A Guide to Personal Resilience

Building Personal Resilience: A Guide to Positive Living

Edited by Dr. Iris Jackson

Building Personal Resilience: A Guide to Positive Living

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Chapter

Topic

Page #

The Psychologist’s Introduction

3

1

Developing a Happy Family: Resolving Couples Conflict

6

2

Developing a Happy Family: Raising Resilient Children

16

3

Developing a Happy Family: Dealing with Parent/Child Conflict

30

4

Attention Deficit Disorder: Disease of the '90's

38

5

Helping Children Cope With Separation and Divorce

44

6

Helping Children Adjust: Custody and Access Issues When Parents Separate or Divorce

52

7

Managing Stress at Work and at Home

59

8

Overcoming Depression at Work and at Home

67

9

Managing Anger at Work and at Home

77

10

Workplace Diversity: Cultural Differences

87

11

Living Free From Addictions

99

12

Consulting a Mental Health Professional – Counselling, Psychotherapy and Medication

107

Important v

The information and advice presented herein are guidelines only and not meant to be a substitute for professional diagnosis. If you feel you suffer from an illness described, see your health care professional. v Please also note that this information has been derived from a variety of sources pertaining to clinical psychology.

The Psychologist’s Introduction Dr. Iris Jackson It is my hope that you will use this book to improve the quality of your life, to develop insight into yourself and others and to increase your compassion for people going through some of the problems and challenges described in the following chapters. Some people will use this book as a manual, reading relevant chapters as they go through their lives.

Others will read this book out of curiosity and find that it helps them understand and empathize with people they know who are going through some of these problems. Still others will consider this book as a stepping-stone to becoming all that they were meant to be.

Here, I would like you to contemplate with me the concept of self-improvement. The human growth movement of the 1970’s has matured and many of us are interested in actualizing our potential. One look at the “Psychology” section of any bookstore illustrates how many of us are seeking to help ourselves develop as complete, whole people.

I have spent many years providing psychotherapy to people, reading the scientific literature and introspecting about my own life experiences. Any good psychotherapist or counsellor will tell you that we learn as much from our clients as we do from our textbooks and scientific journals. When a client asks me “What am I aiming for? How will I know that I have achieved my goals, other than that I will feel better?”, it causes me to analyze and synthesize my professional experience to articulate a reasonable and wellreasoned answer for the client. As a result, I have developed the following list of “adult capabilities” which we, as psychologically mature adults must develop in order to be mentally healthy and happy. As you read them, you can assess yourself and see what areas you might want to work on to more fully be yourself and be happy.

Adult Capabilities: 1. The capacity to deeply experience liveliness, joy, vigour, excitement and spontaneity, without using alcohol, drugs, sex or other people to augment our experience. Also, the ability to relax without using these negative strategies. This entails finding and maintaining a balance of the physical, mental, emotional and spiritual dimensions of our life.

2. The capacity to feel entitled to self-fulfillment, pleasure and support from others to achieve our ends, but also to keep this sense of entitlement within reasonable limits.

3. The capacity to identify our own unique wishes, to initiate the actions necessary to fulfil our wishes, and to assertively express ourselves. This is the capacity to selfactivate, to generate our own excitement and make the things we wish to happen constructively.

4. The capacity to defend our individuality, our actions and our wishes even when attacked and criticized for them. This capacity builds the ability to maintain our selfesteem and self-confidence at a good level on our own, without excessive shoring up by others. This also means living true to our beliefs and our perceptions of reality.

5. The capacity to emotionally connect with others without losing our sense of independent self. This is the ability to find common ground with most other people and allow mutual rapport to develop without feeling threatened. This ranges from the spontaneous rapport of a chat with the bus driver to the deep connection of marital intimacy.

6. The capacity to cope adaptively with our emotions, issues, events, and people in a positive way. This capacity involves accepting rather than fighting our emotions, and

developing ways to re-think things so we can turn adversity into opportunity.

7. The capacity to soothe painful emotions. This is the capacity to modulate, reduce and soothe emotional pain and provide ourselves with comfort on our own.

8. The capacity to experience ourselves as the same individual across time; a sense of continuity of self that allows us to feel that it is, indeed, “me” in that particular experience just as it was “me” in another. Also, the capacity to recognize others as the same even when their moods change. This capacity also involves letting some old selves go when we outgrow them.

9. The capacity to make a commitment to an objective, a goal or a relationship and to persevere, despite obstacles, until we reach the goal. Conversely, the capacity to know when to let go of commitments that have become wrong or bad for us. This means making a strong commitment to ourselves as individuals.

10. The capacity to be creative, to change old familiar patterns into new, unique and different patterns; to connect surprising, different and unusual things (idea, associations, events) to produce new and original things (ideas, events, associations, solutions, products). This is the capacity to be productive in a way that expresses ourselves in all our uniqueness.

11. The ability to see things clearly and in perspective in order to make choices suitable to our personality and circumstances. To develop a sense of humour to help us cope with difficult situations and thereby keep a sense of proportion. The ability to laugh at ourselves and allow our self to be human, not perfect.

As you review the adult capabilities, you may find that there are a few that you could work on that would help you improve yourself and result in being more adaptable, having more fun and being happier.

The Building Blocks of Self-improvement I view the building blocks of self-improvement to look like this:

Proactive Coping

Hope

Information

SelfKnowledge

Self - SelfAcceptance

SelfRegulation

Discipline

To get to proactive coping (at the top of the pyramid) we must develop a solid base of selfknowledge, self-acceptance, self-regulation and self-discipline.

•

Knowing ourselves is harder than we think. It is difficult to look honestly at ourselves, our strengths and our weaknesses. Sometimes we need help seeing ourselves as we are, and having feedback from a trusted friend, family member or counsellor is very useful.

• Self-acceptance actually helps us grow and self-actualize. It is one of life’s contradictions that we are better able to change in a positive way if we accept who we are now rather than criticize ourselves.

• Self-regulation refers to getting enough sleep, eating nutritiously, getting regular exercise and not overdoing these things (at least not very often). Our minds and our bodies are one, and if we do not regulate our bodies appropriately we soon find that our moods and even our thinking become unmodulated too.

• Self-discipline is required to make us get into a reasonable routine which allows selfregulation to be possible. Self-discipline is different from will power. Will power is like a whip we use against ourselves and, as many of us discover, when we try to use will power to achieve a goal, very often we encounter a resistance that operates with equal intensity against our goals: a sort of “won’t power”. Self-discipline is gentler and is based on scheduling and routines that make many repetitive jobs in our daily lives automatic. This leave us time and energy to do other more creative things and keeps our energy resources filled up so that we can work, love and have fun.

Information refers to all of the new ideas and knowledge about others and how the world works that we can get from reading, TV, friends, family and counsellors. Indeed, counsellors can help with all the building blocks of self-improvement, which leads us to hope, without which we would do nothing. With the first six building blocks in place, we can not only cope in a proactive way that prevents many problems from developing, but also enjoy life knowing that while problems may crop up, we have the resilience, stamina and creativity to deal with them.

Chapter 1 Developing a Happy Family: Resolving Couples Conflict Dr. Karen Davies If we find ourselves in adulthood as part of a couple, then clearly we have made a choice sometime during our lives that we wish to share our day-to-day lives with another person. If we are a member of a family with children, then we have made an even bigger decision to share our lives completely with a small social group! In either case, we have come through our adolescence and early adulthood and concluded that we do not wish to live completely on our own.

Living with others provides us with countless opportunities to learn about ourselves, and also about the people with whom we live. Our lives can be dramatically enriched through our participation in the development of our children. Likewise, since we as adults never stop developing and changing, living with another gives us the opportunity to share in this process with another significant person.

If we can experience our partner as a ‘best friend’, most of the time, as we live through all the exciting, sometimes trying and difficult adventures of adulthood, then this very special ‘other person’ can be a constant source of comfort and support. Likewise, we can provide that same comfort and support to our partner.

At the same time, however, living with another person inevitably means that there will be times of disagreement, argument and perhaps serious conflict. If we find ourselves engaged in ongoing, seemingly unresolvable conflict with our partner, then day-to-day life can be difficult and stressful. When faced with serious problems, we can feel quite alone, overwhelmed and unable to explore possible solutions and make good decisions.

Differences of opinion and points of view are normal and healthy in relationships. We come together as two separate people, each with our own unique set of ideas, values, needs, wishes, expectations, beliefs and personality styles. Because we are separate people, there will inevitably be times when some of these are different from those of our partner. The existence of differences does not automatically mean that there will be conflict. However,

• • •

how we express our differences, how we respect these differences in one another; and how we find acceptable resolutions to differences,

can all affect whether or not we will experience serious conflict in our relationships with our partners.

The general emotional tone in a home and in a family is largely determined by the manner in which the adults conduct their lives. The more we are able to create an atmosphere of mutual trust, support and cooperation, the more likely it is that our children will feel safe and secure in their own lives with us. Children are particularly sensitive to the ‘feel’ of things, and if there is a constant underlying tension between their parents, children will inevitably perceive it and respond with behavior that, in some way, reflects their own feelings of discomfort and anxiety.

