resource for teachers and parents who are experienced with children but need a resource to help them focus and get the creative juices flowing. For those who need more background and understanding of the treatment problems, Winter provides an excellent chapter on finding resources. Included are organizations, websites, further reading and resources which can be applied to children with Asperger Syndrome but do generalize to children with a variety of disorders.


    When a child's tantrums become few and far between you know that internally something has changed for the positive and the child is gaining control over himself and the environment. If the emotions continue to escalate and the number of occurrences does not subside, it is time to discuss the problems with your team and/or seek professional help.


    Janet Dix, Ph.D.

    Psychologist

  • Tips for Caregiver Stress Catherine Cherpas, Ph.D.

    Tips for Caregiver Stress


    Caregiving of an elderly loved one can be both physically and emotionally stressful. The stress of caregiving may cause fatigue, headaches, and trouble sleeping. The pressure of a busy schedule can be compounded by feeling inadequate about providing care, by feeling both love and pity for the family member, and by feeling anger at having one's life consumed by the situation.


    It is important to keep two encouraging facts in mind: stress can be beneficial and stress can be controlled. Becoming aware of the stressors in your life and learning ways to control these can be helpful.


    1. Define what stress means to you and be aware of its sources. Which stressors can be changed?
    2. Maintain a positive attitude. Plan short-term realistic goals that can be achieved.
    3. Avoid being hard on yourself. Remind yourself you are doing the best you can given the circumstances.
    4. Learn to say NO. Some caregivers may take on more than their share of work out of sense of "duty". You have a right to control your time.
    5. Arrange for a break from caregiving to do other things you enjoy.
    6. Learn to relax. Regular physical activity is an excellent way to work through frustrations and burn off excess energy.
    7. Ask family and friends for help whenever possible. Accept their help when offered.

    Catherine Cherpas, Ph.D.

  • Children's Art John Lowenfeld, Ph.D. ABPP, Clinical Psychologist

    Children's Art


    November brings Fall colors, Halloween just past, and Thanksgiving. Pumpkins, witches, Pilgrims, and goblins fill our thoughts. It is also a time when coloring contests abound in family restaurants, some schools, and kindergartens.


    Let's take a brief look at the development of artistic endeavor in children. It follows, in general, a series of stages much like the developmental stages described by Piaget.


    In the beginning, at about age eighteen months, children tend to scribble in an uncontrolled, random fashion. They simply enjoy the motion of crayon on paper. Soon, the scribbles become controlled, in circles, up-and-down or sideways motions - this represents children's general attempts to control their muscular development and has little to do with attempts to represent anything. At this stage, for an adult to ask, "what is that?" is meaningless to the child. A little later, children will name their scribbles, and this shows a change in their orientation from emphasizing muscular control to thinking in representational terms. In general, children's art productions are all about enabling and expressing growth -social, emotional, intellectual. They are not about producing artistically beautiful or realistic representations of things as adults may see them. As artistic development continues, we see that as attempts at representation begin to emerge, they are determined by their emotional meaning rather than being accurate or realistic representation. Thus, things of emotional importance are exaggerated while emotionally unimportant things are minimized or omitted altogether. Adult attempts to get children at this stage to draw realistically only stifle their development and convey the message that the children "can't draw" well enough.


    These stages last until about age nine or ten, when more accurate (by adult standards) representational attempts begin to emerge.


    The important thing to remember is that the imposition of adult standards on young children's art merely impedes rather than encourages their creative and mental growth. This has been demonstrated repeatedly in controlled studies in art education, and the results generalize to creativity in the sciences as well, as demonstrated by the research of Guilford and others.


    Back to coloring contests, and coloring books in general. Usually, an adult generated picture of something (a pumpkin, turkey, Pilgrim, etc.) is put before the child, who is enjoined to color it with crayon. The message is, "be careful, stay within the lines, and make it as (aesthetically) pretty as you can". There is little that is creative in this process, and the message that the picture put before the child is better than what the child could draw is quite discouraging. No wonder some kids claim they, "can't draw!" So, my friends, encourage children to draw, but don't show them how to do it: let them express themselves in their own creative ways and stay away from coloring contests! Have a great Thanksgiving!


    John Lowenfeld, Ph.D. ABPP

    Clinical Psychologist

  • Road to Resilience Bonnie L. Fraser, Ph.D. Clinical Psychologist

    Road to Resilience


    There is new branch of psychology known generally as "positive psychology". Researchers in positive psychology focus on people who are happy, resourceful, and able to function in difficult circumstances. They look at the characteristics of those who survive and thrive after losses, disappointments and life-changing traumas. Resilience is the quality of being able to accept change and bounce back after adversity.


    In the last few years there has been a lot of adversity to research: floods, hurricanes, earthquakes, tsunamis and war, in addition to the usual issues of crime, illness, job loss, relationship failures, etc. The memorials for the World Trade Center bombing victims and relatives were a vivid reminder of how extreme human experience can be. And yet, it was clear in the stories that some of those families have recovered and gone on with school, work, new interests, and a new reverence for life.


    So, what does it take to develop resilience? It does help to be born in the right family – the one with good genes, loving relatives, enough money, a peaceful home, and parents with enough common sense not to overprotect you as you are growing up. But even if you weren't, resilience attributes can be practiced and learned. We have all heard stories about the abused children who grow up to be competent, successful and loving adults, and about the injured athletes who come back for successful careers in other fields. Psychologists have identified some ways to practice to increase your resilience.


    To build resilience:


    • Make connections with others. One of the most important buffers for stress is good, close, stable relationships. Those include family and friends as well as people from faith organizations, civic groups, work and volunteering. Too many people rely on one confidante, and then are lost when that critical person is not available.
    • Know that change is part of living. If you are too attached to your life as it is now or your things, as they are now, changes will be more difficult.
    • Develop your confidence by solving daily problems and making decisions.
    • Take care of yourself. You know what that means – watch your diet, exercise, relaxation and work routines. Keep your life in balance.

    To deal with an upsetting event:


    • Avoid seeing the crisis as insurmountable. "I'll never get over this" may seem true now, but it will impede your progress. Your perspective will change in time.
    • Focus on the present. Think only about what you have to do now, not all the complications, which could come later.
    • Make decisions.
    • Take action. People deal with traumatic events better when they do something, however limited the options may seem.
    • Let yourself grieve. If the event means a big life-change, you will have strong feelings. Allow time for them when you can and be patient with yourself.
    • Think about what has helped you to cope in the past. All of us have overcome obstacles and survived. Remember what is normally soothing to you and do it.
    • Stay flexible. Some decisions will not work out. Be willing to try a different approach.
    • Keep trying. To quote the ancient Chinese text; the I Ching, "Perseverance furthers".

    These ideas are adapted from a brochure from the American Psychological Association. There are more ideas on their website at www.APAHElpCenter.org.


    Bonnie L. Fraser, Ph.D.

    Clinical Psychologist

  • Dog Days of Summer Suzanne H. Hetrick, Ph.D. Clinical Psychologist

    Dog Days of Summer


    August days are often called the "dog days of summer"-those last, lazy days before children return to school. Many families take vacation at this time of year. It's the last break before the crush of regular commitments. Even if you aren't planning a get-away-to-the-beach vacation, you can still make time for some summer fun and relaxation. Read books, go to the park, or take bike rides or walks. Pick out some of your favorite activities and do them now. Make time for relaxation every day.


    It's surprising the number of people complaining of being stressed. They don't take time to relax. Some people say that they are too busy for fun. Or they have forgotten how to relax. All of us need to recognize the value of taking time every day to do something special for ourselves. It doesn't have to take much time. Twenty minutes or so will be effective. Learn to de-stress daily. Then keep your sense of humor intact by finding something to laugh about daily. Learn to be open to the joys of each new day. If you look hard enough, you'll find pleasures to keep you smiling. Don't underestimate the power of holding onto good thoughts rather than worrying or anticipating misfortune.


    During these dog days of August take brief daily mini-vacations. Enjoy some stress-free fun. Then keep up that habit of stress-free mini-breaks all year long.


    Suzanne H. Hetrick, Ph.D.

    Clinical Psychologist

  • Blood, Sweat and Tears: The Role of Exercise on Emotional Health Richard C. Rynearson, Ph.D. Clinical Psychologist

    Blood, Sweat and Tears: The Role of Exercise on Emotional Health


    The association between exercise and emotional well-being has been documented by numerous studies over the last 20 years. A recent article in the journal "Clinical Psychology" reviewed eleven well designed treatment outcome studies of individuals with depression, which significantly demonstrated the effectiveness of exercise. Exercise appears to be as effective as antidepressant medication in the treatment of mild to moderate depression. The relapse rates for those who exercise is significantly less than for those individuals treated with medication alone.


    Physical activity has also been found effective in treating anxiety disorders, substance abuse, eating disorders and is associated with improvements in the sleep cycle. Studies have also shown that regular (five times a week) high intensity physical activity is more effective than lower intensity exercise at a lower dose (three times a week or less). Preliminary findings indicate that anaerobic (such as weight lifting) exercise may be as effective in reducing depressive symptoms as aerobic activity (running, biking).


    How exercise exerts positive effects on our emotional state is unclear. It is most likely that the positive effects of exercise are the result of the interaction of physiological and psychological factors. But further research is needed to clarify the specific mechanisms.


    But how do we motivate ourselves to exercise? First, it is important to consider your current and past physical activities and identify what you have enjoyed and what you want to accomplish now, both physically and psychologically through exercise.


    Next, consider the environment in which you are most likely to be motivated to exercise regularly. We are more likely to exercise regularly and at a reasonable intensity if we do it in a social environment and as part of a group. Try joining a gym and hire a personal trainer, recruit friends to join you and set aside a regular time to exercise. Include a variety of activities in your exercise program to avoid boredom and burn out and tell your friends and family to ask about your exercise and progress. Support from others is a powerful motivator.


    Keep written records of your exercise sessions and share them with others, at least at first and look for other ways to increase your physical activity. Walk up the stairs rather than take the elevator and park your car further away from your work or the store.


    Be sure to check with your physician before starting an exercise program. Even if you don't have any physical problems getting baseline data on your physical status is important for later comparisons.


    Finally, reading about healthy behavior and exercise can be very motivating. I high recommend Younger Next Year or Younger Next Year for Women. This is an excellent book, well based on science, easy to read and written by a physician and one of his patients.


    Ref. Crowley, C & Lodge, H.S. (2005) Younger Next Year, Workman Publishing Co., New York, NY.


    Richard C. Rynearson, Ph.D.

    Clinical Psychologist

  • Fine Tuning A Meaningful Life Barbara A. Buchanan, Ph.D. Staff Psychologist

    Fine Tuning A Meaningful Life


    We expect teens and college age young people to struggle with identity and purpose. For example – young people struggle with what they've been taught and what their life purpose should be: career or marriage, balancing social life and obligations, college major and job choice, career or just a job.


    In fact we all reexamine our identity and purpose many times. Gail Sheehy wrote a book called Passages during the 1970's that touches on the idea of adult developmental crises. These crises lead to decisions about who we are and what our purpose is.


    Recently, I have seen a number of adults who have completed many of their life tasks. They got trained or educated for careers. They dated, courted and married. They bought a house and raised kids. Their partner may be ill or failing. Their career may be winding down and retirement doesn't seem like a desirable thing. Their dream of the future feels like it's vaporizing. These adults, 50 plus must rethink who they are and what their purpose is.


    The good news is, there are lots of things that can be done by the able bodied and the physically impaired, as well. For example, when my mother retired, she felt an attraction to literacy training. Her own mother was illiterate and was afraid to fail at learning and therefore, didn't try. My mom had students and a sense of pride as she helped others open their own doors to their improved future. In addition, my Grandma Alyce was limited by her age and poor mobility, but she called shut-ins on a daily basis and was part of her church's prayer chain. To think through identity and purpose as a 50 plus adult we need to ask ourselves some questions. The answers guide us to what we need to do for ourselves.


    What have you put on hold/given up to be a husband and father/a wife and mother? What part of what you gave up can you do now? (E.g. singing in the choir, riding a bicycle)


    What is important to you? (E.g. helping people who can't read, learn to read. Keeping up or repairing meaningful relationships.) How can you put your values to work? (Is there meaningful volunteer work you'd like to do?)


    Do you need time with others or time alone? If you are surrounded by family and friends you may need to be alone for a part of your day or your week. If you are alone you may need to do something with others. (Call shut-ins, join a committee for the neighborhood picnic.)


    Do you need to use your hands, your body, your mind or your spirit? If your work is mental, put your hands to work. (Make wooden toys, crochet or knit a baby blanket). If your work is physical do something using your mind or spirit. (Learn yoga, join an Artist's Way study group or help your Sunday School program.)


    Talk to your pastor, priest or rabbi. What are the tenets of your faith? Consider growing spiritually.


    If you don't know enough about yourself to answer these questions, consider therapy to develop your relationship with yourself. For many of us our "senior" years give us the time to finally put ourselves into the equation of a well-balanced life.


    Barbara A. Buchanan, Ph.D.

    Staff Psychologist

  • How Do I Know If I'm Depressed? Karen M. Desmarais, Ph.D.

    How Do I Know If I'm Depressed?


    Have you ever asked yourself this question? If so, you are not alone. According to the National Institute of Mental Health [1, 2] approximately 18.8 million Americans suffer from some form of depressive illness in any one-year period. Also, we hear the term "depressed", "clinically depressed", and "major depression" all the time. The terms are commonly used in the media, such as in television commercials that advertise the newest and latest anti-depressant medications. It is not surprising then, that we may wonder if the term applies to us, or the extent of our problem when we hear the terms used so frequently, and, all too often, too lightly.


