Friday, May 3, 2013

Is It Really ADHD? Or Just Sleep Deprivation?

What if a substantial proportion of cases are really sleep disorders in disguise? 


"We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses."


Link for full article:

http://www.nytimes.com/2013/04/28/opinion/sunday/diagnosing-the-wrong-deficit.html?_r=2&

Wednesday, March 20, 2013

Should Therapists Play Cupid? by Richard Friedman

"The idea that therapists might play Cupid with patients tantalizes patients and therapists. An anecdotal survey of my psychiatrist colleagues suggests that the matchmaking impulse is very common."


See full article:

http://www.nytimes.com/2013/01/20/opinion/sunday/should-therapists-play-cupid.html

Secret Ingredient for Success by Camille Sweeney and Josh Gosfield

"Merciless self-examination" is linked to success in a variety of fields and industries, and is cited by such diverse talents as chef and restauranteur David Chang, tennis champion Martina Navratilova, and indie rock band OK Go

 

"...we expected to hear that talent, persistence, dedication and luck played crucial roles in their success. Surprisingly, however, self-awareness played an equally strong role."


Link to full article below:

http://www.nytimes.com/2013/01/20/opinion/sunday/secret-ingredient-for-success.html

The Stories That Bind Us by Bruce Feiler

Research shows a strong correlation between what children know about their family and how they handle adversity:


"The single most important thing you can do for your family may be the simplest of all: develop a strong family narrative...The more children knew about their family’s history, the stronger their sense of control over their lives, the higher their self-esteem and the more successfully they believed their families functioned."


Link for full article:

http://www.nytimes.com/2013/03/17/fashion/the-family-stories-that-bind-us-this-life.html?pagewanted=all&_r=0

Tuesday, March 19, 2013

The Gift of Gratitude by Kathryn Berla', Ed.D.

From Kentuckiana Health Fitness Magazine, January, 2007


“‘Tis better to give than to receive,” or so they say.  I’m not going to argue with that, but I am going to suggest that there are aspects of receiving that are just as important.  Gratitude is something that many have trouble expressing, whether it is for a simple gift or for the larger things that may influence or change one’s life for the better.  The importance of gratitude in relationships is no small matter. On the small scale, being able to say “thank you” in a remotely believable way, whether or not we mean it, is a matter of good social skills. Most people can pull that off—for those that can’t, well, that’s a whole different article. On a larger scale, the ability to let others give to you is just as important as the ability to give to others.  So much so that people who do not have the capacity to truly receive and be grateful probably do not have the capacity for healthy intimacy.

I once had a boyfriend who was honest and generous to a fault, but who was seemingly unable to experience or express true gratitude.  This first became apparent one holiday season when various people, including his family members and myself, began to inquire what he might like for a present.  He insisted that he didn’t want or need anything, and that we should not bother.  When we went ahead anyway, he expressed his thanks appropriately, but went on to demonstrate, through various behaviors, that what we had given him was disappointing or had missed the mark in some way. It was true that he could well afford to buy himself anything he wanted, but this was not the point.  Even though he gave generously he was not able to accept others giving to him.  He knew that the people close to him were going to be giving him gifts despite his protests, but he insisted on not cooperating with letting them have the pleasure of giving.  Although it may seem trivial, in fact it was representative of a larger and much more serious relationship problem.  It turns out that this man was restricted in most areas of emotional intimacy.  He was someone who could give the outward appearance of all the right behavior, but who really was too impaired to be able to accept others fully on an emotionally intimate level.