Just as we teach our children how to tie their shoelaces, ride a 2-wheeled bicycle, get along with their brothers, sisters and friends, and the innumerable other tasks of life, so too do we teach them how to work out differences between themselves and others. As they watch us argue, debate, discuss and resolve disagreements, our children learn how to listen, respect, negotiate, and consider different ideas, points of views, wishes and needs.

Likewise, in our own families as we grew up, we were all exposed to the ways in which our parents resolved their inevitable differences. Some of us were fortunate enough to have good role models for conflict resolution, and we learned throughout our childhood how to deal with differences. However, for many of us, our parents were not particularly skilled in this regard, and thus we have come to adult relationships with a lot to learn!

What Distinguishes Healthy Conflict from Destructive Conflict?

Most of us have memories of arguments or debates in which we tried to defend our own personal point of view in opposition to that of another person, perhaps another family member, a co-worker, a friend or even just a passing acquaintance. Healthy arguing or debating is a way in which we can clarify some of our own beliefs and values about different things. If you have to discuss and defend something that you believe in, you have to think about it, and do your best to organize your thoughts and then put them into words.

It is not required that the other person agree with you on every point in order that your views be considered valid and important. In many instances, agreement isn’t necessary at all, and sometimes the resolution to the difference is simply to agree to disagree. Such a resolution allows for a mutual respect between partners that each person has a right to their individual views and beliefs. Such respect is a fundamental building block for any relationship between two individuals, whether they be intimate partners, friends, family members or co-workers.

Sometimes, though, agreeing to disagree just isn’t possible in an intimate partnership.

Sharing a life with another person requires the sharing of many different things: • the many details of the day-to-day running of a household, including meal preparation, housecleaning, tidying, general household chores inside and out; • taking care of children and children’s activity schedules (if there are children); • continuing the relationships with parents and other extended family; • maintaining relationships with individual friends and friends of the couple; • career development plans and needs of each person; • various work-related issues; • day-to-day financial management as well as longer term financial planning; and • individual needs for ‘free-time’, fitness, physical affection and intimacy, • some couples and families also have significant medical issues to cope with as well.

Many of us have very busy lives, and sometimes it seems as though there just isn’t enough time to fit everything in! When we experience any significant conflict with our partner, the task at hand seems to grow ever larger, and the energy available to deal with it seems to diminish. While ‘many hands’ can make most tasks go more quickly, ‘fighting hands’ slow everything down and make the completion of even simple tasks much more difficult.

Simple arguments and disagreements about ‘who does what when’ may come and go, particularly when people are tired or overwhelmed by ‘too much to do in too little time’.

If these are settled quickly, and both people continue to feel that their views are listened to and respected by the other, there is no long-lasting consequence. However, when these same disagreements and arguments rise up over and over again, and no satisfactory solution is found, therein lies the beginning of more serious conflict that may begin to

erode some of the good feelings in the relationship.

Some couples are quite able to identify the ‘same old arguments’ that inevitably end up ‘the same old way’, like running into the proverbial brick wall! Sometimes the argument is so familiar that it feels as though one could just slip in a tape recording after the first line or two, and play out the same responses and counter-responses that have been made so many times before.

If such a pattern of struggle continues over an extended period of time, eventually the predominant emotional tone in the relationship will be one of frustration, helplessness, discouragement, disappointment, and anger. Even the moments of ‘good times’ together will become overshadowed by the lingering sense of bad feeling. If such a situation persists, then it is only a matter of time before the relationship begins to falter, and one or both partners may find themselves actively searching out any number of distractions from the turmoil.

Such distractions may take the form of extra time spent at the office, more and more events planned alone away from the family setting, more time spent with friends, increased use of drugs or alcohol, or even possibly the searching out of another more seemingly understanding and compassionate ‘significant other’. Certainly, many extramarital affairs begin when one partner feels more and more isolated and alienated from the other due to unresolved lingering feelings of anger, resentment and helplessness.

These are times of serious conflict in the relationship that are potentially very destructive for both members.

What Do You Do Now? The very first step that needs to be taken en route to resolving any ongoing conflict within a couple is for some kind of open, non-accusatory acknowledgment of the existence of the problem. Sticking one’s head in the sand and hoping that it will all go away just doesn’t work! Besides, when your head is stuck in the sand, you will inevitably miss all kinds of other things that are going on around you and also in the relationship, including some things that are potentially fun, exciting, interesting and positive.

Rest assured - the important things that you do not talk about and try to resolve now, will

inevitably rise up over and over again, in some form or another, until you do pay attention to them. This is yet another example of the basic fact that life will present us with many, many opportunities to ‘get it right’, whether we are raising children, learning how to work things out with the people we love, or simply learning a new and different task.

It’s best if we don’t try to discuss something important in the heat of the moment, during or immediately after a serious argument when emotions are high. It is hard to think clearly and honestly when we are flooded with feelings of anger, disappointment, and despair. In these states of high emotional arousal, most of us are also much more likely to say and even do things that we do not really mean, and that we seriously regret later.

Very hurtful things that are said or done in such emotionally-charged moments can feel like significant wounds to one or both partners, and it can then take quite some period of time for each person to heal enough to re-engage with the other person. Trusting our partner to do his or her best to safeguard our feelings of comfort and security in the relationship is another significant cornerstone of any relationship, and when this trust is damaged, the process of rebuilding it can take time and some repeated experiences of reassurance. Please, give yourselves a little space and time after a serious argument to let things calm down a little. Then set aside some time to talk.

It really is important that you make some time in your busy schedule to sit down quietly together, preferably not when you are both bone-weary and can hardly see straight, and not when either person has been drinking alcohol or using any other type of drug. Again, in any of these circumstances, we are all less able to think and talk clearly and honestly about what has happened, how we feel about it, what our own part was in it, and what we believe might be an acceptable resolution for the time being.

Similarly, don’t try to have an important discussion about an area of conflict in your relationship in the mad rush before everyone has to be out the door en route to somewhere. It is important that both people feel that there is enough time for his or her views to be expressed, heard, considered and responded to. Furthermore, if you are unable to reach any mutually satisfactory resolution in this ‘rushed’ bit of time, it is quite likely that both people will begin their days in a state of some emotional upset.

Once you have set some time apart to talk, keep distractions to a minimum. Don’t

answer the telephone or the knock on the door. The calling party will call back or come back if it is important enough! If you have young children (up to 9 years of age or so), wait until they are settled in bed. If your children are older, ask them to allow you a little privacy for some adult conversation. They should be quite capable of keeping themselves occupied for an hour or two.

If your life seems too busy to find a couple of hours to sit quietly together to do some serious talking, you may need to figure out what activity or activities can be shifted lower down on the priority list. Couples do need time alone together without others, for the fun things, and also for attending to problems that inevitably arise. Failure to make the time available for each other over a prolonged period of time can sadly result in circumstances where one or the other withdraws so much that the relationship simply falters and dies.

Once you’ve cleared the decks to allow for some serious, uninterrupted conversation, the next step is to begin the discussion with some direct reassurance from each partner to the other. It is important to confirm with each other that you are there together, as partners, to try to find something that can work better for both of you, that you are both committed to finding a solution to something that is not going well.

Remind yourselves that there are certain areas of your shared lives together that are going very well, and that you have resources as a couple that allow you to experience comfort and success in these other areas. These same resources can often be called upon in some fashion to assist in whatever problem solving is currently required.

If your discussion begins with blaming the other for all that he or she has done wrong, you’re sure to get bogged down in defensive responses and further accusations. These can be very hurtful and destructive, and do not contribute in any way to a successful resolution of the problems at hand. In these circumstances, the risk is very high that you’ll end the conversation feeling worse off than when you began. Heightened feelings of anger, disappointment, discouragement and despair only make it that much more difficult to try again to talk with one another about important problem areas in the relationship. Please, do not begin your discussions by blaming your partner for everything that is going wrong!

If this pattern of blame does persist, eventually neither person will be willing to broach difficult topics, and no resolution will be found. At this point, you will probably need professional help to get out of this situation, and to get both people talking again with some sense of hope and optimism about the possibility of resolution. I’ll return to this

point a little later in the chapter.

It’s helpful to remember, and even to make note of, that in all of the things you do well together as a couple, you each play a contributing role in making things go well. For example, if you run your household well, or you manage your finances well, each of you plays a role in making that work. Along the same lines, in those areas of your life in which you experience conflict or difficulties as a couple, each person also has a part to play.

Sometimes it is very difficult for each person in the couple to look openly and honestly at themselves. Yet it is very important that each person try to determine what role they may be playing in contributing to the ongoing difficulties. We all know how easy it is to find the fault in the other person, and how much more challenging it is to turn the tables around and try to see, understand, and accept our own share of responsibility when problems occur.