    Being depressed is much different than feeling a bit "down" for the day . Depression refers to when a person experiences a significant change in their mood, accompanied by any combination of other symptoms. To help determine whether you are depressed, ask yourself the following questions:


    • Has my appetite changed from what it normally is?
    • Has my sleep changed? Am I sleeping much less than usual or much more than usual?
    • Am I feeling excessively tired during the day?
    • Have I lost weight (not due to dieting) or gained weight?
    • Is it a challenge to stay focused on what I'm doing because my mind wanders (such as reading or watching television)?
    • Have I lost interest in things that I used to enjoy doing?
    • Am I feeling bad about myself?
    • Have I had thoughts of wanting to die or kill myself? (See last paragraph for further information.)

    This list is just a way to screen yourself for some of the common symptoms of depression. However, it is not definitive and you should always consult a professional to determine whether you do indeed suffer from some form of depression, and to find out what treatment options are available.


    If you are experiencing some of these symptoms or think that you are depressed, help is available. Counseling, and sometimes a combination of counseling and medication, can help alleviate or substantially reduce your symptoms. It can also help you feel better and get your life back on track. There is no shame in seeking help at a time when you are struggling. Many people seek counseling each year. Also, you have the option of not telling people you are going to counseling if you're concerned about what they might think.


    If you are having thoughts of harming yourself, you should seek help immediately. You can:


    • Go to your local emergency room
    • Contact your local mental health crisis center
    • Talk to a trusted friend, family member, pastor or medical professional right away to help you know where to turn
    • Contact the crisis hotline in your area (or call 1-800-273-TALK, which is the National Suicide Prevention Lifeline number [3] which will connect you to a Resource in your area)

    References


    1. Robins LN, Reigier DA (Eds). Psychiatric Disorders in America, The Epidemiologic Catchment Area Study, 1990; New York: The Free Press. Cited in www.nimh.nih.gov.
    2. http://www.nimh.nih.gov
    3. http://www.suicidepreventionlifeline.org/

    Karen M. Desmarais, Ph.D.

  • Diabetes and Fear of Hypoglycemia Gerald Strauss, Ph.D. Clinical Health Psychologist

    Diabetes and Fear of Hypoglycemia


    Hypoglycemia (low blood sugar) and fear of becoming hypoglycemic are two major concerns for patients who have diabetes mellitus. Actual hypoglycemia can be dangerous for patients because of the potential for accidents or death. Recurrent bouts of hypoglycemia, and the physical and psychological discomfort felt by the individual often leads to treatment nonadherence, higher levels of blood sugar, and subsequent complications (e.g., blindness, kidney failure, neuropathy, and amputations) from chronic hyperglycemia (high blood sugar).


    Hypoglycemia occurs when blood glucose levels drop too low to maintain normal body and brain functions. The hypoglycemia can be classified as either mild (symptoms include shaking, sweating, and slowed thinking; patient can self-treat; symptoms disappear with self-treatment) or severe (severely low blood glucose in the brain causing lethargy, mental stupor or unconsciousness; person unable to self-treat because of low brain blood glucose). Actual measurements of what constitutes hypoglycemia for an individual are variable. However, a recent study of patients with Type 2 diabetes found that 3.2% of blood sugar readings were less than 70 mg/dl (normal ranges from 80 to 120 mg/dl). Patients who are utilizing intensive treatment methods (e.g., multiple daily injections of insulin or an insulin pump) are at greater risk for hypoglycemia.


    Who is at Risk for Developing Fear of Hypoglycemia?


    • Newly diagnosed patients who haven't yet learned to recognize symptoms or self–treat methods.
    • Patients who have had a scary past episode of hypoglycemia.
    • Diabetics who have generalized anxiety in other aspects of their life.
    • Patients who live alone.
    • Patients whose job or career could be negatively affected by hypoglycemia (e.g., truck drivers, pilots)

    How to Recognize Symptoms of Hypoglycemia There are two ways to detect hypoglycemia: 1) self-testing of blood glucose with a meter and 2) detecting physical symptoms of hypoglycemia. Hypoglycemia can have a quick onset when individuals are not testing their blood glucose. Therefore, early recognition of physical symptoms of low blood sugar is very important in preventing a worsening course of events. Early signs of mental and motor dysfunction caused by neuroglycopenia (low blood glucose in the brain) include: difficulty concentrating, slowed thinking, lightheadedness or dizziness, and lack of coordination. There are a number of other symptoms not listed here. Additionally, mood changes such as irritation, anger, stubbornness, or euphoria in someone with hypoglycemia can interfere with others (e.g., family members, coworkers) attempting to assist the hypoglycemic diabetic.


    Can Patients Learn to Recognize Hypoglycemic Symptoms? In a word, yes. The individual with diabetes can learn to recognize their own warning signs that they are headed toward a low blood sugar. However, there are three psychological barriers to accurate symptom perceptions:


    • Inattentiveness which can occur when distracted or paying attention to other interests.
    • Inaccurate symptom beliefs or "false alarms" such as hunger, fatigue, or anxiety which are just as likely to occur with normal or high blood sugars as they are with low blood sugars.
    • Misattribution of symptoms. For example, an individual who is exercising may misattribute his or her sweating as being caused by the exercise rather than to hypoglycemia.

    Patients can be taught blood glucose awareness training (BGAT) which improves their ability to detect and avoid both hypo- and hyperglycemic episodes. Briefly, BGAT involves an objective assessment of the patient's ability to detect hypo- or hyperglycemia and which symptoms most reliably co-occur with low blood glucose levels. The objective assessment involves the use of a daily diary where the patient:


    • Observes themselves of any symptoms and records them on the diary.
    • Records recent insulin or other blood glucose lowering medications, food, drink, or physical activity that the patient believes could be causing changes in blood glucose.
    • Estimates or guesses what their current blood glucose level is and records it on the diary.
    • Measures their actual blood glucose level with their meter and records it on the diary.

    The diary gives a measure of how sensitive and specific a symptom is to fluctuations in their blood glucose. The best symptoms for the patient to become aware of for early detection of mild hypoglycemia, for example, are those that occur mostly when blood glucose is low and rarely when it is not. Patients can also be taught to become aware of neuroglycopenic (low brain blood sugar) symptoms as an early warning sign of hypoglycemia. That is, patients may note they are thinking or moving more slowly and that they have to exert more effort to do simple tasks such as reading, following a conversation, or typing. Patients may ask themselves the following questions to check for neuroglycopenia. Compared to my usual ability:


    • Am I performing this task more slowly?
    • Is it taking more effort to perform this task?
    • Does this task seem more difficult than usual?
    • Am I making more mistakes?
    • In general, how impaired do I feel?

    References:


    Gonder-Frederick, LA, Cox DJ, & Clarke WL. (2002). Helping patients understand, recognize, and avoid hypoglycemia. In Barbara J. Anderson and Richard R. Rubin (2nd Ed). Practical Psychology of Diabetes Clinicians: Effective techniques for key behavioral issues. Am Diabetes Assoc.


    Strauss GJ (1996). Psychological factors in intensive management of insulin-dependent diabetes mellitus. Nursing Clinics of North Am., 31, 737-745.


    Gerald Strauss, Ph.D.

    Clinical Health Psychologist

  • Obsessive Compulsive Disorder in Adolescents Janet Dix, Ph.D., Psychologist

    Obsessive Compulsive Disorder in Adolescents


    Obsessive-Compulsive Disorder is common and can be treated and managed, if necessary, with professional help. Adolescents with OCD often keep their unwanted symptoms a secret because they don't want to be seen as different from their peers or even worse, as "weird". However, knowing how to cope with OCD and who to seek for help can be invaluable information.


    How do you know if you have OCD and how is it treated? People who suffer from OCD have unwanted and unwarranted or senseless obsessions and compulsions. Obsessions are recurrent and persistent ideas, thoughts or impulses which are experienced as intrusive and time-consuming, and interfere with the daily routine of school, work, and social relationships. Common examples include the fear of germs, of catching diseases, of death and dying, of order and symmetry, or of hoarding and saving. An individual who fears contamination has trouble being in public, using public facilities, and/or eating away from home.


    Compulsions, also known as rituals, are deliberate physical or mental behaviors that are the result of obsessions. People perform the rituals to alleviate the worry and discomfort created by the intrusive thoughts. Common themes include excessive washing of the hands, extra long showers to assure oneself of being clean, superstitious rituals such as doing everything in eights (or other numbers), excessive checking of something (hair, clothing, locks on windows and doors) and constant erasing and feeling that work is never good enough.


    Cognitive Behavioral Therapy is often used to treat OCD. The object of the treatment is to understand that there is a "brain lock" and that one's thinking is "stuck". The individual relabels the fear as not being real fear but the OCD giving the brain misinformation. The individual corrects the faulty message and stops performing the ritual. This process has to be performed over and over again, much like exercising a weak muscle, for the brain to get stronger and for the thoughts to disappear. Eventually, the thoughts lose their potency and the OCD weakens and disappears. The OCD can return at different times in a persons life (usually stress-related) but if the individual uses the cognitive behavioral coping strategies, the thoughts and rituals can quickly be dealt with and the individual can feel in control. (This is an over-simplification. Overcoming the OCD is a very difficult process depending on whether the symptoms are mild, moderate, or severe).


    Some of the Cognitive Behavioral Techniques include relabeling, desensitization, relaxation, and flooding. Behavior therapists use the technique of Exposure and Response Prevention (ERP) where an individual is exposed to the unwanted thought (ex.touching the bathroom door at school) and are prevented from performing the usual ritual (ex. washing hands in hot water for a set number of minutes). The individual experiences tremendous anxiety (the intensity depends on the severity of the OCD---some people have panic attacks, feeling like they are going to pass out or even stop breathing). If the anxiety lasts for an hour or more a trained therapist should be working with the individual. As the person continues to be exposed to the unwanted thoughts and stimuli and does NOT perform the rituals, the anxiety lessens and the individual begins feeling more in control and less fearful. Some teenagers admit that they never use the bathroom at school and never touch the classroom doors at school for fear of contamination.


    Medication combined with the therapy can help lower the anxiety. A medical professional should be consulted regarding medication to help alleviate symptoms of OCD.


    Addictions and OCD are different in that addictions are behaviors that are pleasurable. For example, individuals who are addicted to alcohol, cigarettes, chocolate, drugs, shopping, or the Internet gain pleasure in the activity but it interferes with daily functioning. OCD thoughts and behaviors are not pleasurable. They are often are annoying, time-consuming and unwanted but feel necessary to alleviate the discomfort of the tension and anxiety.


    In general, adults and teenagers have the same OCD themes, however, teenagers often approach it differently due to their stage of development. A professional who specializes in treating adolescents should be consulted to assess the nature and severity of the problem. The school counselor or psychologist or family physician would be a good place to start. Parents need to take their teens concerns seriously and get them help even if they insist they don't have a "problem".


    Please feel free to call us at Western Reserve Psychological. Several of the psychologists work with adolescents with OCD and would be glad to do the assessment and make a recommendation for treatment.


    Janet Dix, Ph.D.

    Psychologist

  • Living With a Serious Medical Condition Catherine C. Cherpas, Ph.D. Counseling Psychologist

    Living With a Serious Medical Condition


    Today may be the first day you have had to live with the diagnosis of a serious medical condition, or it may be one of the many days you have survived this disease. Either way, you have probably found out that your medical condition has changed your life in significant ways. You must cope with changes in your feelings, your physical health, your system of support, your body image – your whole outlook on life. Below are some suggestions that have helped others cope with disease. Just as your medical condition has changed your life, the way you live your life can also change your disease from a formidable threat to a manageable condition.


    1. Allow yourself an opportunity to grieve your loss by expressing and sharing your feelings with caring others.
    2. Locate support. Accept the comfort offered by family and friends. Try attending a support group of people who share your concerns and situations. Read publications issued by related organizations.
    3. Cheer yourself on. Ultimately you must be able to comfort yourself since others will not always be there. Keep up your self-esteem. Be kind to yourself.
    4. Take responsibility for your health by learning about your medical condition and treatment and by being assertive with medical professionals about your needs and concerns.
    5. Set goals for yourself. No matter how small, any goal helps you feel a sense of achievement. Watch your grandchildren ice skate, go out with friends, put pictures in an album.
    6. Focus on ability. While your medical condition prevents you from doing some things, there are many activities which you as a living human being can still enjoy.
    7. Turn to your faith and religious tradition.
    8. State your needs. Don’t suffer in silence. No one knows what you can and cannot do as well as you. People may make assumptions unless you educate them.
    9. Keep your sense of humor. Learn to laugh at yourself and enjoy life.
    10. Search for meaning from your adversity. You can find meaning and hope in your darkest days. You can choose your response to painful experiences. You can choose to grow from it and shape it into a positive force in your life.

    Catherine C. Cherpas, Ph.D.

    Counseling Psychologist

  • Smoking-How About Quitting? John Lowenfeld, Ph.D., ABPP, Clinical Psychologist

    Smoking-How About Quitting?


    The holidays are upon us, and soon it will be time for New Year's Resolutions! This year, how about a life-changing resolution, one that will have a major impact on yourself and all those around you? Let's quit smoking! This month's column is about smoking, and its intent is to help motivate you to quit.


    Some Facts About Smoking


    1. Smoking in the United States causes more premature deaths than cocaine, heroin, alcohol, fire, auto accidents, homicide and suicide combined.
    2. Smoking is responsible for more deaths of Americans than all the wars ever fought by this country.
    3. Most smokers began smoking before age 20. More current smokers than successful quitters began smoking before age 18, suggesting that the earlier one began smoking, the harder it is to quit. However, these differences are not great.
    4. Of former smokers (successful quitters) about 70% quit after 1 or 2 attempts, about 20% quit after 3-5 attempts, and about 10% tried 6 or more times before succeeding. Persistence pays!