Otto Kernberg writes, “Gratitude is also one of the means by which love develops and perpetuates itself. The capacity for gratitude…is basic to reciprocity in human relations.” Kernberg was not referring to Christmas presents, but rather the kind of gratitude one feels for the mere existence of those who support, sustain and feed us. Psychoanalytically speaking, the infant experiences gratitude when his/her needs are gratified by the mother.  The infant also experiences frustration and resentment when his/her needs are not met.  In healthy development, we learn to tolerate those conflicted feelings toward those we depend upon.  As adults, we are never more vulnerable than in love relationships, and the lover takes on the same emotional significance that the mother has for the infant.  In order to be in love, we must idealize our partner to a degree in order to overcome the times when our partner inevitably will disappoint us in some way.  Kernberg continues, “The couple’s capacity for idealizing each other is expressed most strongly in their capacity for experiencing gratitude for love received and the corresponding intensification of the desire to give love in return.”  The experience of the expression of love received “as well as of the capacity to reciprocate with love contains the assurance that love and reciprocity will dominate over envy and resentment.”

Now think about the gift giving and receiving as symbolic for the ability to give and receive emotionally. When someone you care about goes to the trouble to ask what would give you pleasure, and one responds by refusing to tell them and/or not accepting what they give, then it is an act of deprivation toward that significant other of something fundamentally necessary for a good relationship.

There is much in the pop psychology world on the subject of emotional dependency and to such an extent that many believe that any feelings of dependency are unhealthy.  That could not be more incorrect.  Healthy mature relationships are characterized by healthy interdependency, which is the ability to accept and be accepted, to be able to rely on someone for our emotional needs and know that they, in turn, can rely on us.  Not only is it okay, even necessary to need others, it is necessary that we are needed right back.

So, keep in mind the significance of true emotional reciprocity and how it functions in your life.  Practice your social skills when you get the fruitcake from Aunt Martha, and consider for yourself whether you make it difficult for those you love to give to you on all levels. No matter the season, we all should be giving when it comes to those less fortunate than us; but when it comes to the ones we love, it is just as important to receive.

Kentuckiana Health Fitness Magazine, January 2007

Dating As A Single Parent by Kathryn Berla', Ed.D.

From Kentuckiana Health Fitness Magazine, April 2005


Dear Dr. Berlá,

My girlfriend and I have been dating for five months.  She has joint custody of two young children to whom she is extremely devoted. Her qualities as a parent are part of what I admire so much about her, but since she has not introduced me to her kids, we don’t get to spend as much time together as I would like.  I don’t want to be pushy, but when is it okay for me to expect to meet them?  How will I know if this relationship can work if she is only my part-time girlfriend?
--C.M., Lousville

I get a lot of questions on this topic; the issue here is twofold.  First, what is the right way to parent when you have a dating life, and second, what is the right way to date when you are a parent?

Many newly-single parents contemplating dating find that they are contending with issues they didn’t have the last time they were in the dating pool.  Conventional wisdom dictates that there should be a certain amount of time before one introduces a new love interest to the children.  Ultimately the decision about when the right time is, and whether a new boyfriend or girlfriend is a good risk, is an individual one.  Most experts agree that kids can be uncomfortable, for a variety of reasons, with the idea of mom or dad dating, and that exposing children to a sexually charged environment is never a good idea.  At the same time, you have to realize that no matter how much you minimize the public displays of affection, your kids aren’t dense; they will catch on pretty quickly what it means that you have a new “friend.” There can be positive elements to this.  Your children can benefit from you modeling respectful, verbally affectionate behavior with another adult.  Your children should not be privy, however to the “adult” aspects of your relationship, be they sexual or emotional.  That is why it is advisable to ensure that your romantic relationship is on the most solid ground possible prior to introducing your children.

Now to the second question:  Even if one is clear about one’s parenting philosophy, it doesn’t make clarity of one’s dating philosophy automatic.  The reality is that being newly-single can feel extremely lonely.  As harsh as it sounds, kids can offer impediments to building an adult social life.  Nowadays, single parents will find that most potential partners understand the demands of parenting. Children really should be the priority for every parent. If your love interest does not seem to “get it,” or seems resentful of the time constraints presented by your child, then this individual is not the right person for you. It doesn’t make them a bad person—they just aren’t your match.