Getting the Conversation Started If you have acknowledged the existence of a problem between the two of you, and you have successfully avoided blaming the other for all that is wrong, now it is time to ‘get down to details’. Choose one specific area of conflict to discuss, and make a plan to stick with it. One or two hours of conversation is not enough to address every single concern you may have. If you fill up your discussion time with a long, long list of problems, you won’t have enough time to actively participate in successful problem solving. Ending each discussion period with some feeling of successful resolution, of at least part of a problem, makes it much more likely that you will try the process again.

Once you’ve agreed on what you would like to talk about, there are a few general rules of good communication that you might try to follow.

1) While one person is talking, it is important that the other do his or her best to listen carefully without interrupting. This sounds easy, but can be surprisingly difficult to do! If you are busy trying to figure out how to get in your ‘two cents worth’, it will interfere with your ability to really listen and focus on what your partner is trying to tell you. It also feels very disrespectful to be interrupted while you are talking. If it turns out that one person is far more likely to ‘hold the floor’ for extended periods

of

time, it is even worthwhile to try using the equivalent to a stove timer to ensure that each person has a chance to speak and be heard. Two to three minutes at a time is quite a lot of active listening to do.

2) Active listening means paying close attention to all that your partner is trying to tell you, without offering critical commentary or suggestions about what he or she should say or do. Try to just listen, without imposing your own views or thoughts, and try to understand all of what your partner is trying to say at the moment. Your turn to talk will come. Be patient!

Active listening also means offering small comments periodically, indicating that you are attending as closely as possible. Comments such as “uh, huh’, “I see”, “OK”, all convey an active message that you are attending. Active listening also includes body language such as nodding, and orienting your body toward the person who is talking, to acknowledge that you’ve heard what was said. Really active listening involves periodically paraphrasing what the other has said.

3)

Try to listen both for the informational content of the message, as well as the emotional content. What is the specific information that your partner is trying to convey to you, and how does he or she feel as this information is being shared with you? Sometimes, to understand the emotional meaning of the message, you have to listen very carefully ‘between the lines’, particularly if your partner is one who is inclined to keep most of his or her feelings to themselves.

4)

Watch carefully for any nonverbal messages that may accompany the spoken words. Are there gestures, facial expressions, tones of voice, or other body movements that you notice and find yourself reacting to? Do these nonverbal messages seem to be different from the words that are spoken? Very often, it is these many nonverbal signals that carry much of the emotional content of a message, particularly from a partner who does not readily talk about his or her feelings very openly. Sometimes, we are not even very aware of what we are feeling ourselves.

This makes it particularly challenging for our partners to figure out!

5) When it is your turn to speak, do your best to express your own thoughts, ideas, or feelings, with an acknowledgment that they are yours, and not necessarily those of your partner. Try to begin sentences with “I”. It’s much more difficult than you think. Try to keep the content of the sentence specifically about

yourself, your own

thoughts, ideas, feelings, perceptions, and beliefs.

“I think that you don’t really want to change anything here” is not an effective statement about your own experience. Perhaps a better way to convey your thought might be to say “I sometimes feel like I am trying to make these changes by myself, and I would really like it better if we were working together on this”.

The less you speak on behalf of the other person, the more likely it is that he or she will feel inclined to join in. The more active participation from each person, the more likely it is that, together, you will come to a mutually agreeable resolution somewhere down the line.

6) Please do not make assumptions or draw conclusions about something that your partner is thinking or feeling. Sometimes when we have lived with someone for a long time, we come to recognize fairly predictable patterns in behavior or speech in our partner. While there may be some circumstances in which it is useful to anticipate and rely on these predictable patterns, this is not one of them. When we are having important discussions about problems in our relationship, it is really important that we always allow our partner to speak for him or herself.

As soon as we make an assumption or an interpretation about our partner’s thoughts or feelings, we run a very real risk in getting something wrong. Not only do we feel that our own thoughts and feelings are not recognized and respected as having meaning and value of their own when someone else tells us what we are thinking or feeling, but furthermore, any error in interpretation or assumption can take the discussion in a completely erroneous direction.

These ‘communication skills’ can take quite some time, effort and experience to learn.

Don’t expect yourself or your partner to get them right all at once. Remember, life gives us countless opportunities to learn new things and to try new skills over and over again, hopefully making little steps of progress with each repetition. Particularly in areas of conflict in our relationships, it is not so very simple to convey clearly to our partner exactly what we intend to convey, nor to receive with complete accuracy the message that our partner intends for us to receive.

When two people try to share thoughts and feelings, the information going out and being

received is filtered through our own individual histories, experiences, expectations, and interpretations. Sometimes what we think we hear and subsequently react to is more a function of this individual filtering process than it is a function of what the other person has really said or intended.

Thus, it is essential that we take an active role both in conveying our message as clearly as possible, and in doing our best to listen carefully to the entire message that our partner is doing his or her best to share with us.

If our communication is consistently unclear or incomplete, there is an increased likelihood that, in our own individual ways, depending on what our life experiences, expectations, and interpretations are, we may well end up “filling in the blanks” with assumptions about the other person’s meaning or intent that may be totally inaccurate.

If we give our partner persistent ‘mixed messages’, that is, where we say one thing with our words, but convey a very different, contradictory message with our tone of voice, facial expressions, or gestures, it will become virtually impossible to have a meaningful, continuing discussion. Our partner will be confused, and may in fact feel quite distressed by the contradictory nature of what we are trying to convey. Sometimes, we don’t even realize that we are giving such mixed messages, particularly if we don’t really fully understand our own emotional reactions to something.

Why Do We Sometimes Get So Stuck?

Sometimes, despite our best efforts at talking clearly, listening, and struggling to understand our partner and the conflict that exists in our relationship, we just can’t find a way to a mutually acceptable resolution. Tension and distress continue, and hopelessness and despair may follow. If this goes on for a prolonged period of time, the relationship will suffer.

Sometimes, conflicts around day-to-day issues are more symbolic or representative of problems at a deeper level. If basic trust and respect between partners have been seriously damaged, then there can be an underlying tension that regularly surfaces in the form of major outbursts in response to seemingly inconsequential incidents. These can rise up out of nowhere, it seems, and then leave both partners feeling overwhelmed by the intensity of reactions that both people experience.

Emotional and Physical Intimacy When couples are experiencing significant, seemingly unresolvable conflict, the intimate relationship (emotional and physical) between the two is very often affected as well.

Where once there was a comfortable, satisfying, mutually enjoyable sexual relationship, couples in conflict often find themselves lonely, confused, disappointed and/or angry about the absence of pleasant affectional and sexual contact.

Sometimes, the ‘poor sexual relationship’ gets interpreted as the source of the couple’s problems, and a demand is placed on the reluctant sexual partner to become more sexually interested and involved. If the underlying nature of the conflict in the couple is not understood and addressed, the unsatisfying sexual relationship rarely improves. In fact, the ensuing conflict around the sexual relationship itself can make problems worse for the couple.

Sometimes, it does occur that one partner has a specific sexual problem that has affected his or her ability to participate comfortably and enjoyably in the sexual relationship. If this goes undiagnosed, and misunderstood, it can contribute to an ongoing misperception that he or she is no longer interested, willing, or wishing to have a sexually intimate relationship with their partner.

Some people do in fact have difficulty being intimate partners with others. Emotional intimacy requires: • a high level of trust in another person; • a willingness and ability to learn about and to share many aspects of oneself with another; • a willingness and ability to be vulnerable to another and to let the other person see parts of yourself that you keep mostly to yourself; • a willingness and ability to soothe and comfort another, and also to let another person provide soothing and comfort to yourself; • a basic respect and acceptance of the differences between two people without feeling compelled to compromise important elements of who you fundamentally are; • a reasonable level of physical and psychological health.

When there are significant differences in a couple between the individual wishes, needs and capacities for emotional intimacy, there can up be an ongoing struggle to find an

acceptable level of intimacy that works for both partners. Sometimes one wants to be emotionally closer than the other can tolerate or enjoy. Sometimes there is a distance that suits one person, but feels too lonely and isolating for the other.

When Do We Look for Professional Help? How Do We Do It? When a couple finds themselves struggling for months at a time, and can not seem to find an acceptable resolution that allows both people to feel reasonably content and fulfilled in the relationship, it is a wise decision to seek professional help. Just as we should never leave a serious medical condition untended, neither should we ignore our needs for psychological tending when we are unable to make things better ourselves.

It is sad to see two people, who have clearly loved and cherished one another once upon a time, hovering on the brink of divorce, when some assistance earlier on in the process of coming apart might have helped a great deal in finding far better solutions.

Once you have decided that you just can’t sort out some area of conflict on your own, despite trying and trying for 4 to 6 months, ask around to get the name of a well-trained, respected practitioner in the field of marital therapy. If you have a trusted friend who has previously sought out such help, ask him or her. If you have a family doctor whose advice you have valued and acted on in the past, consult with him or her.