    Smoking and Health


    1. Smokers have 800% higher rate of death from lung cancer than non-smokers.
    2. Smokers have 1000% higher rate of death from emphysema than non-smokers.
    3. Smokers have twice the rate of death from heart disease than non-smokers.
    4. Smokers have increased incidence of brain damage from stroke, multi-infarct dementia and "senility" due to anoxia.
    5. Smokers have 110% higher rate of other cancers (stomach, spleen, larynx,liver) than non-smokers.
    6. Smokers have higher rates of serious complications in all diseases involving problems with circulation Reynaud's Disease, Diabetes, burns, poisoning and asphyxiation, gangrene, etc. Smoking diabetics have 800% higher rate of complications.
    7. Smokers impose health hazards on those around them; the (non-smoking) children of smoking mothers have twice the over-all illness rate of the children of non-smoking mothers; non-smoking spouses have 25% increased risk of lung cancer.
    8. Careless cigarette smoking is the leading cause of fatal fires in home, workplace and forest.
    9. Smoking far outweighs industrial pollution as a cause of disease; and the bad effects of both add up together.
    10. Smoker's superficial wounds heal more slowly and are more frequently infected than those of non-smokers.
    11. Many accidents are attributable to smoking (flammables and explosives, inattention and fumbling for a smoke or light, falling asleep or dizziness due to lowered oxygen levels secondary to monoxide poisoning and/or blood vessel constriction, ashes or coals causing pain, etc.).
    12. Death due to lack of stamina (drowning, freezing and exposure, etc.) occurs more often in smokers than non-smokers.
    13. Infant mortality is much higher in offspring of smoking than non-smoking mothers. Pregnant women should not smoke.
    14. Birth weight of children of smoking mothers is less than that of children of non- smoking mothers.
    15. Smokers lose their teeth more frequently than non-smokers due to increased periodontal disease.
    16. Smokers have impaired sense of smell and taste compared to non-smokers.
    17. Two thirds of impotent men are smokers. This is twice the rate in the general population. The cause is probably poor penile blood circulation which has been found in 25% of male smokers.
    18. Sperm count and motility are reduced in smoking men.
    19. Women smokers are three times more likely to be infertile than non-smoking women, and their average age at menopause is almost two years younger.

    Smoking & Appearance


    1. Women smokers, when age is estimated by appearance in controlled studies, are judged to be 8 to 10 years older than their non-smoking counterparts.
    2. Incidence of baldness in men is three times as high in smokers than in non- smokers. (Both 1 and 2 are due to impaired peripheral circulation, causing increased wrinkling and hair loss.)
    3. Persons who quit smoking experience an average initial weight gain of five pounds, which tend to be lost again during the first year. However, in order to produce as much harm to overall health as continuation of smoking would cause, these persons would have to gain over 80 pounds.
    4. Smokers:
    • smell bad
    • re unpleasant to kiss
    • frequently burn clothes and furniture
    • have duller hair
    • have more dandruff
    • often develop stained hands and fingers
    • almost always have stained teeth

    Quitting


    Get into a smoking cessation program; it is harder to do on your own. The following are ways smokers have actually used in retraining themselves to live without cigarettes, cigars or pipes. Anyone or several of these methods in combination might be helpful to you.


    1. Concern yourself with today. Tomorrow will take care of itself.
    2. It is not that you will never be able to smoke again, but that you do not want to smoke today.
    3. Telephone an ex-smoking friend when you have a desire to smoke.
    4. There is no such thing as just smoking one cigarette.
    5. Do not have cigarettes, matches or lighters on your person today.
    6. Put away all your ashtrays.
    7. When you crave a smoke, take frequent deep breaths with long exhales.
    8. Instead of gesturing with cigarette in hand while you talk, substitute a pencil.
    9. Keep your hands occupied.
    10. When you feel irritable or tense, talk it over with someone.
    11. 11. Take warm showers to calm nerves.
    12. 12. Change your behavior; walk or exercise instead of smoking, especially after meals.
    13. If you smoke during breaks, plan another activity -- reading, puzzles, knitting, walking.
    14. Try quitting with a friend. You can encourage each other.
    15. Reward yourself with small and frequent luxuries throughout the day. Use the money you save by not smoking.
    16. Notify your family, friends, and co-workers that you are quitting so you cannot bum cigarettes from them.
    17. Avoid friends who smoke and places like bars or coffee shops where many people will be smoking.
    18. Avoid caffeine containing beverages such as coffee, tea, and colas. Substitute fruit juice or water.
    19. Frequent places where you can't smoke -- libraries, theaters, swimming pools, department stores, public meetings in public buildings.
    20. If you substitute snacks for cigarettes, reach for low calorie foods.
    21. Chew sugarless gums or mints.
    22. Chew bits of fresh ginger when you want to reach for a cigarette.
    23. On a piece of paper, make two columns. List why you want to stop smoking in one column, why you want to continue in another column. Compare them.
    24. Keep busy, volunteer your services to schools or non-profit organizations where you can't smoke.
    25. Drink plenty of liquids to flush the poisonous nicotine out of your body.
    26. A brisk walk will help get rid of the carbon monoxide left over from your last cigarette.
    27. A plastic cigarette or toothpick may prove a good oral substitute.
    28. Wear a lung association "Thank you for not smoking" button to let everyone know you enjoy smoke-free air.
    29. Ask for assistance from a higher power.
    30. Call your lung association for help.
    31. Join a stop smoking clinic group.
    32. Eat properly to keep your nutrition up.
    33. Only one-third of the people who stop smoking gain weight. Don't worry about weight gain now. Tackle one problem at a time.
    34. Think positively and choose to stop smoking.

    Symptoms of Withdrawal


    • Restlessness
    • Irritability
    • Anxiety
    • Drowsiness
    • Headache and muscle aches
    • Gastrointestinal disturbance or upset
    • Sleep disturbance (frequent awakenings)
    • Impatience
    • Difficulty concentrating
    • Slowed reaction time
    • Slowed metabolism

    Most of these disappear 2-4 weeks after quitting.


    Now that you know a bit more about smoking, isn't it time you quit! Have a happy, healthy New Year.


    John Lowenfeld, Ph.D., ABPP

    Clinical Psychologist

  • Suggestions for Creating a Happier Holiday Carole P. Smith, Ph.D., Staff Psychologist

    Suggestions for Creating a Happier Holiday


    Sit quietly for a minute or two and recall a pleasant holiday season you would like to repeat or recreate. What particular elements made it so enjoyable? For example, is it the activities, people, pace, priorities, important values incorporated into it, your attitude and expectations or other qualities?


    Recall very briefly a holiday that wasn't so nice.


    Now compare the two. What's the difference that makes the difference? Be specific.


    If you feel a little stuck or have never had an enjoyable holiday, then imagine how a friend or relative (or even Oprah) would celebrate a better one even if they were in circumstances similar to yours. What would they appear to be feeling? What would they be thinking or preparing? What would they avoid and what would their beliefs and priorities be? Exchange places with that person and experience doing it their way. Now, step into yourself again, bringing all those new ways of being with you. Add some of your own creativity as well and feel this whole new experience.


    How can you recreate the desirable components for this year's holidays and avoid the less desirable ones?


    What obstacles do you anticipate? What resources do you already have to get past the obstacles?


    What is one step you can take right now to make this happier holiday become a reality?


    For the next minute or two, imagine yourself already doing this and experience the good feeling that comes with starting to make this desirable change.


    This guided imagery can help many of you move toward a happier holiday season. If you have holiday issues from the past that remain a problem, you might want to contact a mental health professional for further help.


    Carole P. Smith, Ph.D.

    Staff Psychologist

  • Extraordinary Events and Psychological Resilience John S. Schell, Ph.D. Clinical Psychologist

    Extraordinary Events and Psychological Resilience


    Life is hard. For some people, life may be extremely hard. Often we face circumstances that threaten our well-being and challenge our most basic coping skills, leaving us feeling overwhelmed and distraught. Whether we are dealing with the recent hurricanes and their devastating aftermath, or the damage that comes from a lifetime of poverty, abuse, or trauma, we are all called upon at times to contend with significant adversity. Some of us may cope very well, while others may not. What separates these two groups?


    Our ability to tolerate distress depends on a number of factors-the nature of the stressful situation, the intensity of the emotion that is generated, the amount of stress we are already experiencing, our overall physical and psychological health, and the effectiveness of our coping style. Research on children raised in hostile, abusive environments suggests that there may be another factor that buffers us from the otherwise deleterious effects of stressful life events-psychological resilience.


    Individuals who are more psychologically resilient seem to share certain qualities or characteristics that inoculate them against stress and enable them to survive, even in the face of extreme adversity. Psychologically resilient individuals are typically intelligent, self-confident, and able to recognize their own competencies. They have the ability to appreciate the "big picture" and see beyond their current life circumstances. They can control their impulses, think through the ramifications of their life choices, and avoid some of the more maladaptive coping strategies utilized by so many. Furthermore, they refuse to blame themselves or take responsibility for circumstances beyond their control. And perhaps most importantly, they are able to remain optimistic and hopeful, even in very trying times.


    In short, these individuals have perseverance and hardiness. They are not easily overwhelmed, and have the mental flexibility to adapt to difficult life circumstances, adjusting their tactics rather than trying to apply a more rigid problem-solving approach that has limited utility. Simply stated, they are able to stay positive.


    As we come to better understand the genetic and biological underpinnings of these characteristics, it seems clear that only an unfortunate few are born genetically pre-programmed to experience great distress and develop psychopathology in the face of adversity, while on the other hand, only a select few are born with a genetic make-up that truly buffers them from such even in the worst of circumstances. Most of us fall somewhere between these two genetic extremes, and specifically where we fall along the continuum can change over time.


    For example, research has empirically demonstrated the importance of social support. Specifically, being able to turn to someone who cares about us and who can help us shoulder life's burdens can positively affect our ability to cope with even the most difficult of stressors. Having and utilizing social support can positively impact our overall psychological resiliency.


    Furthermore, developing a life philosophy or perspective that enables us to remain positive, even in the face of adversity, is also critically important. Perhaps this has to do with the ability to find meaning in our lives, and by extension, in our suffering. As Nietzsche so aptly pointed out, man can survive any how if he has a why. Finding some way to understand and accept life's difficulties is also consistent with greater psychological resiliency.


    In the end, it is clear that we all face adversity, big or small, in our lives. We may have an easier or more difficult time adjusting, depending upon our genetics and our life histories, but we all have to do what we can to increase our psychological resiliency. When we find ourselves overwhelmed, when we experience symptoms of depression, anxiety, or another mental health ailment, or when we turn to maladaptive coping skills, this is the time to step back and examine what else we can do to face the adversity in a more adaptive fashion-what else we can do to cope when life is particularly hard.


    John S. Schell, Ph.D.

    Clinical Psychologist

  • Procrastination—Why We Do It Karen M. Desmarais, Ph.D. Psychologist

    Procrastination—Why We Do It


    Do you ever wonder why you have a hard time getting things done or tend to put them off? There are a great many reasons why we do this. Fortunately, however, there tend to be a few key reasons that the majority of people find themselves procrastinating.


    One reason many people procrastinate has to do with perfectionism-wanting things done `the right way' or done perfectly without making any mistakes. If we are afraid of making any mistakes, then we're afraid to get started on a task since we could make mistakes along the way to completing the task. Often, if we hold the belief that things need to be perfect, a significant amount of anxiety can occur as we attempt to reach perfection regarding the task at hand. Realistically, it is rarely possible to do anything `perfectly'. The result is often a feeling of being overwhelmed, immobilized, and unable to complete the task in question. Our ability to make decisions regarding how to proceed on the task is often impacted. Self-criticism also often results due to having set high standards for oneself and then being unable to meet those standards-we feel like a failure and feel inadequate.


    A related explanation for why some people procrastinate has to do with setting extremely lofty, unrealistic goals. For instance, if we believe "Before I can relax, I have to clean the entire house", anxiety and procrastination can result. It's unlikely that one can get the entire house clean without a significant amount of time and effort. More often than not, we become immobilized since it's an unachievable task, or we spend so much time cleaning that we do it at the expense of other important activities (i.e., time relaxing, time with friends and family, taking care of our emotional and mental health).


    Sometimes we procrastinate to avoid something we perceive as unpleasant. For instance, we may avoid completing a task for fear others may criticize or ridicule what we have done. That fear of being judged by others can get in the way of doing things we need to get done. We may also avoid a task if the task isn't something we really want to do (i.e., a teenager being told by his parent to clean his room before he can go out).


    We can learn to overcome procrastination. The first step is to self-reflect and identify one's own reasons for procrastinating. Sometimes, overcoming procrastination is simply done by making the decision to just go ahead and do whatever needs to be done rather than putting it off. We can prevent unnecessary anxiety and dread a great deal of the time by simply getting the task over with. For other people, learning to not procrastinate may require learning to challenge the need to do things perfectly, being willing to tolerate imperfections, and setting realistic, modest, and achievable goals. Seeking help from a mental health professional can also help you overcome your procrastination. Just as there are many reasons why we procrastinate, there are many different things that can help a person work through their tendency to put things off, and a mental health professional can help you find what will work for you.


    Karen M. Desmarais, Ph.D.