On the other side, what if you are the childless person trying to date a single parent?  You have been understanding and flexible with the needs of your new friend’s lifestyle with her children, and have always striven to work around the obstacles to seeing each other in a solution-focused manner.  Now though, it seems like the relationship is not moving forward and your patience is beginning to wear thin.  You aren’t certain how you and the children will mesh because you haven’t yet met. It is getting increasingly difficult to picture a long-term relationship with this person you care about due to the unknown quantity of the dynamic with the children.  There cannot be one answer to fit the circumstances of every relationship, but there are some elements that are reasonable for anyone to want no matter what the situation.

First, it is reasonable to want to know where the relationship—any relationship—is headed.  It is always okay to express your desire to have your relationship be a committed one, and to know what the other person’s idea of commitment is.  If notions of the terms and goals of your relationship are different for each of you, you have the right to get out and pursue what it is that you want.  There is no shame in wanting to be committed and married; there is also no shame in knowing that is not what you want or are ready for.  What you shouldn't put up with, after a reasonable amount of time together, is someone being vague or evasive with you about the subject. You shouldn't nag or pressure them, but you do have a right to know.

Second, you have a right to know what your partner’s provisional plan is for you and her children.  Nothing is written in stone, but I guarantee you that she has some idea of what she envisions between you and her kids if she plans on keeping you around.  She should be able to give you some indication of what she is thinking.  She may only be able to give you an estimated time frame--she does not owe you a specific date and time for the introduction, nor should you expect to hold her to an exact plan. She should, however, be able to give you a sense of where she sees the relationship heading.  She should be able to communicate that to you in a way that builds your feeling of security with her, not in a way that makes you feel uncertain, shut out, or wrong for asking the question. That doesn’t mean that you won’t be coming in second for a long time to come, but when kids are in the picture, that just comes with the territory.  You are an adult and are supposed to have more resources for dealing with your uncomfortable feelings.  The kids can’t help where they are, and they can’t just get out of a relationship if they are unhappy.

If your girlfriend is not able to engage in the type of discussion described above, it probably means one of two things:  she is not that serious about you, or she has issues independent of you that she needs to resolve on her own.  Either way, at this point, she isn't capable of giving you what you want in the relationship. You might want to give serious thought to moving on. 

Hopefully, she will be able to tell you what you want to hear and the two of you will continue working together and moving forward.  Only you can decide if the answer you are getting is the right one for you.

Kentuckiana Health Fitness Magazine, April 2005

Do's and Don't of Post-Divorce Parenting by Kathryn Berla', Ed.D.

From Kentuckiana Health Fitness Magazine, April 2007


It is time for a spring-cleaning refresher course on the do’s and don’t’s of parenting in a post-divorce world.  Many of you have heard it all before, but it never hurts to go over it again. Additionally, and unfortunately, there are a bunch more newly-divorced parents who have joined the ranks, and they brought their kids with them.  There is also a much older and more jaded crop of kids whose parents never learned it in the first place. Divorce is horrible to go through for everyone, and some parents are better than other at really putting the children’s concerns ahead of their own.  Others less so.  In the course of my day job, I routinely do custody evaluations for high-conflict families who have pushed our overworked family court judges to their limits.  It never fails that many of these parents show up in my office, look me in the eye and tell me that their number one concern is the welfare of their children, and then turn around and act out in ways that demonstrate their total failure to understand what that even means.  Below, I have constructed a handy pocket guide in order to refresh everyone’s familiarity with some basic guidelines.  Please clip ‘n save.

Undermining

Anything you do or say that could in any way diminish your ex in the eyes of your kids is against the rules.  It doesn't matter if it is true! Your children need and should be allowed to be free to love and experience both of their parents as fully as possible.  Interfering with or discouraging your ex’s access to the children is a no-no. Any message that you convey overtly or explicitly that the other parent is in some way no good is a message that your kids are reading that there must be something wrong with them too.  You say, “Your father is a deadbeat.”  They internalize, “Since you are made from your father, you are a deadbeat too.”  You say, “Your mother is crazy.”  They hear, “You are half-crazy.” Your kids identify with both mom and dad. Anything you do to undermine the relationship with the other parent is in actuality tearing up a piece of your kid.