If you have no idea where to start, you can call the local licensing and/or registering bodies for psychologists, marital therapists, and family counsellors. These phone numbers will be available in the yellow pages of your local phone directory. From each of these separate associations, you will get a short list of names of individuals who are trained to provide couples counselling.

Call around and speak to several of these people. It is OK to ask questions about their training, qualifications, and experience and to request a consultation interview. For many of us, it isn’t easy to reach out for help with our relationships. It usually feels better to take an active role in making a choice of a therapist who appears to be a good fit for you and your partner. Once you’ve made these calls, completed a couple of consultation interviews, and settled on a couples’ therapist, you can both relax a little. With a trained professional to help you out, you no longer have to struggle alone with something that seems to have grown beyond your control.

The whole process of couples’ therapy can be extremely rewarding, even if at times it is difficult, stressful and frightening.

• You will have opportunities to learn more about yourself and your partner in a safe environment.

• You will learn new ways to talk to one another about things that are very important to the well being of your relationship.

• You will have the opportunity to learn to identify patterns of behaviour that arise between the two of you that seem to come up out of nowhere, but, in fact, do have their origins in other parts of your life.

• The more you become aware of the existence of these patterns, and where they come from, the more you will actually have some choice in altering them and their effects on your relationship with your partner.

Good Luck!

Chapter 2 Developing a Happy Family: Raising Resilient Children

Dr. Karen Davies

Our children are born, and we are immediately launched on one of the most exciting, challenging and long-lasting adventures of our lives. Along with those parts of this adventure that we can anticipate, plan for, and predict in advance, are the countless experiences and events that life just brings our way. As parents, we are immediately granted both the privilege and the responsibility of guiding our children, from the first moments of their lives, over the next 18-20 years, through this adventure of growing up.

What can we do as parents to ensure that our children have the best possible start in their lives, and to best prepare them for the whole range of life experiences that they will encounter as they grow up? In this chapter, it is my wish to share with you some of what I have learned and experienced, both professionally and personally, about one of the most

challenging and rewarding of adult life experiences – raising our children.

Soon after our children arrive, we are inundated with vast quantities of information about loving, bathing, feeding, diapering and generally taking care of our babies. For some of us, we're too tired to remember most of this information on the first go-round, so we pile up all the booklets and pamphlets on our bedside tables and try to make sense of the many words of wisdom and information in those few spare moments of peace and quiet that we come to treasure!

Of course, we must immediately begin to learn about the second-by-second realities of parenting from direct trial and error as our babies need to be fed, bathed, changed and loved from the moment they are born, and they cannot wait until we've figured it all out!

Fortunately, our children are very patient learners, and we have time to learn with them.

In fact, just as our children grow and develop over the course of their lives, we also grow and develop as their parents.

Personally, I've always been very grateful for the fact that we don't have to get it all right, all at once. Without a doubt, parenting is a big job. It is one of the most demanding and most important jobs that many of us will do in our lives, and it is only reasonable to expect that we will need time and experience, and sometimes a little help along the way, to develop our own best parenting styles and skills.

Even with time, experience and a little help, we are bound to make mistakes, sometimes lots of them! We need to learn to be forgiving of ourselves for the mistakes that we make, and to use these mistakes as opportunities to learn something new about ourselves and our children. The more resilient that we are able to help our children to be, the more easily they too can live with (and learn from) our mistakes.

All parents begin the adventure of parenting wanting the very best for their children.

Ideally, we try to create the best physical and emotional environment possible for our children, one that allows our children to grow physically strong, and emotionally resilient.

What is a Resilient Child?

One who bounces back!! In the simplest of terms, resilient children are children who ‘bounce back’. We often remark as adults how fast children seem to be able to recover

from physical injury or illness. As adults, we all know that the complete healing of a badly sprained ankle or a broken arm can take weeks, months, or sometimes even years before we really feel that things are back to normal.

Many of us have been amazed at just how fast a child can heal from similar injuries.

Children seem to be naturally more physically resilient -- they bounce back. But such physical resilience doesn’t just ‘happen’. As parents, we play an active role in contributing to the general physical health and well-being of our children, and in so doing we actively help develop the resilient qualities we see in the healing of children’s physical injuries and illnesses.

When our children our born, we do our best to take care of all their physical needs. We prepare rooms to receive them into, and make various changes to our homes to accomodate the presence of our new little ones. In our quest to save them from any physical harm, we follow various safety procedures around our homes and in our cars.

To ensure the good physical health of our children, we begin making important decisions about nutrition, cleanliness and medical care. We follow immunization schedules to protect them from various childhood illnesses, and we set up regular medical check-ups to follow their physical growth and development. In providing the best physical care that we can, we do our utmost to keep our children well, and in so doing, we endeavour to make them as resilient as possible to illness and disease.

Just as we participate in the process of providing for such physical resilience, we also have the opportunity to lay the groundwork for providing our children with a strong emotional resilience. However, this isn't done with doctor’s appointments and immunization needles! Rather, it is done in the countless day-to-day interactions we have with our children, beginning in the earliest days after they first come into our lives. I’ll talk at more length about this in a moment.

How Else Might We Think of a Resilient Child?

A resilient child is strong on the inside. Not tough, but strong. Strong on the inside means having a core set of beliefs and experiences that one is loved, valued, capable, and can recognize and trust one’s own thoughts and feelings. If a child is strong on the inside, then that child will be much more able to withstand and bounce back from the many ups and downs that life inevitably brings.

Sometimes these ups and downs are quite minor, although they may not feel that way at the time: perhaps an argument with a friend, an unpleasant interaction with a grouchy teacher who is having a bad day, an invitation to a birthday party that doesn’t arrive, a disagreement or argument with a parent or sibling.

Sometimes, though, life brings significantly more traumatic events into the lives of our children: the breaking up of a family through separation and divorce, a serious threat to the physical security of a child and his/her family, or the serious illness or even death of a family member.

The stronger and more resilient we can help our children to be, the more able they will be to cope with these various events, from minor to the most serious. Of course, depending on the severity of the event, the time and parental support required to get through the disappointment or loss will vary considerably. But each successful ‘getting through’ of the small events provides our children with an ever-expanding base of experience and belief in their own ability to adjust and adapt to a wide range of difficulties and disappointments.

How Do We Contribute to Our Children’s Resilience or Emotional Strength?

Internal emotional strength develops primarily from the experiencing of ourselves as lovable, valued, capable and important human beings -- not just at individual points in time, but as part of the continuing experience of ourselves in our relationships with significant others. Of course, as children, the ‘most significant others’ in our lives are our parents, our brothers and sisters, our extended family, and any others who play a part in providing primary care to us over the years as we pass through our childhood and adolescence.

Teachers, neighbours, coaches, and friends’ parents can all play important roles somewhere along the way in supporting the growth and development of a child’s emotional strength.

Sometimes, it occurs in a child’s life where parents have serious difficulties of their own that limit their ability to contribute positively to the development of emotional strength in their children. In these circumstances, growing and developing through childhood and

adolescence is a much more difficult experience, and these children can reach adulthood feeling incapable of coping with some of what life brings to them.

However, even if we don’t have the opportunity to develop such emotional strength in our own families while we are growing up, it is never too late! As adults, we have to play a much more direct and active role in learning how to develop this emotional strength within ourselves, and sometimes, getting some help in the process can make it much more manageable and even enjoyable.

If, as parents, we find that we are too often too angry, too sad, too confused, or too uncertain in our interactions with our children, then we might wisely consider speaking to a psychologist or counsellor about these experiences. These professionally trained people can help a great deal with exploring just why it is that we struggle in our efforts to provide the best emotional support possible to our children. A family therapist or counsellor can also be a tremendous source of guidance and assistance in learning how to deal with our children differently, more effectively, with less emotional upheaval and uncertainty.

When and How Do We Start to Contribute to Our Children’s Resilience?

It is never too early or too late to take an active role in our children’s lives to significantly contribute to their development of emotional strength and resilience. There is no single best ‘window of opportunity’. There are countless opportunities at every point in a child’s life for parents to provide important messages about their lovability, their worth and value, their capability and their importance.

Of course, it is important that these messages are conveyed as part of the larger context of parenting. As parents, we must also provide the necessary guidance, instruction and modelling (what we ourselves do) for our children to learn the difference between right and wrong, to understand what constitutes good behavior and bad behaviour, and to learn how to mix the child’s own individual needs and wishes with those of a larger social group, such as a family, a class, or a network of friends.

No doubt, parenting is a big job. And as I mentioned earlier, it is OK if we take some time to figure it all out. Over the next few pages, I would like to offer some ideas about how we, as parents, can help to make our children emotionally resilient. I am dividing

this information into sections, focusing on different ages and stages of children’s development. Feel free to read from the beginning right on through, or if you prefer, flip ahead to the section that addresses the age of your own child, or a child that you know.