    Psychologist

  • Making Friends Virginia F. Clark, Ph.D., Clinical Psychologist

    Making Friends


    Some children have difficulty making and keeping friends. This can lead to sadness, worry, isolation, being bullied and even depression. One psychologist, Fred Frankel, Ph.D., has looked at what children do or do not do that contributes to their problems making friends. He has then addressed each individual behavior and developed a program to train children how to make and keep friends by learning specific new behaviors. In his book Good Friends are Hard to Find, he teaches these methods to parents in an easy to read fashion.


    For example, in playing a child might tend to clown around, frequently break the rules, and not let others get a turn. He might also frequently get in arguments and stop playing when losing. After a while other children will not want to play with him. You as a parent can learn to teach the rules of being a good sport. Dr. Frankel gives very specific directions that are clear and easy to follow.


    Some of the topics he covers are finding friends, making friends, keeping friends, dealing with teasing, bullying and meanness and helping your child out of trouble. More specific topics range from stopping rumors to how to deal with having friends stolen.


    This book is recommended reading for the parents of children with any of the above problems. Therapists are also educated in friendship training. Some work individually with children, others work with children in groups.


    Reference: Frankel, Fred, 1996. Good Friends Are Hard To Find. Los Angeles, CA: Perspective Publishing


    Virginia F. Clark, Ph.D.

    Clinical Psychologist

  • Psychological Aspects of Sport Injury Gerald J. Strauss, Ph.D., Clinical Health Psychologist

    Psychological Aspects of Sport Injury


    In an effort to promote healthy life styles and as an effort to stem the epidemic proportions of obesity in our society, participation in sporting events is encouraged. Sport injuries are an unfortunate aspect of attempting to stay healthy. In a study of sports and recreation related injuries in the U.S. between 1997 and 1999, Conn, Annest, and Gilchrist (2003) found that, "annually, seven million Americans receive medical attention for sport related injuries (25.9 injury episodes per 1000 population)". They go on to state the highest sports injury rates were for children between 5-14 years of age (59.3 per 1000 persons) and 15-24 years of age (56.4 per 1000 persons). Males were injured more than twice as often as females; whites 1.5 times as often as blacks. Basketball injuries were the most frequent.


    In a study of sport related injuries in Western Australia, Stevenson, Hamer, Finch, Elliot, and Kresnow (2000) found that 51% of participants (n = 1391) who participated in a survey had sustained one or more sports related injuries. Most injuries were moderate (58%) or minor (40%) with 3% requiring treatment in an emergency department or hospitalization. Football (soccer) was the sport incurring the most injuries (20.3 injuries per 1000 hours played). Field hockey incurred 15.2% and basketball 15.1% injuries per 1000 hours played. Most injuries occurred in the first four weeks of the season and in participants who were between 26 and 30 years of age compared to those less than 18 years of age. Injured individuals, coaches, trainers, and health care professionals are most concerned about the injured athlete's physical health. Often little regard is given to the psychological aspects of sport (?) related injury. This is the focus of this brief article.


    Pargman (1993) cites a number of behavioral factors that some studies have found to be correlated with sport injuries. First, personality has been implicated as a factor in sport(s?) injuries but the relationship is tenuous and needs more research. Second, compliance or adherence with rehabilitation, after injury, is an area where a great deal of psychological research and clinical practice points to success in many individuals returning to sport related activities. Third, self-concept or sense of mastery with athleticism, are additional areas that are important to the self-esteem of an athlete. However, while adequate self-esteem is necessary to perform well in athletic competition, inflated self-esteem, combined with other factors such as impulsivity and thrill-seeking behavior, may actually do more harm than good and lead to greater risk of injury. Fourth, social factors, such as interactions with others in a negative or positive fashion, can influence attitude, mood, and behavior, thus influencing the risk of injury. A study completed by Bramwell, Minoru, Wagner, and Holmes (1975) examined social and athletic readjustment to various life events in 82 college football players. The researchers found that the football players with low life event scores had the lowest injury rate (35%), those with medium scores had injury rates of 44%, and those with the highest life event scores had an exceptionally high injury rate of 72%. One can look at the recent unfortunate events of Cleveland Browns tight end, Kellon Winslow, and find personality, non-adherence to rehabilitation, thrill-seeking behavior, and social factors influencing his off-the-field injuries that have on-the-field and career implications.


    When an athlete is injured and the physical damage is surgically repaired or the injured body part is immobilized and is healing, rehabilitation becomes the next, and longest, part of treatment. This is the time psychological interventions are employed. Grove and Gordon (1991) expanded upon a model of rehabilitation from sport injury first described by Anderson and Williams (1988). The model is described in this diagram.


    Diagram about sports injury


    As one can see, rehabilitation of sport injuries (from a psychological perspective) is multifactorial and can be complicated. If you, a family member, or colleague is struggling with the aftermath of a sport injury and need the assistance of a sport psychologist in the rehabilitation process, please ask our staff.


    References

    • Anderson, MB & Williams, JM (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10, 294-306.
    • Bramwell, ST., Minoru, M., Wagner, NN., & Holmes, TH. (1975). Psychosocial factors in athletic injuries. Journal of Human Stress, 1 (2), 6-20.
    • Conn, JM., Annest, JL., & Gilchrist, J. (2003). Sports and recreation related injury episodes in the U.S. population, 1997-99. Injury Prevention Online, 9, 117-123. http://ip.bmjjournals.com/cgi/content/abstract/9/2/117
    • Grove, JR & Gordon, S. (1991). The psychological aspects of injury in sport. In J. Bloomfield, P.A. Fricker, & K.D. Fitch (Eds.), Textbook of science and medicine in sport (pp. 176-186). London: Blackwell.
    • Pargman, D. (1993). Psychological Basis of Sport Injuries. Fitness Information Technology, Inc. Morgantown, WV.
    • Stevenson, MR., Hamer, P., Finch, CF., Elliot, B., & Kresnow, MJ. (2000). Sport, age, and sex specific incidence of sorts injuries in Western Australia. British Journal of Sport Medicine Online, 34, 188-194. http://bjsm.bmjjournals.com/cgi/content/full/34/3/188

    Gerald J. Strauss, Ph.D.

    Clinical Health Psychologist

  • Work Hard at Playing Well Janet Dix, Ph.D., Psychologist

    Work Hard at Playing Well

    An effective psychologist helps the client deal more effectively with life style stressors. Our world, both on a personal level and in the work place, has become more fast-paced and stressful. Most adults are faced with job and relationship uncertainties, economic stress, family demands, and even homeland security issues. As a result, illness in the workplace is an issue. What people don't realize is that by balancing work and play, a key concept in career psychology, they can build up a resiliency to stress and physically and emotionally recover from traumatic events more quickly. By learning how to make time for play one can prevent the onset of an illness.


    Often people who are extremely productive and don't waste a minute find they don't make time to relax and chill out. Human beings make themselves sick by working hard to earn money. Then they spend money trying to make themselves healthy again.


    The following is a list of strategies for adding fun, play, laughter and/or leisure into your already full life.


    1. Make play/leisure a goal. Add it to your list of "Things to Do".
    2. Check your schedule for balance. Spread out the "need to's" to make room for some "want to's".
    3. Allow your inner child to be creative.
    4. Create a supportive environment. Add nutrition, exercise and nurturing relationships to your life.
    5. Become aware of the little things that make life worth living. Here are a few. Create your own list.
    • The smell of new-mown grass.
    • A hot shower when you're freezing.
    • Pizza delivered to your door.
    • The service department saying, "No problem. That's on warranty".
    • Dogs that sense when you're sad and come over to make you feel better.
    • Room Service.
    • Your suitcase being the first one to appear on the airport baggage carousel.

    Recent research shows that a person's positive lifestyle, attitudes and emotions can help in the recovery from an illness but more importantly can prevent the onset of an illness. Try to increase the role that play and leisure have in maintaining health and wellness in your life. Play, as defined here, is the opposite of seriousness, not the opposite of work. It is finding nourishment and pleasure in the moment. Norman Cousins cured himself of a life-threatening illness through his self designed laughter therapy. Finding pleasure in life is an individual thing. It may vary from day to day. Devote the next three days to listening for and looking for the strokes which are aimed in your direction. Accept them with nothing more than a thank you. Some experiences you might notice are:


    • The admiring looks of your children.
    • A motorist who stops and lets you through the traffic.
    • A phone call from a friend.
    • Your newspaper left in a plastic bag on a rainy day.
    • A feeling of well being...

    The January 24, 2005 issue of Fortune magazine reported that too many employees miss work each day because of workplace stress. Fortunately, many companies are investing in the emotional well being of its employees for the pay off is a healthier bottom line.


    Janet Dix, Ph.D.

    Psychologist

  • Use It Or Lose It--How To Keep Your Memory Strong Catherine C. Cherpas, Ph.D., Staff Psychologist

    Use It or Lose It—How To Keep Your Memory Strong


    Everyone has minor memory lapses. From time to time, we forget a name or misplace our eye glasses. However, as we grow older, these lapses in memory do increase. The reason why is simple: The brain experiences normal wear and tear just like the rest of the body. The good news is that the normal brain has a marvelous ability called "compensating regeneration". This means that brain cells in the neighborhood of impaired cells send out new growth to take up the slack. Recent research has found that we may be able to fight our forgetfulness by engaging in activities that stimulate the growth of these new connections and keep our brains young.


    A study at the University of Illinois at Urbana-Champaign that tested the impact of physical activity found that aerobic exercise improved cognitive ability in adults aged 60 to 75 years old who had been sedentary. Participants who walked three hours a week in as little as six months, increased their short-term memory, their capacity to focus on a task, and their potential for multi-tasking.


    Other studies offer practical suggestions for keeping the mind strong. These include reading books, playing stimulating board games, varying your routine, eating a balanced diet full of fruits and vegetables rich in antioxidants like Vitamin C and E, and maintaining emotional fitness. For example, spending time with family, friends, and even a pet can be helpful in decreasing stress and promoting a sense of well-being.


    Catherine C. Cherpas, Ph.D.

    Staff Psychologist

  • Staying Positive During A Career Transition Chaille Anne Walsh, Ph.D., Counseling and Consulting Psychologist

    Staying Positive During A Career Transition


    Change is part of life: the change of seasons, the daily changes in weather, the cycle of birth, aging, and death. Change is one thing we can count on and it seems to happen more quickly in today's technological society. Dealing with change can be a very difficult and emotional process for people, even when the outcome is positive. Going from what is known and comfortable to the unknown and untried can be frightening. One major life change that many people encounter in their lives is the loss of a job.


    As we begin the New Year, some of us may be experiencing a recent job loss or the prospect of possible company layoffs. Recently, a Plain Dealer article cited a survey conducted by the Bureau of Labor and Statistics which found that Cleveland was second only to Detroit in having the weakest employment opportunities. Such news can be disheartening and anxiety provoking if we let it. To make a successful career transition, it is essential that we keep an optimistic attitude but have realistic expectations. For example, it is likely that another job will be found but perhaps it will be in a different industry, working in a different capacity, starting up one's own business, consulting, or perhaps relocating for a job.


    How the rest of the family reacts to the news of the job loss is often affected by the attitude of the job seeker. If he is pessimistic, his attitude may unduly alarm the rest of the family. If he panics and reacts too quickly, making announcements that "the house will be sold, the family will move and leave friends and relatives, there will be no more vacations," and does so implying that things will be awful and terrible, strong negative reactions by family will result. The job seeker needs to be realistic and let the family know what has happened but reassure them that good things can come from change. Alexander Graham Bell once said, "When one door closes another door opens: but we so often look so long and so regretfully upon the closed door, that we cannot see the ones which open for us."


    Some useful tips on how to stay positive during your job search include:


    • Balance the job search, personal time, and family time. Designate a certain portion of each day to work on your job search and then put it aside. No one can stay positive and be productive if they work at it 24/7.
    • Make time each day for physical exercise. It's a great way to relieve stress and prevent depression.
    • Develop a support group of relatives, friends, and business associates. Many people have experienced a job loss and would be happy to give assistance in the job search.
    • Avoid hasty decisions. Take things a step at a time. Consult experts for advice when needed (i.e. financial planner, relocation consultants, career counselors, recruiters).
    • Nurture your spiritual life (i.e. meditation, prayer, yoga, church services, volunteer work).
    • To control anxiety, set up a specified worry time. If you are bothered by excessive worrisome thoughts, restrict your worry to a few minutes each morning and early evening. Write out your worries, challenge negative thinking, and write down possible solutions. This will help avoid sleepless nights.

    Remember - keeping a positive attitude is the most important thing in searching for your next job. In the words of Mahatma Gandhi, "Keep your thoughts positive, because your thoughts become your words. Keep your words positive, because your words become your behavior. Keep your behavior positive, because your behavior becomes your habits. Keep your habits positive because your habits become your values. Keep your values positive, because your values become your destiny."


    Chaille Anne Walsh, Ph.D.

    Counseling and Consulting Psychologist

  • Thinking Straight And Feeling Good -- A Primer John Lowenfeld, Ph.D. ABPP, Clinical Psychologist

    Thinking Straight and Feeling Good—a Primer


    We have all had the experience of having something happen that makes us feel a certain way -- happy, sad, anxious, angry, disappointed, frightened, etc. While our experience tells us that what we feel is the result of what happened, that is an over-simplification. What really takes place is that something happens, and we perceive it and "filter" it through what we have learned previously -- our values, attitudes, beliefs, knowledge, preferences and convictions. Based upon all this, we then "tell" ourselves things about what just happened -- we interpret the event to ourselves. Our feelings are then determined by what we have told ourselves about what happened, how we interpreted it, and not by the event itself. This process occurs so quickly that mostly we are unaware of it. This explains why the same event can be experienced differently by different people.