DON’T badmouth your baby-daddy or baby-mommy.
DO let your kid know that there are all kinds of wonderful parts of themselves that they have inherited from both parents.

Dating

Congratulations on finding another adult human being that you are interested in spending time with!  That is not an easy thing to do.  Thing is, don’t expect that your kids will be as supportive and thrilled as I am.  In their world, the only person who belongs with Daddy is Mommy, and vice versa.  Go easy on rushing into the introductions—it won’t hurt you to keep the parties separated for a time.  When the time comes, test the waters with your kids.  Talk to them about how you need grown-up friends the same way they need their friends. If your new love is going to come around, keep the activities child-focused or at least family-friendly. No kissing, rubbing or hand-holding in front of the kids for a while. And, no, Biff or Muffy are definitely not allowed to spend the night while the kids are there, even if they are “sleeping on the couch.”

DON’T bring your kids along on what is really a date for you.
DO have your own life.  You won’t harm your kids by exposing them to other trusted adult friends.  But stay connected.  Talk to your kids about what their feelings are and take them into consideration, without giving the kids total control.

Honesty

Some parents take great pride in being “honest” with their kids.  Problem is, “honest” sometimes means disclosing adult matter to little ears. Now lean in and get really close to the paper so you can hear me clearly. DON’T DO THAT! Your kids do not need to know about your child support woes, or that mommy is dragging you back into court.  It is harmful to tell them that daddy’s new Muffy is a homewrecker. Your kids do not need to hear you fighting with your ex, either on the phone or in person.  The single biggest factor that affects kids’ adjustment to divorce is the level of ongoing conflict between the parents. Exposing them to your fighting and tension is just chipping away at their little souls.

DO tell your kids the truth about things that will directly affect them, such as housing  and school changes or the visitation schedule.
DON’T tell them their lifestyle is going to change for the worse because “daddy couldn’t keep it in his pants,” or “mommy took all daddy’s money,” even if it is true.

Messenger Service

When there is ongoing tension between parents, some think it is better to avoid contact altogether.  This can be a little tricky if you are sharing visitation and co-parenting your kids. Some people think the solution is to have the kids transmit messages back and forth between Mom and Dad. “Mom said she needs the child support check,” or “Dad said he needs to switch next weekend on the schedule.” This is a terrible position to put the children in.  Not only are they being exposed to implied criticisms or failures of their parents, but they are also taking the brunt of whatever to message receiver’s reaction is going to be. As a further step, some parents actually quiz their kids about the other parent’s spending habits, lifestyle, whereabouts, and adult company. Your kids are neither an answering service nor are they your own private surveillance team.  If you need a third party to communicate, find a family member or pay a professional to mediate. Don’t ask the kids to spy for you.  If you legitimately need a private detective, hire one.  If you are just obsessed and embittered, it might be time to go back to therapy.

DON’T rely on your children to transmit or provide information. You are hurting them.
DO keep the kids out of it

One last note: you parents need to take care of yourselves so that you can take care of the kids.  A depleted parent means anxious, frightened, or depressed children. If you have been prescribed medication, take it.  If you are experiencing insomnia or loss of appetite, go to your doctor. Engage a therapist.  Get some exercise. Avoid excessive alcohol consumption. Use common sense, and finally, trust your gut.

Kentuckiana Health Fitness Magazine, April 2007

All Family Matters Matter by Kathryn Berla', Ed.D.