Please note that the age ranges I provide are approximations, and I am fully aware that each child is unique and develops at his or her own pace. In fact, what we often notice is that even within a single child, there can be substantially different rates of development of various aspects of that child. That is to say, a child’s physical development might move along at a considerably different pace than his or her social, emotional or intellectual development.

Parenting our Newborn Children From Birth to 18-24 Months Our babies are born, and from that first moment of life outside the womb, the very first step has been taken toward the development of a unique, separate human being, with all of his or her unique attributes, needs, wishes, interests, ideas, capabilities, and experiences. Of course, this is a process that takes many years, and all along the way, we parents have endless opportunities to participate in this quite amazing process. What a gift it is to be a parent!

In truth, we may not feel that it is such a wonderful gift at every single moment! Our new babies have many needs, and in these early months, it is our job to meet these needs as well as we can. Our new babies need to be held, fed, bathed, and changed, at very frequent intervals it seems, and just as often in the middle of the night as in the middle of the day!

In addition to our babies’ needs to be physically cared for, our babies need to be loved and cherished. To love and to cherish is to value, respect, nurture and support unconditionally the healthy growth and development of our children. This is the very cornerstone of the relationship between parents and children, and it’s something that we build on throughout our lives together.

In the first few months, our babies have no ability to discriminate needs from wishes.

That is, they simply experience a state of needing some kind of care and comfort, and they literally cry out for it. Some babies are louder than others, some are more persistent

than others, but they all try in some way to bring a caring adult into their company to make them feel better.

Some babies sleep a lot, some sleep very little. Some babies need lots and lots of physical contact, others need less. Many babies need feeding very often in the first few months as their stomachs are so tiny that they can only manage very small quantities of food at each feeding time. Some babies need lots of stimulation in the form of people and things to hear, see, and touch, while others need less.

Our task as parents, even in these very early months, is to begin to learn about the unique needs of our baby. Who is this tiny little creature, and what makes him or her special and unique? As we begin the task of parenting our babies, we become students of our children’s development. In our efforts to learn about our children, we convey a fundamental respect for them as little human beings in their own right, with a developing set of their own likes and dislikes that are not necessarily the same as ours. The older our children get, the more aware we will become of the dissimilarities between some of their interests and preferences, and our own (just ask any parent of an adolescent!).

Over the longer term, the better we come to know and understand the individual uniqueness of each of our children, the better are our chances of supporting and encouraging them to be all of what they might be, and to feel happy and satisfied with most of the choices they make throughout their lives. Perhaps this is the greatest gift of all that we as parents can give to our children.

For many of us, it is quite easy to recount at some later point in time certain unique characteristics or behaviours that we noticed in our child almost from the day he or she was born. Different levels of activity in responding to the environment can be seen right from birth: some babies are more content to quietly watch the world go by around them, while others are constantly trying to actively engage with the world from very early on.

Also in these early days, we see different levels of reactivity to change: some babies constantly seek out new sights, sound and touch, while others react with varying degrees of distress at even the smallest of changes.

Somewhere in the first 4-6 months, and every baby is different in some way, together, we and our babies discover that we establish some kind of pattern or routine to their sleep, eat, and play schedules. While trying to meet the many needs of our new babies, even from the beginning, we have to find a way to fit their needs in with some of our own. We

too must eat, sleep (do brand new parents ever get enough sleep?), work, take care of our homes and other children, and play (or relax!), although in the very earliest months it can seem quite a challenge, if not impossible, to fit everything in.

Usually by around 6 months of age, things settle down somewhat, but our babies continue to be completely dependent on us to provide for all aspects of their physical and emotional care. Our babies grow increasingly interactive with us and the world around them. They still do not have any understanding of the difference between a ‘need’ and a ‘want’ -- everything is still experienced as a ‘need’ – although clearly we can see them learning and responding to different behaviours of ours.

We also come to learn what our babies like and don’t like, and ideally, we are able to play with them and tend to their needs in ways that mostly bring them comfort and enjoyment. Again, we see individual differences very early: some babies like to sleep on their sides, some on their stomachs; some babies like to be carried facing into our shoulders, others prefer to be held more in a rocking position; some like the motions of a baby swing, others prefer more stationary positions; and I could go on and on.

Throughout the first year, we learn vast amounts about who our children are. In recognizing and respecting the uniqueness of each of our children, and responding to this as best we can, we convey to our children that they are important and valued little people. By taking pleasure in each of their accomplishments along the way, we convey to them that they are capable. By doing our best to respond to their physical and emotional states and needs, we provide them with a sense of security and certainty about their lovability and their importance in our lives.

In the latter part of the first year and throughout the second year of their lives, we watch with amazement, the incredibly fast pace of development as our children become more and more mobile, and more and more vocal. Now, we must be ever watchful to ensure that they can explore the world safely. We establish rules and boundaries about where they may safely go, and what they may safely do. We also begin to teach our children the meaning of yes and no. As developing little people, they don’t just automatically know what is OK and what is not OK. Throughout the years of our parenting, we are both students and teachers of our children’s development. In these early years, our children rely on us completely to provide them with a sense of physical and emotional safety. While we encourage our

children to explore and experience their world, and express their own emerging thoughts and feelings about it, we must also provide them with limits that ensure that they are not overwhelmed by physical dangers or excessive emotional intensity.

We have all seen two year olds completely ‘beside themselves’ in a fit of rage or apparent ‘desperation’. It is, at times, not possible for little children to manage the intensity of their feelings. If they are tired, and/or hungry, it becomes an even more impossible task!

At these moments, children must depend on their parents or caregivers to provide them with comfort and soothing and emotional control.

Quiet words, a gentle touch, reassurance that the adult will take care of things: all of these will help to settle an upset child. Sometimes simply removing a child from a difficult situation is enough to calm things down. Sometimes it is helpful to give a child a little quiet time to him or herself. Again, as students of our own children’s development, we can learn through experience what works best for which of our children, as each is different from the other.

It is important to understand that little children are not trying to be emotionally out of control. They truly cannot help it. Managing emotional reactions is something that we all learn throughout the course of growing up. We have to allow our little children time and experience to learn about their own feelings and reactions. If we react with emotional intensity (angry, impatient or critical), it is like throwing a lit match into the gasoline!

The situation becomes far more difficult to settle down, and children perceive that there is something fundamentally wrong about them that has triggered such an intense reaction in their parent.

As we teach our children about the world of feelings, and how to experience and express them safely, it is also essentially important that we provide validation and confirmation of the feelings that they do have. Learning to recognize and trust our own feelings has its very roots in these early childhood experiences with our parents. If we can come to recognize and trust our own feelings, we can listen to them and use them as guideposts in making important decisions that shape our lives as we grow up.

Parenting our Pre-School Children Ages 2-4 Years Up until this time, we the parents and caregivers have played the most central role in the lives of our children. Our children have been completely dependent on us for virtually all

of their care. Most of their experience of the world and of themselves has centered around their experiences and interactions with us.

During these pre-school years, children often become more involved with other children as they join nursery schools, play-groups, and various other pre-school programs. The world of the small child expands dramatically, and we see leaps and bounds being made in social development. Again, social skills, how to get along with others in cooperative and mutually satisfying ways, are skills that are learned. As parents, we also are teachers of social skills, although the job is shared by others as well, if our children spend time with other groups of children.

These are very important years for the continuing development of a sense of oneself as a lovable, important, valued and capable little person. Young children are trying out new activities and skills at a tremendous rate. As any parent will agree, these are the years for an ever expanding array of creative productions: arts and crafts of all sorts and sizes, creations in the sand and in the water, and with any kitchen ingredients that children can get their hands on!

Children are growing increasingly physically competent, and they take great delight in walking, running, jumping, and in any other ways, moving through space, exploring their world and their expanding capabilities. It is usually a time of high energy and unbridled enthusiasm. As parents, we can often only marvel at what seems to be a never-ending source of creative and active energy. If only we could recapture a small portion of that in our later years!!

During this period, children have a tremendous need to have their new skills and accomplishments recognized and applauded by the people around them, especially by those people who are most important in their lives. Thus, we hear the endless refrains of ‘watch this’, ‘watch me jump’, ‘look at my picture’, ‘do you like my sand castle?’, ‘do you want a mudpie?’ And I rather expect that you could add at least another 1000 examples from your own experiences with your preschool child!

Yes, this is attention getting behaviour, of the very best kind! During these years, children are more actively experiencing themselves as growing, creating, producing, performing, interacting, physically adventuresome little people. And while they are trying out all of these new things, they are looking to the significant adults in their lives to celebrate their growth and development with them.

It is the positive, affirming responses that we offer back to our children during these years that form the very solid foundation for their belief in themselves as valued, capable, and important people. We take note of the things they do and the accomplishments they experience, and in so doing, convey that they matter to us. We congratulate them on their efforts and on their many newly acquired abilities, and in doing this, convey that they are absolutely capable of trying and learning new things.