    Since we cannot influence our feelings directly, that is, we cannot "will" ourselves to feel as we wish to feel, it follows, then, that if we wish to change how we feel, there are really only two places where we can intervene. One is to change the event; for example if we have a bad job and leave it for a better one, we have changed things so that our experience is different. Sometimes we can do that; much of the time we are "stuck" with the world we are in. If we cannot change our world, the only other place we can make changes is in what we tell ourselves about the events we perceive. If we can learn to capture the things we tell ourselves, our thoughts about the events, we can analyze these thoughts for how reasonable and sensible they really are, and to substitute more reasonable and sensible thoughts for the ones we had earlier. It has been found that most really bad feelings or emotions are based on thoughts that are unreasonable in one way or another -- exaggerations, distortions, catastrophizing or "making mountains out of molehills" over generalizing, drawing conclusions from insufficient evidence, etc.


    When we find ourselves feeling bad -- depressed, anxious, angry, disappointed, etc., that should be our clue that we probably are not thinking straight, and to then ask ourselves, "what are my thoughts that are giving rise to these feelings?" When we examine these thoughts, we generally can find more reasonable thoughts with which to replace them, our feelings follow, and we are better off for it!


    Happy Holidays


    John Lowenfeld, Ph.D. ABPP

    Clinical Psychologist

  • Simple Steps Barbara A. Buchanan, Ph.D, Staff Psychologist

    Simple Steps


    Recently, I heard something from a client that I found disturbing. He was separated from his wife and children, and wanted to go home. He said, "We fight all the time and I know I contribute to it because I want to win!" My response was to ask "What's the real goal? Do you really want to win?" I think every fight he won was a battle won, but he was losing the war.


    Gottman, a researcher and mentor for marital therapists, says he can tell within three minutes of an argument whether a couple is headed for divorce or not. Unfortunately, it is not necessary to be Gottman to see the gentleman mentioned above and his wife are at risk.


    Professionals like Gottman offer a great deal to us, (Why Marriages Succeed or Fail, Gottman '94) but here are some simple ideas to help us get on and stay on the right track. First, think things over before you say anything. Check your reasons out. Are they significant enough to even put out as issues? Second, talk to and about your partner as if he or she were a good friend. We tend to respect our friends and often give them the benefit of the doubt. Third, stick to facts rather than interpretation (e.g. Please don't leave wet towels on the new quilt. vs. What? Were you born in a barn?).


    Based on "Grandma's Wisdom" that you get more from honey than vinegar, find something positive to say to or about your partner. One lady couldn't think of any positives for her taciturn and gruff husband. I asked, "Is he a good provider? Did you ever wonder if he was running around on you?" She said "No, I never worry about that and he always took care of the family. Always! " She added, "He's really quite a guy, isn't he?" And yes, he really is.


    Barbara A. Buchanan, Ph.D.

    Staff Psychologist

  • Cognitive Distortions Carole P. Smith, Ph.D., Staff Psychologist

    Cognitive Distortions


    "I can't change. It's just the way I feel. I can't help it." How many times have you heard this or perhaps said it yourself?


    Almost 25 years ago Dr. David D. Burns published a pioneering book in a relatively new approach to changing negative emotions entitled "Feeling Good: The New Mood Therapy". It is based on the premise that how you think determines how you feel. A thought, perception, or belief precedes every emotion. When thinking is based in reality, the emotion is appropriate; but when thoughts are distorted, the feelings can be unnecessarily painful. When we change our thinking, our mood changes too. The cognitive approach is now applied to depression, anxiety, anger, guilt, shame, and even to couples issues.


    Dr. Burns referred to 10 categories of faulty negative thinking as "Cognitive Distortions". Most of us use them occasionally. Some of us use them frequently. Read them over and decide which is your" favorite". When used too often, this way of thinking can cause real but unnecessary problems.


    ALL-OR-NOTHING THINKING: This refers to a tendency to evaluate things in extreme, black-or-white categories. If a situation falls short of perfect, you see it as a total failure.


    OVERGENERALIZATION: A single negative situation is seen as a never-ending pattern of defeat by using such words as "always" or "never".


    MENTAL FILTER: You pick out a negative detail and dwell on it exclusively so that you filter out anything positive and the whole situation becomes negative. "One ant spoiled the whole picnic."


    DISQUALIFYING THE POSITIVE: You reject positive comments or experiences by insisting they "don't count" for some reason or other. You can then maintain a negative belief that is contradicted by your everyday experiences.


    JUMPING TO CONCLUSIONS: You interpret things negatively even though there are no definite facts that convincingly support your conclusion.


    MIND READING: You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check it out.


    THE FORTUNETELLER ERROR: You predict that a situation will turn out badly and accept it as fact. "I just know I'll flunk that test."


    MAGNIFICATION (CATASTROPHIZING) OR MINIMIZATION: You exaggerate your own faults and minimize your desirable qualities while inappropriately magnifying someone else's accomplishments or shrinking their imperfections. This is also called the "binocular trick."


    EMOTIONAL REASONING: You assume that your negative emotions necessarily reflect the way things really are: "I feel so guilty. I must be a terrible person."


    SHOULD STATEMENTS: When you apply "should", "must", or "ought" to motivate yourself, the emotional consequence is guilt or rebellion. When you direct should statements toward others or the world in general, you feel anger, frustration, and resentment.


    LABELING AND MISLABELING: This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. "I'm a loser." You may also apply labels to others when they do something hurtful or annoying. "He's a jerk." When you confuse someone's thinking or behavior with his/her very identity, it leaves little room for constructive dialogue. Mislabeling also involves describing an event with language that is highly colored and emotionally loaded.


    PERSONALIZATION: You see yourself as the cause of some negative external event, which in fact you were not primarily responsible for or you blame others for events not entirely under their control.


    When you notice yourself using any of these distortions, stop and find more realistic, less extreme substitutes. If you have trouble making these changes yourself or would like assistance in applying cognitive therapy, consider asking a mental health professional for help.


    Carole P. Smith, Ph.D.

    Staff Psychologist

  • Driven to Distraction: ADHD John S. Schell, Ph.D., Staff Psychologist

    DRIVEN TO DISTRACTION: ADHD


    As the long days of summer begin to wane, parents begin to anticipate and prepare for their children's return to school. What they are often unprepared for, however, are the notes that may soon be sent home by teachers indicating that their child “cannot sit still,” “is having trouble concentrating,” and “is disrupting other students.” Such remarks are certainly concerning, and for many parents, mark the beginning of a journey designed to distinguish normal childhood behavior from a true problem.


    In these instances, sometimes too quickly, teachers and parents alike are willing to speculate about attention-deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder that can cause hyperactivity, impulsivity, and difficulty with attention and concentration. ADHD, the newer term for ADD, affects between 4 and 12 percent of school-aged children, and is 2 to 3 times more likely to be diagnosed in boys than in girls. Epidemiologically, ADHD has become much more prevalent within our society over the past several years, causing many to consider it epidemic. Needless to say, this has elicited much controversy, not only amongst educators, psychologists, and physicians, but in the general public as well, and has led many to consider ADHD to be over-diagnosed and over-treated.


    While there may be some truth to this, it is probably more accurate to say that ADHD is too often misdiagnosed—missed in certain situations, and too often confused with other problems. For example, distractibility as a symptom is not specific to ADHD—it may be caused by depression, anxiety disorders, or interpersonal difficulties such as peer conflict and family stress. Furthermore, ADHD often co-occurs with other disorders, making it all the more difficult in some situations to establish an accurate diagnosis. Although these reasons may, in part, account for the increase in the number of cases of ADHD, more clearly articulated diagnostic criteria, as well as increased awareness and a greater willingness to seek treatment, may also explain the rise in numbers.


    Symptoms

    Although inattention, hyperactivity, and impulsivity are the hallmarks of ADHD, the disorder can manifest itself differently across individuals. Very often, children with ADHD will be easily distracted and unable to stay focused, making it difficult for them to read and to pay attention in class. They may have trouble staying organized, may be prone to procrastination, and may often have difficulty following through on tasks, making it difficult to both start and complete projects. In children where hyperactivity is also a concern, parents and teachers often report excessive restlessness or fidgety behavior, an inability to sit still, and increased impulsivity (e.g., difficulty taking turns, more interruptive behavior, acting without thinking through the consequences). Furthermore, children with ADHD may have problems with short-term memory, may be more careless and accident prone, and may report more emotional distress and interpersonal difficulties.


    While this is not an exhaustive list of symptoms, it covers the basics and explains why so many children with ADHD have difficulty in academic settings. However, it is worth noting that the symptoms must cause significant impairment in more than one area of functioning to warrant the diagnosis. Furthermore, the symptoms must be present before the age of seven, and must not be better explained by some other condition such as depression or a learning disability.


    Assessment

    Again, because ADHD is so easily confused with other disorders, a thorough assessment is absolutely necessary in establishing an accurate diagnosis. Other explanations, including intellectual giftedness and being bored in class, need to be ruled out. Although clinical interviews and behavioral observations are the cornerstone of a good evaluation, psychological testing, in most cases, is also an integral part of the assessment process. There are a handful of questionnaires that directly assess ADHD symptoms, but an intelligence test to evaluate cognitive strengths and weaknesses is perhaps even more important. Additional tests of memory and neuropsychological functioning are also usually included in a comprehensive test battery.


    Although many clinicians rely solely on clinical interviews to establish an ADHD diagnosis, conducting a more thorough evaluation would certainly reduce the number of misdiagnosed cases and potentially reduce the controversy around this often misunderstood condition.


    Treatment

    While there has been much research into the etiology of ADHD, the cause remains unknown. ADHD seems to run in families, therefore it seems likely that there is some underlying genetic contribution. At the same time, a variety of additional factors, including dyes and preservatives in food, a history of head injury, and premature birth, have all been considered in the onset of ADHD.


    Because the exact cause remains undetermined, there is no specific cure at this time. While many children seem to outgrow the condition by adolescence, or at least find ways to adaptively work around the symptoms, many adults remain affected. Epidemiologically, it is estimated that as many as 50% of children affected by ADHD will continue to have difficulties as an adult, and more attention is being paid to adults who may never have been diagnosed as children.


    In terms of treatment, a parent's initial reaction may be to seek a pharmacological answer, although medications remain a controversial subject. Parents may turn to their pediatricians or primary care physicians for answers, but many feel that psychostimulants such as Ritalin, Adderall, and Concerta are over-prescribed, especially in mild cases. And as with any medication, the side effect profile needs to be carefully balanced with the therapeutic gains of the medication.


    Of course, many parents prefer psychotherapy as an alternative to medication. In this realm, providing parents with education and support may be most critical in enabling them to coach their children through difficult situations. Children also often respond well to behavior therapy, which focuses directly on symptom management and the establishment of effective coping skills. At the same time, children with ADHD often benefit from cognitive therapy aimed at improving self-esteem and minimizing any secondary distress, as well as social skills training to improve interpersonal relationships and minimize the negative impact ADHD often has on peer relationships.


    Again, although there is no specific cure for ADHD, medication and psychotherapy, which are often used together, are both effective in the reduction of symptoms and distress, and the minimization of impact on the child's life. More broadly speaking, it may also be helpful to consider the fact that ADHD is culturally defined, and as such would cease to be a relevant diagnosis if we lived in a society where learning could actually be tailored to each individual child thereby taking advantage of his or her strengths and weaknesses. Then children would be encouraged to work with their ADHD, rather than fight against or be controlled by it.


    John S. Schell, Ph.D.

    Staff Psychologist

  • Living in the Moment Barbara A. Buchanan, Ph.D., Staff Psychologist

    Living in The Moment


    Psychologists and other mental health professionals extol the virtues of Living in the Moment, the Now, the Present. Unfortunately, as we speed through life doing our work, keeping our home, helping our friends and caring for our families, we may be mystified by what that means.


    We can think of time as a continuum; a line with the Past at one end and the Future at the other end. In the middle is Now, the present. The more time we spend in the moment or the Now, the more we experience life and the flow of living.

    Past--Now--Future


    Whenever we stay in the past, we ruminate over if onlies, remorse and guilts. For example, repeatedly reviewing how it would have gone if we had only told them off, keeps us stuck in a dead zone because the past cannot be changed.


    Whenever we stray to the future, we obsess about how it will be, what could happen and fears about what could develop. We are powerless over the future so planning how it will go in minute detail is not a good use of time. We can plan and even schedule, for example, a trip to Brazil on July 15th, 2004. However, if terrorism erupts in Brazil, please cancel and make a new plan.


    You will notice the more you spin your mental wheels in the past or in the future, the less you experience your own present! Try staying in the moment, in the Now. Here are some exercises to try if you are serious about living more fully.


    1. Look at things (people or places) and notice how it is as opposed to how you want it to be. What are the characteristics you notice and how do you feel noticing those characteristics?


    • Have you ever looked at or into the eyes of your partner, friend, mother or child?
    • Have you ever been surprised when you finally saw the tree in your backyard or the lilacs blooming in Spring?

    2. Pay attention to your body.


    • Stretch before you move or exercise. What does it feel like to stretch?
    • At work, walk between appointments, tasks or on your break. Watch someone walking with a cane or walker. Can you tell how amazing it is to just walk?

    This morning as I left for work, the sky was blue, the clouds fluffy white and there were children on bikes down the street. As I carefully backed up the drive, I heard the children yell The Bookmobile! and Mama, the bookmobile is here! When was the last time you were so fired up about a library? Children are spontaneously in the present, but without executive intellectual oversight. Do what children do: taste, smell, hear, see, move, play and work right now this minute.


    Reality is lived right now, one moment at a time. Past can and does inform and shape the present. Future is always out there, but isn't here yet. Only now is lived in real time.


    Barbara A. Buchanan, Ph.D.