From Kentuckiana Health Fitness Magazine, February 2007


Happy families are all alike; every unhappy family is unhappy in its own way.
                                                                 --Leo Tolstoy, “Anna Karenina”

There is an expectation among many therapy patients--a misperception really--that it is a goal of therapy to get the patient to “talk bad” about one’s parents, or to assign blame to them for one’s problems.  Many people are reluctant to acknowledge or talk about the complicated feelings they may have toward family members because they feel it is wrong or that it makes them a bad person.  Some people are afraid that if they acknowledge their anger or disappointment toward their parents, that it will somehow compromise their ability to also love them, or that they will be unable to maintain a loving relationship with them.  It is not uncommon for patients assume that, if they talk about “negative” feelings in therapy, that they then will have to confront their parents with these feelings and have some kind of a show-down, much like the ones seen on daytime talk shows.

It is a universal truth that our relationships with our parents are fraught with ambivalence.  It is in the nature of human development to love, resent, be disappointed with, long for, idealize and despise our parents.  In fact, during the adolescent years, it is common to experience all of these feelings toward one’s parents in the course of a few hours.

People come into therapy because there is something about their lives that isn’t working well for them.  No matter what the severity or the particulars, the fundamental aim of therapy is for the patient’s life to work better, whatever that means for that particular patient. Psychologists know that people’s lives usually “work” a certain way because of how we relate to other people.  We also know that relational patterns are almost entirely rooted in the patterns of our family of origin.  Intimacy, affection, competitiveness, self-esteem, attachment, self-concept, identity, occupational choice, sex, choice of mate, and worldview are just some of the areas in our adult lives that find their origins in the relationship we had with our parents during infancy and childhood.

That is why it is imperative to understand the dynamics in one’s family of origin. It does not mean that one’s family has to be characterized as dysfunctional.  In fact, I believe in happy families.  I also believe that it is possible to grow up in a happy family with loving, supportive parents and simultaneously to experience times when one has not felt truly seen, understood, or heard.

Talking about one’s parents and childhood in therapy is not about having to identify dysfunction or inadequacies.  It is simply about understanding the real dynamics that existed within the family in order to better understand oneself and to make changes in our own lives that help us to function better in love, at work, and with friends. No parents are perfect, and nor does any psychologist expect them to be. But ignoring the disappointments or frustrations one experienced growing up does nothing to help one adjust to healthier adult interactions with others.

As every family is unique, so is every individual’s experience of their family.  Siblings who grew up in the same household at the same time can have vastly different experiences of family life.  No one’s “story” is any more accurate than anyone else’s; our experiences are ours alone. A good therapist wants to hear one’s story, in one’s own words, because we cannot presume to know a person just because we have an outline of their history.

I am reminded of the line of dialogue in “Good Will Hunting,” where Sean the psychologist, played by Robin Williams, has an exchange with Will, his court-ordered patient, played by Matt Damon.   Will has just given Sean a scathing interpretation of who Sean is based on one of Sean’s paintings. Sean comes back the next day and addresses the orphan Will’s approach: “You think I know the first thing about how hard your life's been, how you feel, who you are, because I read Oliver Twist? Does that encapsulate you? I can't learn anything from you, I can't read in some [expletive] book. Unless you want to talk about you, who you are. Then I'm fascinated. I'm in.”  Sean’s point is that we can study all of the texts and literature that we can, but that will never really give us the story of who someone is.  When I am working with a patient, I am interested in anything and everything that person experiences as a sentient being.  Things that may seem mundane or small are all very significant to me when I am trying to understand someone.  It is never boring; if someone really can start talking about what it is like to be them, then I’m fascinated.  I’m in.

The process of therapy and recounting one’s past is not about parent-bashing, nor is it about glossing over our family’s shortcomings. With all due respect to Tolstoy, no family, happy or unhappy, is the same as any other. Whether in the context of therapy or not, the most fulfilling lives are the ones where we can be authentic, honest and real with ourselves and those we love.  Often, in order to silence the past, we need to first give it a voice. Sometimes, in order for us to really hear our own voice, we need to say it out loud to another person.  We each must speak our own story, for no one else can do it for us.  And I believe that to be unheard can be the very worst thing of all.

Kentuckiana Health Fitness Magazine, February 2007