The more of this positive affirmation that we can provide during these early years of our children’s lives, the better we help to prepare them for what lies ahead. If they feel sure and confident about their abilities to try and learn new things in these early years when most children have an abundance of energy and desire to learn, we help them to believe that it is OK throughout their lives to try new things.

At the same time that we try to provide a fairly steady level of positive affirmation, we must also be attentive to our role as teachers of ‘good and bad’, and ‘right and wrong’.

All children need the structure and guidance of their parents’, teachers’, and caregivers’ authority to teach socially and personally appropriate behavior. Fair limits need to be set, and appropriate consequences need to be assigned when children’s behavior goes beyond those limits.

It is absolutely reassuring to children to know that limits exist, and that the adults are able to keep things from getting out of control. These are essential lessons in learning to grow up in a world full of people, where respect for the needs and wishes of others must be learned along with the confirmation, recognition and understanding of one’s own needs and wishes.

Small children are generally like little sponges when it comes to learning new things, but it is reasonable to expect that they will need many repetitions of an experience before they get it just right. This applies both to new skills and accomplishments, and also to learning about rules and consequences. Remember, we have lots of time to teach and learn from our children, and it is OK to go slowly. If they don’t learn a particular skill or lesson the first or second time around, trust me, you will get many, many more opportunities to help them try it again.

Little children are not little adults. They can’t and they don’t think like us; they haven’t had years of experience yet, like us; they don’t have adult capacities to figure things out.

It is very important that we not place adult expectations on them to know and understand

as we do. When expectations are too high, children can only experience repeated feelings of failure and disappointment.

Parenting our School-Aged Children Ages 5-12 Years During these ‘middle’ years, we continue to watch our children’s interests, activities, and abilities grow and expand. Their social world plays a larger and larger role in their lives, and their immediate needs of us slowly, gradually begin to diminish. Many parents speak of large portions of these years to be the ‘chauffeur’ years. Our children become more and more involved in the outside world, and a big part of our parenting is to get them to where they need to go!

Our children are still trying new things, and continue to need our support, encouragement and positive affirmation of the efforts they make. But the requests for such affirmation don’t usually come as fast and furiously!

As our children’s abilities to understand expand dramatically, they begin to try to make sense out of many of the experiences they have, and of the things they observe around them. Our conversations with our children take on a different tone as we try to answer their questions, and help them struggle to grasp some of the more difficult things in life that they become aware of during these years.

Sometime during this period of development, our children figure out that we are not perfect, that we do not know everything, and that there are some questions for which we cannot provide the perfect answers. It is often a time in our relationships with our children that we begin to be a little more aware of who we are as individuals in these relationships. We are not just moms and dads, but also individual human beings with our own needs, wishes, interests, thoughts, ideas and personalities.

Our children become more aware of our imperfections, and if we have given them permission to speak their minds, they will begin to reflect back to us certain truths about ourselves. This can be quite exciting if we are open to learning more about ourselves as well as our children, or it can be quite unnerving! Or, it can be some of both!

If we, as parents, can acknowledge some of our own imperfections and essential humanity to our children, and take responsibility for our own parts in both the things that

go well, and also in the conflicts that we will inevitably have from time to time, we can teach our children through direct experience that both persons in any relationship play an ongoing role in how the relationship develops.

Learning to take responsibility for our own behavior (the great stuff, the good stuff, and the not-so-good stuff) helps to teach our children not to automatically blame others when things do not go well. In these middle years, friendships form, and shift, and reform again. Some children are fortunate enough to have one or two steadfast and reliable friends with whom they learn many of the ups and downs of interpersonal relationships during these middle years of childhood. Where possible, we as parents can help to support and encourage our children’s friendships with others by assisting in setting up ‘play dates’, so that children have opportunities for one-on-one play times in addition to the larger group play experiences that occur in the classroom and out on the playground.

Again, these are important years for learning how to work things out in personal friendships. If we are willing to be available, our children will look to us for guidance, support, understanding and encouragement. Remember, it does take time, and our children are generally ready and willing to learn! We have had more experience than they have so far, and sometimes we do have some useful words of wisdom. Sometimes, our children just need someone to listen patiently, and provide them with a safe place to talk through some important experiences in their lives.

By taking the time to talk and listen, we continue to convey to our children that they are important in our lives. Listening, without judging, to their various thoughts and feelings acknowledges that they too have something of value to contribute to our conversations and in a greater sense, to our lives. Supporting them in their various endeavours, whether academic, musical, sports-related, or creative, is a continued confirmation of our belief in their capabilities.

Encouraging our children to find and pursue interests and desires that are uniquely theirs is another important task of parents during these years. Sometimes, it can be a little tough to separate out what we wish for our children, and what truly reflects our children’s own best choices for themselves. It is OK if this is something of a process by trial and error that takes place over a number of years. Trust me, if your child hasn’t found his or her ‘best thing’ by the time they are 6 years old, all is not lost.

These days, we have access to so many activities for our children that we can feel

overwhelmed both by the sheer extent of the choices available, and the idea that our children need to be exposed to everything before they reach the age of 10. During the school year, 2 or 3 extra actives outside of school are certainly enough for the vast majority of children. Some children are quite content with 1 or 2.

If you can determine what is the best fit for your own child, in terms of variety and intensity of extracurricular activities, then these activities will provide enrichment and pleasure for everyone. If you mistakenly choose too many or too few, too challenging or not challenging enough, there will be resistance and perhaps even conflict around your child’s continued participation. Again, if we get it wrong at one point in time, we can simply adjust accordingly for the next ‘sign-up’ period.

Children do not have to proceed through all the levels of all the activities that they try, but when they do find something that brings them a sense of joy, satisfaction, and accomplishment most of the time, then it is wise to encourage them to pursue this to the best of their ability.

It feels good for children to find something that they enjoy and at which they experience some success. These experiences provide opportunities for children to discover and subsequently believe in their ability to try and learn new things. This provides a basis of self-confidence that carries children comfortably into new experiences throughout their growing up. Of course as adults, we know that life brings a never-ending stream of new experiences: some exciting, some frightening, and some unfortunately traumatic.

Parenting our Teenaged Children Our children enter adolescence, and a new adventure of parenting begins! During these next few years, our children are making their passage from the world of childhood into that of adulthood. It’s a time that can be full of energy, optimism, and the belief in limitless possibilities. It can also be a time of struggle, uncertainty, and considerable conflict. This can be conflict between parents and their adolescent children, or conflict within the adolescent themselves, as they begin to grapple with some of the larger issues in the world.

Over the course of their adolescence, the child’s world expands enormously, and in these days of massive access to information, and the amazing speed of transfer of information,

adolescents are becoming greatly aware of the world around them, including much that is fascinating and beautiful, and much that is quite terrible.

These are the years for young people to strive for increasingly greater amounts of independence and responsibility, and individual decision-making. Many adolescents look more to their peer group than their parents for some of their discussions and decisionmaking, as they understandably experience their peers to be more similar to them. These are also important years for adolescents to begin to explore the possibility of more intimate relationships. The emergence of strong sexual feelings presents a whole new world to discover and explore and make some important decisions about, and for parents to lose sleep over!

For parents, one of the toughest parts of adolescence is to watch our children make ‘mistakes’, particularly when we are certain that we could protect them from experiencing the unpleasant consequences of such mistakes. Yet, even as younger children learn from trying, sometimes failing, and trying again, so too do adolescents.

The parent who can resist the temptation to say “I told you so” conveys to their teenaged child a basic trust that he or she is quite capable of learning well from their mistakes.

One of the biggest challenges of parenting adolescents is to find that ever-moving best balance between ‘letting go’ and ‘holding on’. Rules and consequences are in a semipermanent state of change, but it is important that parents continue to provide reasonable and fair guidelines that allow all members of a family to live within an atmosphere of trust and respect.

Adolescents continue to need the presence and security that their parents can best provide, but they also need many opportunities to try new things on their own, and then draw their own conclusions about their experiences. Certainly, it can be enormously helpful to begin to learn and interact with the larger world out there with the security of home and caring parents safely in the background.

If children have come to adolescence with a pretty solid foundation of belief in their own capabilities, belief in their fundamental value and importance in the world, and a reasonable ability to identify and trust their own thoughts and feelings, the passage through adolescence is going to be dramatically easier. Not that it will occur without incident, but it is far less likely that these adolescents will find themselves dramatically off the general course in life that they have chosen.

Keep talking with your adolescent children – not at them, but with them. Try to listen to what they have to tell you, and remember that they too are still trying to work out their way in a much more adult world.

What Can We Do to Help Our Children When They are Not Coping Well With Life?

Despite our best efforts to nurture and support our children’s emotional resilience, sometimes it does occur that our children struggle with something in their lives.

• We might see a change in their sleeping habits: they may have difficulty falling asleep, or wake up more frequently during the night looking for company and comfort, or wake up very early in the morning and be unable to fall back asleep.

• We might see a change in eating habits: a sudden increase or decrease in appetite, or a dramatic change in food preferences.