    Staff Psychologist

  • Developmental Tasks Janet E. Dix, Ph.D., Staff Psychologist

    Developmental Tasks


    Often parents have a fear that their children are not on track developmentally compared to other children. To address this issue, an educator R. J. Havighurst (1972, Developmental Tasks and Education), defined benchmarks for human development called developmental tasks. These tasks are society's expectations at any given age beginning with infancy and continuing through to adulthood and serve as useful tools for parents, teachers and health care providers.


    The Developmental Tasks through adulthood include:


    Infancy and Early Childhood: up to 6 years


    1. Learning to walk-between 9 and 15 months
    2. Learning to take solid foods.
    3. Learning to talk-between 12 and 18 months
    4. Learning to control the elimination of body wastes-between 2 and 4 years
    5. Learning sex differences and sexual modesty
    6. Forming concepts and learning language to describe social and physical reality
    7. Getting ready to read
    8. Learning to distinguish right and wrong and beginning to develop a conscience--occurs during the later years of early childhood

    Middle Childhood: 6-12 years


    1. Learning physical skills necessary for ordinary games
    2. Building wholesome attitudes toward oneself as a growing organism
    3. Learning to get along with age mates--to develop a social personality
    4. Learning an appropriate masculine or feminine social role
    5. Developing fundamental skills in reading, writing, and calculating
    6. Developing concepts necessary for everyday living--occupational, civic and social matters
    7. Developing conscience, morality, and a scale of values
    8. Achieving personal independence
    9. Developing attitudes toward social groups and institutions

    Adolescence: 12-18 years


    1. Achieving new and more mature relations with age mates of both sexes
    2. Achieving a masculine or feminine social role
    3. Accepting one's physique and using the body effectively
    4. Achieving emotional independence from parents and other adults
    5. Preparing for marriage and family life
    6. Preparing for an economic career
    7. Acquiring a set of values and an ethical system as a guide to behavior-developing an ideology
    8. Desiring and achieving socially responsible behavior

    Early Adulthood: 20 years +


    1. Selecting a mate
    2. Learning to live with a marriage partner
    3. Starting a family
    4. Rearing children
    5. Managing a home
    6. Getting started in an occupation
    7. Taking on a civic responsibility
    8. Finding a congenial social group

    The developmental tasks fall into three major categories. They are:


    1. physical maturation
    2. societal pressures (including social interactions and social skills)
    3. individual values and self-aspirations: including moral development/knowing right from wrong and motivation and achievement

    Particularly when children enter pre-school and kindergarten, their level of development becomes more obvious. Professionals can usually spot the highly competent, well developed and perhaps gifted children as well as the children who are struggling. Young children develop at their own rate, some walking first, some talking first, and some being more aware of their surroundings. No cut and dry rule exists as to what children should do first as long as they eventually progress in all the areas at an age appropriate time. It is a mistake to compare siblings in terms of development because children's process of development will most likely differ.


    Parents should not hesitate to act if it comes to their attention from others that there might be a problem. Keep in mind that early intervention is the key to getting children on track with their peers. Seek feedback and ask for recommendations from the primary care physician, the teacher(s), and/or a child psychologist. Professionals have the tools to do multi-faceted assessments to determine a child's actual age versus "test" age in any given area and regarding any one of the developmental tasks.


    Janet E. Dix, Ph.D.

    Staff Psychologist

  • A Heart Does Not Beat Alone John J. Zarski, Ph.D., Staff Psychologist

    A Heart Does Not Beat Alone


    Coronary artery disease (CAD), in its various forms, is listed as America's leading cause of death (American Heart Association, 1996). CAD accounts for nearly one million fatalities and five million hospitalizations each year (Braunwald, 1997). CAD is associated with unpredictable daily variations in functional capacity, and it always carries the threat of death. As such, CAD may be the most debilitating of all chronic disorders (American Heart Association, 1996). Cardiovascular disease exacts a huge financial and emotional toll on afflicted individuals and the public at large.


    In his recent book, Thriving With Heart Disease (2003) Dr. Wayne Sotile suggests that some partners/families flounder in anger and confusion in the aftermath of heart disease while others bounce back, reclaim hope, and continue to find meaning in life. Rachel Freed in her book Heartmates (2002) offers several quideposts to help partners/families create a new foundation of meaning in their lives.


    • Give yourself permission to be vulnerable and human, to grieve.
    • Consider the efficacy of prayer, spirituality, and religious affiliation.
    • Find meaning in adversity. Crisis offers us an awakening.

    Finally, Dr Sotile, in a earlier book, Heart Illness and Intimacy (1992), suggests the following ways to help your relationship with a significant other become a "healthy, healing partnership."


    • Nurture and care for each other
    • Know that relationships grow and change.
    • Take responsibility to be honest in the relationship.
    • Let others know you value your partner.
    • Be more gentle and forgiving in your relationship.
    • Keep the spirit of healing alive.
    • Attend to intimacy needs in the relationship.

    Should you decide a therapist might be helpful in working through difficult issues, appendix B in Dr. Sotile's 1992 book offers a list of facts to help you select an appropriate professional (see the Books of Interest section of this website under Chronic Illness and Relationships).


    John J. Zarski, Ph.D.

    Staff Psychologist

  • Grief - Facing the Holidays Without a Loved One Catherine C. Cherpas, Ph.D., Staff Psychologist

    Grief - Facing the Holidays Without a Loved One


    Whenever we face loss, we experience grief. The responses we have as we grieve are very unique and individual. Some have found it helpful to describe grief as a roller coaster, full of ups and downs, highs and lows. Often the holidays are low times because they are filled with many memories. It is very natural that the pain of loss would intensify at this time.


    If you are facing the holidays and someone you love will be missing, the following suggestions may be helpful.


    1. Balance time to yourself with being social. Solitude can help renew one's strength. Being with people you care about can be just as important. Attend some holiday parties, You may surprise yourself by having an enjoyable time.
    2. Find a creative way to remember your loved one. For example, volunteer your time to your loved one's favorite organization or charity.
    3. Re-experience the happy time. Select 2-3 special memories of past holidays with your loved one. Recall them often especially if outbursts of grief seem to occur at an inappropriate time.
    4. Locate and use available supports. If your religious faith is important to you, attend holiday church services. Seek out a support group or start your own to help you through the holidays.

    Facing the holidays without a loved one can be difficult, however, this can also be a time for some joy. Having a good time over the holidays does not mean that you have forgotten your loved one or that you love him/her any less. Remember that time alone and time with others both help the grieving process.


    Catherine C. Cherpas, Ph.D.

    Staff Psychologist

  • The Family Dinner Suzanne H. Hetrick, Staff Psychologist

    The Family Dinner


    Parents want to ensure that their children grow up healthy and happy. No one wants a child who is difficult or gets into trouble. Preventing unhealthy, risky behaviors can seem like a mystery. There aren't parenting manuals that come with each child specific to all of the situations that are encountered as kids are growing up. Parents often worry about their youth getting involved with the wrong crowd, using illegal drugs, or getting in trouble at school or with the law.


    Surprisingly, one of the best ways to prevent behavior problems is to sit down as a family for dinner every day. The family time provides parents an opportunity to connect with their kids and find out what is happening in their lives. It also gives parents time to talk about family values and what is important to do and not do. Family meals provide opportunities for working together as a family group. Even young children can help set the table or clean up after dinner.


    Family time is a precious commodity in our busy lives. Youth are involved in many activities that can make finding a time for a family meal almost impossible. It is amazing how few families eat together. Kids and parents are on different schedules and often grab food on the run. Or they eat at separate times. There are many families that feed their children at earlier times than the adults. Perhaps this habit remains from infancy. Or maybe parents get home so late from their jobs that it is almost bedtime for their children. Many families have not grown up in homes that emphasized family meal times.


    Parents may not realize how important it is to eat together as a family. Now that there is research on the preventive power of family meals, maybe more parents will insist on getting together as a family every day. Something so simple can mean fewer problems in the tricky teen years. Preventing problems is always easier than dealing with difficulties after the fact. Eat dinner as a family every day and prevent behavior problems. It's a good anti-drug program.


    Suzanne H. Hetrick, Ph.D.

    Staff Psychologist

  • Self Help Carole P. Smith, Ph.D., Staff Psychologist

    Helpful Self-help Books


    Psychologists use a variety of approaches and techniques to deal with problems in living. I often recommend self-help books or manuals to supplement psychotherapy. These books give clients a reference to use between sessions and offer more detailed information than I can give during the session. Workbooks include exercises and questions to reinforce learning and to help in developing independent problem solving. Two that I have found useful are described below.


    The Anxiety & Phobia Workbook, 3rd revised edition by Edmund J. Bourne, Ph.D. is a comprehensive and holistic approach to the anxiety disorders. It is described as "simple, concise, step-by-step directions for mastery of relaxation exercise; coping with panic; real-life desensitization; overcoming negative self-talk; changing mistaken beliefs; visualization; expressing feelings; assertiveness; self-esteem; nutrition; medication". Background information about the various anxiety disorders and their possible causes is detailed and thorough. The specific skills are practical and cover a wide range of behavioral, interpersonal and cognitive strategies. Most chapters are summarized for easy reference.


    Cognitive therapy may be the fastest growing psychotherapeutic approach in the past several years. It is based on the premise that dysfunctional thinking (self-talk or internal dialogue) is related to many common mental health problems. Mind Over Mood: Change How You Feel by Changing the Way You Think, by Dennis Greenberger, Ph.D. and Christine A. Padesky, Ph.D. explains cognitive therapy and applies it to depression, anxiety, anger, guilt and shame. Four fictionalized persons show how a 7-column approach can be used to develop alternative or more balanced self-talk. Subsequent chapters cover mistaken beliefs; how to use behavioral "experiments" to test new ways of thinking; and explanatory information on depression, anxiety, anger, guilt and shame. Ease of comprehension, chapter summaries, plenty of space to write and extra blank forms at the end make this workbook user-friendly.


    Both books can be used independent of psychotherapy but I have found that clients often have questions and sometimes get stuck at one place of another. When this happens, it is helpful to turn to a professional for guidance in applying the suggestions that have been read


    Carole P. Smith, Ph.D.

    Staff Psychologist

  • August John S. Schell, Ph.D., Staff Psychologist

    August


    For many people, it is the first indication of summer winding down. Although arguably such a view point may reflect a "glass is half empty" perspective, August certainly does signal back-to-school time for children and parents alike. Some children may be getting bored or antsy at home and may be looking forward to seeing their friends again, while others may dread the upcoming academic year. Parents may also be experiencing mixed emotions, perhaps feeling a bit antsy themselves, but also lamenting their children's return to school and the changes that will have on the family.


    Obviously this much anticipated time of year may be experienced as exciting or stressful, depending on the situation and one's perspective. This is true regardless whether your child is heading off to kindergarten for the first time or leaving to finish his or her last year in college. Contextually, when the new school year is met with a positive framework, the stress is tolerated well, and everyone adjusts accordingly. However, of course, these types of transitions do not always go so smoothly.


    Some children do experience apprehension and anxiety as they face returning to the classroom. Of course, there are a number of different factors that may be disconcerting to children, and they tend to vary depending upon the age and the developmental level of the child. Young children, as well as college students leaving home for the first time, are often concerned about separation issues-separation from Mom and Dad, the family itself, or friends and peers. They may wonder if they will be able to fit in and make new friends, if they will succeed academically. All of these concerns may be normal, but how well each child navigates them can have a potentially profound impact on their sense of self, their self-esteem, and ultimately their interpersonal and academic success.


    Parents should pay attention for signs of anxiety that may be associated with back-to-school concerns. These may include direct expressions of fear or worry, physical signs of anxiety (e.g., stomachaches, headaches, loss of appetite, difficulty sleeping), or changes in behavioral routines. Again, some children may be self-aware enough to raise their concerns, while others may not, and may even deny them or be avoidant of discussions around the topic. Because of individual differences, these concerns may manifest in a variety of ways.


    Regardless, the task of the parent is to help children cope effectively and adaptively, and to find ways to be supportive of the transitional process. This may mean talking to children directly about their concerns, or simply letting them know that it is okay to feel the way that they do. A more hands-on approach might involve helping children prepare for the upcoming school year, academically as well as emotionally. Not just shopping for school supplies, but helping children anticipate what other resources they might need to be successful; perhaps helping children to anticipate their difficulties and to be proactive in addressing them. This might mean helping children develop insight and awareness to the underlying reasons behind interpersonal problems or academic difficulties. If nothing else, this is an important time for parents to be empathic-to give children the opportunity to talk and to be heard. Asking questions and actively listening to the answers helps parents move past their own assumptions and really see things from the child's perspective.


    While parents have the task of trying to help their children navigate these challenges, they also have the added responsibility of being attentive to their own feelings. For example, they may be sad if a son or daughter is heading off to college, but at the same time may feel pressure to be happy and excited. Sometimes the sadness does not hit until well after the fact-September or October when the kids have been gone for a few months. Regardless of the situation, parents should attempt to be self-reflective, acknowledge their feelings, and find productive and effective ways of working through them-perhaps finding ways to stay connected with children through visits or e-mails, maybe pursuing other interests or hobbies that had been previously shelved because of lack of time, spending more time with your spouse or reconnecting with old friends.


    Again, August is a time of transition in many ways, and change can often mean stress. By attending to one's feelings, back-to-school can be an exciting time of year and the start of another school year filled with good memories.


    John S. Schell, Ph.D.

    Staff Psychologist

  • Child Safety Barbara A. Buchanan, Ph.D., Clinical and Developmental Psychologist, Staff Psychologist

    Child Safety


    All the folks with children are outside more in spring and summer weather. We are on the go and the children are too. Which brings up the issue of child safety. We all know children need shin pads for soccer and knee pads for roller blading,but we sometimes don't think about "child-proofing" our children for social safety.


    The following are some child safety ideas:


    1. Where you can see me .We often tell children to stay where we can see them. This is not useful information to a child under the age of ten or eleven, who lacks the capacity to take your perspective. The better course is to train them to stay where they can see you. Then, if it gets crowded, they move to us. Hold them accountable by using the phrase, when you retrieve them, "You couldn't see me so you need to come where I am".
    2. What happens if you can't see me? If children do get separated from you, let them know they can get help from a clerk or store manager ("the man or lady behind the counter.") Children who aren't in a store, e.g. outside a strip mall, an art festival or the zoo, should be encouraged to look for a grownup with children. It is a good bet that a nice Daddy, Mommy, Grandma or Grandpa will help your child. A helpful adult will take them to the security office or an office where grownups will find you through search or page.
    3. All children need to know their first and last names and their parents' first and last names. Older children, 5-6 and over, need to know phone numbers and addresses. I also suggest when the children are old enough, they be taught to carry phone money, a quarter or thirty-five cents, which can be tucked into the laces of tennis shoes. Teens can be issued an emergency phone card for their pocket. The quarter and the phone card are emergency items. Train children to tell the difference between daily wants and a true emergency. Keep in mind, to a six year old, not being able to see you is an emergency.
    4. Labeling the Obvious About Transitions and Schedules. Work on having good communication with your children by labeling the obvious, which is obvious to you, but not to the children. At a county fair, say, "Let's go see the bunnies". If you lose a child in the 4H pet shed, don't leave there. A lost child can remember where you were separated if they know the name of where they were or what was going on there, e.g. "We are going to see people riding horses."
    5. Give children transition time. (e.g. "Let's finish seeing the bears and go see the big cats".) Give them notice, "We'll leave the bears in five minutes". Transitions smooth out moving on and make it less likely for a child to go back for a few minutes and end up lost.
    6. Roaming from Home Base. We begin safety training at home where we keep the children in the yard and out of the road. We gradually let children out of the yard when we know they will come back when called and that we can trust them to stay out of the road. For example, children over eight may go to the corner but not around the block. Be sure to practice "Where you can see me" limits. If a child can't do the limits in a relatively safe, uncrowded environment, consider keeping to known family and friends' locations. Toddlers (12months-36 months) cannot exercise the accountability for the "Where you can see me" concept.

    Remember that crowded places require more watchfulness from adults. Have safe fun this summer, and be sure to keep the children where they can see you.


    Barbara A. Buchanan, Ph.D.

    Clinical and Developmental Psychologist

    Staff Psychologist

  • Returning Home from College---Tips for Parents and College Students Karen Desmarais, Ph.D., Staff Psychologist

    Returning Home from College: Tips for Parents and College Students


    May is the time of year when college students may be returning home to their families. This can be an exciting time for both the students and their families. They may be looking forward to enjoying the time away from school with no worries about homework or grades, and spending time with the people they missed while they were away (friends, family, significant others).


    While it can be an exciting time, it can also be a challenging one for the whole family, particularly for the parents and the college students. This is especially the case after the first year that the students have been away. However, the challenges faced can be present regardless of the students' year in college, or if the students are returning home upon graduating from college.


    For parents, your challenge is often one of struggling with the realization that your 'children' are growing up. In addition, this awareness that your children are making the transition into adulthood can feel both scary and painful. Scary, because as part of the transition to adulthood, you may be watching your sons or daughters make choices with which you do not agree. Learning to allow your children to become more independent involves learning to redefine your role as 'parent' (to what degree you feel you must protect them from harm (or bad choices), offering advice, setting rules) and allowing them to make mistakes and (hopefully) learn from those mistakes. This process can be a painful one in that as they mature and become more independent, you may feel as though they no longer need you. This is a normal feeling. However, it is not that they no longer need you, but that they may need you in a different way than they did when they were younger.


    Here are some ideas that may be helpful to keep in mind as your sons/daughters return home from college:


    • Recognize your own struggle with watching your children become more independent (awareness can help keep your behavior in check, such as when you may be tempted to "take over" for them and make decisions for them that they are capable of making).
    • Recognize that your children are going through a difficult transition as well-they are also redefining their roles from 'child' to 'adult'.
    • You and your children may wish to sit down and re-negotiate roles at home, household rules, and expectations of behaviors (chores, curfews, amount of time on the phone, letting you know where they are). For example, while in college, your children had to take care of their own laundry. Upon returning home, it can be easy to settle into old roles-either the parents want to continue to do their laundry as they may have done when the students lived at home, or the sons/daughters may expect that the parents will 'pick up where they left off' and continue to do this chore for them when they are perfectly capable of doing this themselves.
    • Be a good listener.
    • Support their efforts at becoming more independent.
    • At times, you may choose to offer ideas/advice that may be helpful to them. You may do this, but remember that it is best to do this if your children ask for your input, but it may not be well-met if your advice was not sought out. When you do give advice, remember that your sons/daughters have the right to decide whether to listen to your advice, or try something their own way.
    • When your children make a mistake, don't say, "I told you so". Instead, ask them if they would like your help and how you can be helpful.
    • Be respectful of differences of opinion.
    • Keep the lines of communication open.

    For the college student, you may be concerned about what life will be like when you go home for the summer. You've most likely changed over the past year and become more independent. You've lived on your own (possibly for the first time), made new friends, and been in charge of how you spent your time (how often to study, spend time with the new friends you've made, defining your own sleep schedule). It can be anxiety-provoking to return home, not knowing what will be expected of you and whether your parents will be ready to accept that you've changed. It can be very easy for you to fall back into the same role as the one you had before you left for school, and just as easy for your parents to expect and do the same.


    Here are some things that may help if you find that you and your parents' expectations are at odds upon returning home:


    • Try to remember that it may be difficult for your parents to watch you "grow up". They may be feeling unneeded, and may not know how (or be ready) to adjust their behaviors to how you've changed (i.e., they may still expect you to have the same curfew you had before you left, even though you didn't have a curfew while away at college).
    • When talking with your parents about how you've changed and become more independent, be patient. Don't just expect that your parents should automatically treat you very differently. Learning to do that is a process for your parents and may take time.
    • Although you've changed a great deal over the past year and may be a very different person, you will continue to grow and change (as we all do) and be a very different person a year from now. Remember that your parents may still have some very useful perspectives and advice, as they've been around longer and had even more time to grow and change as individuals.
    • Respect differences of opinion-be able to agree to disagree.
    • When differences do occur, stay calm, and recognize that differences are likely to occur. The more calm you are able to remain, the more likely you will be able to talk things over in a meaningful way with your parents.
    • You and your parents may wish to sit down and re-negotiate roles at home, household rules, and expectations of behaviors (chores, curfews, amount of time on the phone, letting them know where you are). For example, while you were away at college, you were responsible for many things for yourself, such as having to take care of your own laundry, cooking for yourself, etc. Upon returning home, it can be easy to settle into old roles-either your parents want to continue to do things for you that they used to (like the laundry and/or cooking), or you may expect that your parents will 'pick up where they left off' and continue to do these things for you while they may be thinking that you should now do these chores. When re-negotiating roles, be patient and again, remain calm. Try to find a solution that works for both of you.
    • Try to remember that while you may be frustrated with your parents' behavior at times, their intentions may be good. This can help in remaining calm in the face of disagreements.
    • Finally, be a good listener.

    Karen Desmarais, Ph.D.

    Staff Psychologist

  • Dealing with Aggressive People Richard J. Shurell, Ph.D., Staff Psychologist

    DEALING WITH AGGRESSIVE PEOPLE

    One of the most difficult challenges of day-to-day life is finding effective ways to cope with the angry and aggressive people we are all occasionally confronted with. Whether directed at us by a loved one or a total stranger, aggressive behavior can catch us off guard and may lead to defensive or counter-aggressive reactions which only make the situation worse.


    Stay calm and non-defensive


    Your most valuable asset in dealing with someone who is potentially out of control is to be totally in control yourself. Staying calm provides the best opportunity to keep the situation from escalating. To do so requires accepting aggressive people as they are, even if you do not like them and wish they would go away. Insisting that demanding, condescending or verbally abusive people should not be the way they are is akin to saying that weather that we do not like should be different. It is much more fruitful to begin with a realistic view of others, and to acknowledge that allowing yourself to get upset will just make things more difficult. Take a deep breath, count to 10 and recognize you will have to be persistent and probably do more than your share of the work in order to calm down an agitated individual.


    Know what gets to you


    When others become verbally abusive, they often have a uncanny ability to identify and exploit our weaknesses. It is essential to recognize your own "triggers" or "hotspots", and the have effective ways of maintaining control when situations start to get to you. Remind yourself there are many reasons why people make hurtful comments, and try not to take it personally even when they are pointedly directed at you. If you keep your cool and do not let someone else's behavior control the way you feel, chances are you will walk away from the situation feeling good about yourself.


    Remain task-oriented


    When dealing with aggression, do not get sidetracked by other's accusations or attempts to manipulate you. Identify what your most important goals are in the situation, and do not lose sight of what you are hoping to accomplish. Acknowledge that in every conflict situation there are two points of view, and try to fully understand what the other person thinks, feels and wants.


    Enlist the person's help


    When dealing with hostile or aggressive people, try to make them a ally by enlisting their help in resolving the situation. Let them know that they are an important part of the solution and reinforce this notion by asking for their ideas. Example: "I know you are angry and you have a right to be, but let's see if we can figure out a way to resolve this problem".


    Disengage


    One of the most useful strategies in controlling the escalation of anger and aggression is the time-out technique. If the situation is getting out of hand or if you are having a difficult time controlling your own feelings, disengage. A cooling off period enables people to be more objective and to change their mind or make concessions without feeling they have lost face. Offering to get back together when things have settled down helps to insure that the disengagement will not be viewed as an attempt either to be punitive or to avoid unpleasantness.


    Set limits


    When you have made your best effort to settle a situation and cooperation is still lacking, limit-setting is often important, Resist the temptation to engage in personal characterizations or name-calling, and instead, give the person a choice. Describe the behavior and spell out the consequences that will occur if it continues. Example: "I want to work this out, but if you keep yelling and swearing at me, you are going to have to leave."


    If the above strategies fail, and you feel your safety is threatened, get out of the situation, get help, or do what ever else is necessary to protect yourself.


    Richard J. Shurell, Ph.D.

    Staff Psychologist

  • Informing Children about Divorce John J. Zarski, Ph.D., ABPP, Staff Psychologist

    Informing Children about Divorce


    Approximately 40% to 60% of couples in the U.S. recently married divorce and the rate is 10% higher for remarriages. One part of the process facing divorcing parents is telling the children of the decision. Results from a recent article in Contemporary Family Therapy summarizes the event from the child's perspective and suggests ways they would have preferred being told.


    Findings suggest the following: children would have preferred being told by both parents; they would have preferred that parents would communicate openly with each other; it was very stressful to hear one parent "bad mouthing" the other; children wanted parents to tell them they were loved and also showed emotional support.


    Here are some additional suggestions.


    • Answer childern's questions honestly, avoid unnecessary details
    • Tell the children about the process of visitation
    • Be consistent and on time to pick up and return children
    • Guard against cancelling plans with children
    • If you are angry with your ex-partner, do not express the anger in front of the children
    • Likewise, avoid putting children in the middle and in the position of having to take sides.

    Resources:


    Blau, M. (1993). Families apart: Ten kays to successful co-parenting. N.Y. : G. P. Putnam $ Sons.


    Lansky, V. (1991). Vicki Lansky's divorce book for parents. N.Y. : Signet


    Westbery, A., Nelson, T.S., Piercy, K.W. (2002). Disclosure of divorce plans to children: what the children have to say. Contemporary Family Therapy, 24 (4), 525-542.


    John J. Zarski, Ph.D., ABPP

    Staff Psychologist

  • Spring Time by John S. Schell, Ph.D., Staff Psychologist

    Spring Time


    With the arrival of the crocuses and the promise that the daffodils and tulips are not far behind, spring has finally reached Northeast Ohio. Soon the trees will bud and those buds will quickly be replaced with green leaves, just as nature's palette of winter grays is replaced with the vibrant hues of new life.


    Although spring may have personal meanings for each of us, it is typically considered a time of rebirth and renewal-naturally, aesthetically, spiritually, and symbolically. As we begin to enjoy the warmer weather and the longer days, we may notice that our mood seems elevated and our spirit somewhat rejuvenated.


    But spring is more than this--it is a time for a fresh start. For many, the changing of seasons and the beginning of spring marks a time for reflection. A time to look inward, to reassess our lives, and to reevaluate our needs and our wants as well as the direction we have taken in our own lives.

    As we do this, it is important, not only for our happiness but our overall well-being, that we be honest with ourselves, that we listen to our inner voice, and that perhaps we take the opportunity, personally, for a fresh start once again.


    John S. Schell, Ph.D.

    Staff Psychologist

  • COUNSELING CHILDREN: Halloween Anxiety by Janet Dix, Ph.D., Staff Psychologist

    Counseling Children: Halloween Anxiety


    Halloween can be one of the most fun times of the year for young children, or it can be a traumatic and anxiety-provoking experience. Parents whose children exhibit symptoms of fear, withdrawal, crying, hyperventilation, or tension need to understand what is causing the adverse reaction and know how to cope with the problem behaviors.