• Sometimes when our children are not coping well with something, we see a change in behavior: they might become more rebellious, seemingly rude and outspoken, or they might become increasingly withdrawn, quiet and generally less involved with the normal activities of their lives.

• Sometimes, when things are not going well, our children may appear to be more emotionally fragile. Tempers may flare, or tears may come more readily.

Sometimes, our children can simply tell us that something is bothering them: that they are feeling sad, or angry, or confused about something in their lives.

When we become aware that all is not well with our children, the best thing to do is to listen, as carefully as possible, to what they might try to tell us, without judgement or criticism. If we are able to understand the nature and extent of their concerns, we may be able to offer some gentle guidance, reassurance and support.

Has there been some significant event recently that they are trying to make sense of?

When major changes happen in children’s lives, children do need time to adjust. They need time to think about what’s happened, talk about it, and take some kind of action to help calm and soothe themselves in the face of the change.

Significant life events include: the serious illness or death of a family member or close family friend; serious marital conflict or other conflict within the family; separation or

divorce; moving to a new home in a new neighbourhood or city; and change in the economic stability of the family.

Sometimes the significant event is something that a child has only thought about, imagined, or misperceived or misinterpreted from something that has happened or something that they expect to happen. These ‘internal’ events can be much more difficult for parents to know about, but if we are patient, and give our children the opportunities to voice their thoughts, feelings, and ideas, these events may be brought to light.

Whatever has risen up to bring about any lasting distress in our children, we can best help our children by making the time available to listen carefully, to convey an acceptance of the range of thoughts and feelings they might express, and to participate with them in looking for ways to calm their upset feelings.

If signs of our children’s distress continue on over a period of weeks, and we are unable to determine the source of distress and/or the means to alleviate it, there is help available.

A call to your family physician can be the first step in making contact with a professionally trained counsellor, social worker, or psychologist who has experience with children and adolescents of various ages. You might also consider speaking to the principal of your child’s school, as many school boards now do provide some access to professional counselling services.

If your family physician is not able to make an appropriate referral for you, you can check in the local yellow pages for the phone numbers of the national, provincial or state referral services (for psychological services) in your region. Of course, if you have a friend who has had a good experience with a professional counsellor or therapist, you might consider discussing this with them.

We cannot expect ourselves to be able to provide for all of the physical health needs of our children, and sometimes we must seek out the assistance of appropriately trained medical personnel. Similarly, it can happen that we need professional assistance in tending to the psychological and emotional needs of our children. When help is needed, the earlier the better. Often the help that we do get in dealing with our children’s distress provides us with new opportunities to learn about ourselves, our children, and how we might all cope better when life brings us difficult and stressful experiences.

Summary Resilient children are children who believe in themselves as lovable, capable, valued and important people who can recognize and trust their own thoughts and feelings. They can: • forgive themselves when they make mistakes, • they won’t give up without making a decent try, • they can soothe themselves when they are upset, • they can ask for help when they need it, • they can take responsibility for their own parts in making relationships with others go well or not so well, and • they can mostly make good decisions for themselves, or live with the consequences of less-than-perfect decisions.

The more resilient that we can help our children to be, the more able they will be to get through the ups and downs and changes that life brings along.

Chapter 3 Developing a Happy Family: Dealing with Parent/Child Conflict Dr. Sandy Ages One of the classic images that comes to mind when one thinks about parent child conflict is the frazzled looking parent with the furrowed forehead that mutters to his/her child: “I have one nerve left, and you’re getting on it.”

Parent child conflict involves a struggle or opposition between a parent (s) and his/her offspring. The child wants his/her way and the parent is determined to have his/ her way.

Indeed it can involve a single isolated incident or a series of situations. Oftentimes, the parent believes that what ever he/she says to their child, the child will be in direct contrast. The power struggle can become exceedingly challenging especially when one has a child who is adolescent.

Case examples: The examples are fictitious due to client confidentiality.

Jonny (8 yrs.) often forgets to take his lunch to school. His mother is upset because the school will then call when she is at work and expect her to deliver his lunch. This is somewhat typical of Jonny who is forgetful of his things. This creates friction between Jonny and his mother.

Allison (14 yrs.) frequently goes to a friend’s house after school and neglects to tell her parents. In fact she usually comes home anytime between 8:00 to 11:00 in the evening and becomes upset when her parents question her. This is a constant source of conflict between Allison and her parents.

Kevin (16 yrs.) tells his parents that he does not have any homework. He spends his time watching TV or with his girlfriend. However his report card indicates that his work is either handed in late or often incomplete. He argues with his parents to stop pestering him about his schoolwork. This creates tension between Kevin and his parents. His Dad has been spending more time at work to avoid the conflict in the evening.

Daniel (6 yrs.) frequently gets into fights at home and at school. He has had several school detentions for his poor behaviour on the playground. His parents frequently argue with him about his behaviour. He goes to his room and slams the door.

Do you recognize any issues that may be similar to what you have to deal with at home?

Do you find that parenting is a power struggle with your child? There just is not the cooperation or the respect for your authority. You recall some familiar words that your parents spoke to you when you were growing up. The words of your parents’ haunt you: “Just wait until you have children of your own!”

Let us do a checklist on what is happening in your family.

Question Am I working longer hours to avoid being with my child?

Do I have more negative interactions with my child than positive interactions?

Is there more tension in the house because of the conflict with this child?

Do I take my frustrations out on other family members?

Answer Yes No Yes

No

Yes

No

Yes No

If you have answered yes to one or more of these questions, what can you do about it?

Are there some suggestions that you can follow to alleviate some of this conflict and tension?

For a start let us look at your parental style of discipline.

•

Parental Behavior demands obedience

Child’s Behavior/Feelings • power struggle with parent • rebels • lacks self-confidence

•

encourages choice

• •

overindulges child gives into demands

• • • • • •

knows when to say NO encourages mutual respect demands perfection criticizes child encourages child sets realistic standards

• cooperates • learns to problem solve • self-confident • child is selfish • child does not respect rights of others • respects the rights of others • frustrated/discouraged • •

attempts new experiences relaxed

Where do you fit in? Are you basically demanding of your child or do you encourage decision-making? Are you overindulgent with your child or are you able to say “No”?

Do you demand perfection of your child or do you set realistic standards?

Depending on your parental style and your own belief system, there are messages that your child learns from the interactions.

Parental Belief • parent is right • parent is in control • child can make decision and/or help in decision making • others are more important than me • I want my child to be happy • all individuals are important • my child needs to learn to handle disappointments

•

Message to Child winning is most important

• my feelings and thoughts count • expects to have his demands satisfied by others

•

everyone counts

• • • •

• Believes that he/she is not good enough • it is okay to make mistakes • we learn from our mistakes • mistakes are a challenge • learning is a positive experience What is your belief system and what is your child learning from you? How does this belief system influence your behaviour and interactions with your child? How does this belief system contribute to the parent child conflict?

I must be perfect I cannot make a mistake it is okay to make mistakes we learn from our mistakes

Positive parenting is best achieved in a family setting where love, caring and nurturing are the foundation of the home environment. Please complete the following checklist to assist you in reflecting on your positive parental behaviours.

Positive Parental Behaviour

I greet my child by name and with a smile.

I provide clear guidelines about basic routines.

I model the good manners I expect from my child.

I show respect to my child.

I actively listen to my child.

I believe that my child has potential.

Frequency of occurrence.

Check appropriate column. always / usually / seldom

I encourage my child to be responsible for his/her own belongings.

I help my child to celebrate his/her achievements and his/her victories.

I support my child in setting and achieving realistic personal goals.

I encourage my child to solve his/her own problems and I am willing to assist.

I encourage and support kindness and peacemaking.

I encourage cooperation with my child.

I spend more of my time on positive than on negative behaviours.

I make each day a fresh start for my child.

I have realistic standards and expectations for my child.

Congratulations to those who have checked the “always” column for some or all of the positive behaviours. Now, please look at the ratio of the number of ticks in the “seldom” column to the number of ticks in the “usually” column? Do you notice a pattern of your parental behaviour that may affect or influence the behaviour of your child? Can you set one or two behavioural goals for yourself that might enhance your parenting style and decrease the number of parent/child conflicts?

To determine what to focus on in your relationship with your child, examine the following two charts on: communication skills and problem solving strategies.

Communication Skills Active listening: paraphrase, clarify, feedback Assertive statements: say what you mean and mean what you say Take turns talking: not talking over each other or interrupting

Stay non-blaming Stay non-defensive Recognize the difference between a discussion and an argument Recognize the difference between an excuse and an explanation Choose words carefully: no put downs or sarcasm Listen for the emotion behind the content.

Be understanding: put yourself in your child’s place Control non-verbal behaviour: tone and volume of voice and body language

Active listening is a two way process. When one person is talking, the other person is actively listening. To listen actively, paraphrase, clarify and give positive feedback to your child. Paraphrasing means that you state in your own words what you think your child just said: “What I hear you saying is that ..........”