    In general, preschool children, ages 3-5, often exhibit problem behaviors at some point in time. It is common for them to exhibit fear, anxiety, have nightmares and be impulsive. They also have difficulty expressing themselves due to their limited range of speech. Cognitively, their thinking is illogical, egocentric, symbolic and magical. Their judgments are based on their perceptions which often times are illogical. Also, the young child's thinking is one-dimensional which means he/she can only attend to one attribute or dimension at one time. In other words, if Daddy puts on a scary mask, Daddy becomes the scary creature. The Trick-or-Treaters, due to magical thinking, take on the characteristics of the costumes to the young child. Some young children like their own costume and may have picked it out but will refuse to wear it. Some children believe they will be transformed into a different person.


    There are several ways to handle the Halloween "experience" with your young child. Particularly if your child gets scared when seeing scary things, you can begin exposing him/her to the Halloween decorations early in the month. Let the child see and, if possible, play with the ghosts, goblins, witches and Jack-o-Lanterns just to familiarize them with the faces.


    A parent can expose the child to Halloween books where happy, normal children dress up in costumes. Let the young child know that Halloween is fun and exciting rather than scary. Let your child dress up in grown-up clothes or costumes prior to Halloween so the association is positive and perceived as a fun game. The more exposure a child has to things being real vs. not real, the less anxiety he/she will experience during the events of Halloween.


    Because pre-schoolers thinking is concrete, and they have difficulty generalizing from one situation to the next, they still may be traumatized with the sights and sounds of Halloween. So not matter what kind of preparation you do with your pre-schooler, you still may be faced with a scared child. In fact, the scary visions can cause violent nightmares and lingering bad thoughts. Protect your young child from experiencing really scary images. Three to five year olds are too young to be subjected to haunted houses, to adult Halloween parties, or to scary movies. Some children will not have an immediate reaction to the scary images but will have nightmares that linger for some time.


    If your child wakes up crying from a bad dream or is afraid and scared, the first thing to do is help him/her relax. Use a calm soothing voice and assure your child that everything is okay and that he/she is safe and secure. If you yell at your child and tell him the monster is not real, the negative emotions can intensify and make the problem worse. The preschooler's perception of what is real and not real is illogical to others but make perfect sense to the child. The feelings of security usually offset the intense anxiety, and the fear quickly fades.


    As your child gets older and develops physically and emotionally, Halloween usually becomes less scary and more fun. Middle age children (ages 6-11) can deal with two pieces of information and understand that masks do not transform the person into a character. They also have developed better use of speech and language and understand the concept of Halloween. They have the ability to separate reality and make believe.


    If your child does not outgrow the fears and anxieties and is experiencing panic attacks, phobias and ongoing anxiety, the problem may be more chronic in nature, and your child may require professional help. You will want to work with a person who has experience in treating children. You child can learn how to anticipate anxiety, how to reduce worry, and overall feel more in control.


    Janet Dix, Ph.D.

    Staff Psychologist

  • Interventions in Morbid Obesity by Gerald J. Strauss, Ph.D., Staff Psychologis

    Interventions in Morbid Obesity


    Abstracted from Innovations in Clinical Practice: A Source Book (Volume 20, 2002).


    More than 50% of adults in the U.S are overweight or obese. The prevalence of overweight and obesity has risen tremendously since 1960. In the last decade the percentage of overweight or obese adults age 20 years or greater has increased to 54.9%. In addition, the number of overweight children has doubled in the last 20 years.


    Obesity is now viewed, much like diabetes or hypertension, as a chronic disease. This multifactorial chronic disease has its roots in genetic, metabolic,physiological, social, behavioral, and cultural factors.Although we may inherit the tendency to develop obesity, the expression of obesity is affected by diet and exercise.


    GOALS OF WEIGHT LOSS


    Weight loss of 1-2 lbs per week is reasonable as a immediate goal. An intermediate, and potentially long-term, goal may be 10% weight loss from baseline. The NIH (1998) guidelines suggest a reasonable time line for a 10% reduction in weight should be six months. Once a desired weight is attained, a maintenance program must be instituted. It is well documented that weight is regained within a year once any treatment is stopped. Again, it is necessary to view overweight and obesity as a chronic condition that needs ongoing attention.


    WEIGHT LOSS STRATEGIES


    Diet: In any weight reduction plan a balanced deficit of 500 to 1,000 kcal/day is necessary. Reduction of total calories from fat to 30% or less is also necessary. Of course, many of the fat calories removed from the diet should be saturated fat. Reduction of saturated fat enhances lowering of the LDL-cholesterol. However, reducing fat calories alone will not promote weight loss. Similarly, replacing fat calories with carbohydrate calories will not lead to weight loss. Reduction of fat and carbohydrate calories will be necessary to produce a sufficient deficit for weight loss.


    Exercise: While most weight loss occurs because of decreased caloric intake, physical activity remains an important factor in weight loss. However, the NIH (1998) Guidelines suggest that exercise will not lead to substantially greater weight loss over a six-month period. Additionally, specific kinds of excercise (e.g., muscle building activities) may limit weight loss or, actually, promote weight gain. However, increasing lean muscle mass is still beneficial because muscle requires more energy expenditure for use as fuel. The fuel source used can be stored fat, which promotes weight loss. Maintenance of physical exercise is helpful in preventing weight gain. An additional benefit of exercise is the reduction of cardiovascular and diabetes risk factors.


    Behavior therapy: Specific, learning-theory based principles, such as reinforcement, self-monitoring (of both food intake and physical activity), stimulus control, contingency management, cognitive restructuring, stress management, and social support are very important in attaining weight loss and weight maintenance.


    Combined Therapy: Combining the above three methods (low calorie diet, increased physical activity, and behavior therapy) provides the most success for weight loss and weight maintenance. This combination approach should be instituted and maintained for at least 6 months before pharmacotherapy is entertained (NIH Guidelines, 1998).


    Gerald J. Strauss, Ph.D.

    Staff Psychologist

  • Stress Alert by Catherine C. Cherpas, Ph.D., Staff Psychologist

    Stress Alert


    Stress is an everyday fact of life. You can't avoid it. Stress is any change that you must adjust to. While you usually think of stressful events as being negative such as injury, illness, or death of a loved one, they can also be positive. For example, getting a new home or a promotion brings with it the stress of change of status and new responsibilities.


    You experience stress from three basic sources: your environment, your body, and your thoughts. Your environment bombards you with demands to adjust. You must endure weather, noise, crowding, interpersonal demands, time pressures, and various threats to your security and self esteem.


    The second source of stress is physiological. The rapid growth of adolescence, aging, illness, accidents. poor diet and sleep disturbance all tax the body. Environmental threats also produce body changes which are themselves stressful. Your reaction to problems, demands and dangers is very much influenced by an innate "fight or flight" response which you inherited from our primitive ancestors. In simple terms, your body undergoes the following changes when you experience the "fight or flight" response: When stimuli coming in are interpreted as threatening, the regulating centers give the body information to speed up in preparation to confront or escape the threat. You muscles become tense to deal with the challenge. Blood pulsates through your head so that more oxygen reaches your brain cells, stimulating your thought processes. Your heart and respiratory rates increase. Blood drains from your extremities and is pooled in your trunk and head, while your hands and feet feel cold and sweaty. If the body is not given relief from the biochemical changes that occur during the "fight or flight" response, chronic stress may result. When you are already stressed and more stress is added, the regulatory centers of the brain will tend to overreact. This causes wear and tear on the body and potentially breakdown and death. For example, the chronic arousal of the "fight or flight" response can turn transient high blood pressure, or hypertension, into permanent high blood pressure.


    The third source of stress derives from our thoughts. How you interpret and label your experience, what you predict for the future can serve either to relax or stress you. Interpreting a sour look from your boss to mean that you are doing an inadequate job is likely to be anxiety provoking. Interpreting the same look as tiredness or preoccupation with personal problems will not be as frightening.


    You can't escape all of the stresses of life or completely turn off your innate "fight or flight" response to threat, but you can learn to counteract your habitual reacting to stress by learning to relax. The very centers of the brain that speed up your biochemical processes when you are alarmed can be called upon to slow these processes down.


    Catherine C. Cherpas, Ph.D.

    Staff Psychologist

  • Back To School by Suzanne H. Hetrick, Ph.D., Clinical Psychologist

    Back to School


    It's fall and children are back in school. Summer is a time of relaxation and play for youngsters. Returning to school is eagerly anticipated by some children and dreaded by others. With the start of school, schedules become important. The days take on structure for school, homework, sports or other activities. At the start of the school year, there may be complaints about teachers and homework. Signs of difficulty adjusting to school can include stomachaches, headaches, and other complaints to avoid going to school. School refusal or school phobia is not all that uncommon. The school counselor can be a resource in helping you get your child on track with the responsibilities of the classroom. If the problems seem severe, you may need to contact a mental health professional outside of the school. School phobia does respond to treatment. The earlier problems are caught, the quicker the recovery.


    If you are contemplating professional mental health services, you may be confused about the choices you encounter. The phone book is filled with ads for various individuals, offices and agencies. First of all, you need to determine if your choices are limited by the benefits that you may have. Mental health and substance abuse services are often managed by behavioral healthcare companies. It that is the case, you need to call and receive authorization for treatment before services are covered and paid. At the time of the call, you may be given a list of providers in the network of your insurance carrier.


    The next step involves contacting the persons on the list and determining who may be the best individual to treat the problems or concerns you have. If you are seeking medication instead of or in addition to therapy, you need to know that psychologists, counselors, and social workers are not able to prescribe medications. Your primary care physician may prescribe or you may need to go to a psychiatrist for medication. Feel free to ask questions before making that first appointment for the best possible solution possible to meet the mental health needs of your child.


    Suzanne H. Hetrick, Ph.D.

    Clinical Psychologist

  • Building Memories by Barbara A. Buchanan, Ph.D., Staff Psychologist

    Building Memories


    What do you remember about your childhood or adolescence? The big trip? Always getting to lick the beaters when Mom made a cake? The warmest memories are often about small things shared over and over again. What's in your kitchen? Jello or instant pudding? What's out your window?


    Spring is a great time to get out into nature to watch it grow and change. Take a toddler or a preschooler for a walk to find ants. Go out after a rain to look for worms or to count the number of kinds of worms. Collect tadpoles and watch them transform. Get a map of your local park's bike and hike trails and hike your way into spring. Older children and teens might enjoy a night hike led by a park ranger.


    Great memories are low cost and fit into every budget. Building memories takes a little imagination with some time and sharing. Keep in mind that time is structured by the child's attention span.


    Barbara A. Buchanan, Ph.D.

    Staff Psychologist

  • Setting The Stage for Change by Carole P. Smith, Ph.D., Staff Psychologist

    !--TL Setting The Stage for Change by Carole P. Smith, Ph.D.--> Setting The Stage for Change


    Many of us are under the illusion that change is an all-or-nothing matter. "Just make up your mind and do it!"


    Not so, say two research psychologists. James Prochaska, Ph.D. of the University of Phode Island and Carlo DiClemente, Ph.D. at the University of Maryland, have done studies on over 3,000 people to assess their readiness to take steps to address a problem. Their research indicates that individuals go through several well-defined, separate stages, often cycling back through them a few times before the new behavior becomes habitual or comfortable.


    Precontemplation. People in this stage don't recognize or accept that they have a problem. Typical remarks might be: "It's your problem. If you would get off my back, everything would be OK". There's no intention to do anything different. A serious legal, health or relationship consequence sometimes can be a wake up call.


    Contemplation. People in this stage may be willing to admit that something is wrong and that they are seriously thinking about change within the next 6 months. They feel ambivalent and may begin to recognize some anxiety about doing what it takes.


    Preparation. In this stage there are intentions to take some action within a month and a person may already have tested the waters in minor ways. Telling a friend of their intention, getting information on a self-help grouup, committing to a starting date are examples. There is still likely to be ambivalence or hesitancy.


    Action. Only about 10-15% of people making changes are in this stage at any given time. Even when they perform specific actions incompatible with the undesired (old) behavior, they may also telll themselves it isn't fast enough or good enough. Support by family and friends is very important here.


    Maintenance. Even after new behavior is initiated, it isn't automatically living "happily ever after." Practice to strengthen the gains made in the action stage is crucial. Relapse prevention requires awareness of early backsliding and support against feeling discouraged it there is a temporary slip back into old behavior.


    Whether the person in need of change is yourself or a loved one, recognizing where one is in the process makes for a more realistic evaluation. Accepting some temporary backsliding to an earlier stage and celebrating even small improvements are essential to lasting change. Remembering this will enable you to be patient and give the appropriate kind of support to ensure the best chance of success.


    Carole P. Smith, Ph.D.

    Staff Psychologist

  • The Post Divorce Family by John J. Zarski, Ph.D. ABPP, Staff Psychologist

    The Post Divorce Family


    Divorce has become endemic to the American society. Two decades ago it was relatively rare; today more than 50% of partners will choose divorce as the solution to marital dissatisfaction. As a result of divorce the U.S. Bureau of Census has created a new family form, the single-parented household. Regardless of the individual dynamics of any given family, all single-parent families experience a number of problems adjusting to this new style of life. Three major issues for these families include: finances, parenting, and social relationships.


    As a single-parant you will face a multitude of personal choices. Here are some guidelines to help you on your journey. Don't denigrate your ex-partner in front of the children or otherwise. Do respond in a civil, respectful manner, the children will respect you.


    Don't try to be a super-parent and do everything yourself. Do ask for help and have the courage to be imperfect. Don't interrogate your children when they return home from your ex-partner. Do create a ritual that lovingly welcomes them to your home. Don't project your resentments on your children. Do respond in a caring, compassionate,comforting manner.


    Remember: change is an opportunity for growth.


    John J. Zarski, Ph.D. ABPP

    Staff Psychologist

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