“If I understand you correctly ..........”

If you consistently paraphrase you will correct any misinterpretations immediately and help to keep track and to remember the important points of the communication.

After you paraphrase what you heard, you may learn that your interpretation of the communication was erroneous. With clarification you ask questions to clarify and to refine your comprehension of what your child said to you. The focus of clarification is to understand, to learn, to help. The intention is not to put down or to interrogate your child. Your tone of voice (pleasant vs. sarcastic) and the volume of your voice (moderate vs. loud) will also convey an important message to your child.

Assertive statements begin with the word “I”. The format is quite simple.

(1) I feel ....... ( state emotion ) (2) when you ...... ( state child’s behaviour ) (3) and I would like you to ....... ( state new behaviour ) With this direct kind of statement, your child knows: (1) how you feel ( positive or negative feeling ) (2) about his/ her specific behaviour ( acceptable or unacceptable ) (3) and what you would like him/her to do ( new behaviour ).

To assist in taking turns talking, try setting a timer for 5 or 10 minute intervals.

Oftentimes statements that begin with “you” can be accusatory or blaming. If you practice stating “I” statements as noted above, the conversation will take on a more positive tone.

Taking a break from a discussion is a good idea especially if the emotions are running high. If you are shouting at each other, the important message is completely lost.

Reschedule another talk and recognize that the emotions have taken over and the content of the message is being overshadowed by this heightened emotion.

You now have the tools to assist you in moving on to the next stage of addressing the conflict. Problem solving strategies between parent and child are important to develop. It teaches the child that the problem has ownership and the parent wants to jointly handle this issue with the child’s input. It is not a control issue of the parent versus the child.

The message to the child is that he/she can contribute to the solution of the problem.

Essentially the strategy is broken into two functional parts: talking time and action time.

Problem Solving Strategy - Talking Time What is the problem?

Who owns the problem?

How does the child feel?

What does the child think the parent feels?

How does the parent feel?

What does the parent think the child feels?

What does the child need?

What does the parent need?

Problem Solving Strategy : Action Time Brainstorm ideas: List all possible solutions without judging or criticizing them. Use a pencil and paper to complete the suggestions.

Test an idea by asking: What would happen if ........ ?

Choose the best idea.

Negotiate the next best solution.

An important issue to teach the child is that solutions to problems can be negotiable and that the parent and child can collaborate on finding the solution. This is an important point to stress particularly with adolescents.

When would it be advantageous to seek professional help?

Sometimes the conflict is such that the communication between the parent and child is so strained that the two parties cannot communicate and problem solve together. Seeking professional help from a counselor can be beneficial to bridge this gap. The important message to both the parent and the child is that we need to seek professional counseling to be able to improve our relationship. The parent does not focus on the child being the problem.

In the latter scenario the child will be a hostile non-participant in the counselling process.

There is no set rule when a parent should seek professional help from a counsellor. For some parents, when the conflict and stress becomes pervasive to their everyday encounters with their child then they seek professional counselling. An important point to remember is that it is never too early and it is never too late.

What to expect when you call the counsellor?

If I receive a phone call from a parent who wants to make an appointment for his/her child, I tell the parent that the child can choose to see me alone or with the parent; the choice is the child’s. Oftentimes the child feels more comfortable meeting alone because he/she has an opportunity to talk with me without the parent sitting in judgment. If the child wants to see me alone for several sessions to work on some of the conflict issues, that is acceptable to me. I inform the parent that he/she will be involved at a later date.

The therapeutic alliance between the counsellor and child is an important component of therapy. This also gives the child some sense of ownership of the problem and a chance to develop some strategies with the counselor on how to communicate with the parent.

There have been some cases that the child, particularly an adolescent has not wanted to

come to my office. I have worked with the parent alone in terms of his/her parenting and communication skills. With most cases, the adolescent has later decided on his/her own to come to my office. If the parent starts to make positive changes to his/her behaviour, the adolescent becomes interested in the process and wants to be involved. With reluctant adolescents, I find it effective for the adolescent to interview me on the telephone to decide if he/she wants to make an appointment.

The role of the counsellor in working in the area of parent/child conflict is not to be the decision-maker to settle the disputes. Refining parenting and communication skills is the focus of therapy. In fact, I like my clients to know that they will be learning techniques that will benefit them with peers and other adults.

How to access professional help?

Accessing professional assistance can be done through your employment assistance program, which will have a list of a number of counselors who work in the area of parent/child conflict. Your family physician will be able to recommend a counsellor. Also professional associations, such as the Psychological Association of your province or state can provide you with names of counsellors or therapists in your area

Chapter 4 Attention Deficit Disorder: Disease of the New Millennium Dr. Frances Smyth During the past two decades, parents and educators have been referring increasing numbers of children to mental health professionals for assessment and treatment of Attention Deficit /Hyperactivity Disorder as there has been a growing recognition that this disorder can, if untreated, lead to adjustment difficulties both at home and school.

What is an Attention Deficit/Hyperactivity Disorder? (Abbreviation commonly used is ADHD) Individuals suffering from ADHD tend to have difficulties with attention, hyperactivity and impulsivity. Problems with organization and memory are also common features of this disorder. It is important to recognize that we all experience difficulties in these areas at times but that those who have ADHD experience these problems more

frequently and more intensely than does the average person. It is also important to know that some people are hyperactive while others have the traits described but are not hyperactive. ADHD is a biologically based disorder, which is present throughout the individual's life. You cannot "catch" ADHD, you are born with it. The following description of "John" is typical of children who are diagnosed as suffering from an Attention Deficit /Hyperactivity Disorder.

Please note that we protect the confidentiality of our clients, so our case example is fictitious A psychologist working in his community saw John, aged nine, at the request of his parents. Although his parents had some concerns about his adjustment at home and in the community, it was his problems in the school setting, which had led them to seek professional assistance. While John's teachers had always commented that they felt he was of at least average ability, his teachers since Kindergarten had identified him as a problem child. He had been observed to be a restless child who had difficulty remaining seated during group activities. He also appeared to have a very short attention span and was easily distracted. As a result, he was inclined to begin playing with toys or looking out the window when his teachers were giving lessons. John learned to read and spell without much difficulty during his primary school years. However, his tendency to encounter difficulty focusing his attention and concentrating meant that his teachers found that he never completed written work unless he was constantly reminded to stay on task.

Since more written work was required as he grew older, John began to fall behind academically. His parents found that completion of homework was a daily struggle and the assignment of a project like a book report, to be completed at home, led to stress for the whole family. John's teachers and parents found that he had other problems, which also got in the way of his achieving academically. He was likely to forget relevant books and materials which were needed to complete work at home or at school. He also seemed to have difficulty organizing himself when a task required several steps or phases for proper completion.

While John's academic performance had been the primary reason for his parent's seeking help for John, they readily acknowledged that they became very frustrated with him at home. His parents needed to monitor him constantly during the mornings if there was to be any hope of his washing, dressing, eating breakfast and getting his lunch and school

books ready to leave the house in time for the school bus. Although John had friends, his parents noticed that he tended to get into conflicts with other children more frequently than had been the case for his older siblings. He frequently behaved in a manner that irritated his peers. (i.e. he had trouble waiting his turn, he tended to interrupt other people etc.) . He was also inclined to be moody and easily irritated.

Originally, Attention Deficit /Hyperactivity Disorder was viewed as a condition which children would "outgrow" as they reached adolescence. However, recent research has indicated that at least 50% of children diagnosed with this condition will continue to display these characteristics (and therefore to continue to have some adjustment problems) in their adult life. While it is very probable that the hyperactive behaviour seen in childhood will disappear, other problems will remain. Since the characteristics of individuals with ADHD lead to difficulties with academic and social adjustment, it is not surprising to find that individuals with ADHD tend to develop low self-esteem and other emotional difficulties. Therefore, diagnosis and treatment early in life are important to promote healthy development in children who suffer from this disorder. Although the prevention of difficulties through early diagnosis is not possible for adults who have never been identified as ADHD, they can be helped to achieve a better adjustment in the present through diagnosis and treatment. Better late than never! How does a person recognize that they or their child may have ADHD? The following list indicates factors that are associated with ADHD. • • • • • •

Relatives, parents, or siblings who have been diagnosed with ADHD Parents with depression, alcoholism or antisocial behaviour.

Low maternal education and financial status Single parent Pregnancy complications and problems at time of delivery Alcohol consumption during pregnancy

It is important to note that these factors are not causes of ADHD, but are more commonly found in the history of individuals diagnosed with ADHD. The next list describes the characteristics of ADHD and ways in which these characteristics are demonstrated in the behaviour of those with this condition.

Characteristic

Behavioural Symptoms

Problems Organizing and Activating to Work

Trouble Sustaining Attention and Concentration

Trouble Sustaining Energy and Effort

Problems Managing Emotions

• has difficulty “getting going” with work • children have difficulty starting homework • adults have trouble paying bills, writing reports • children and adults have trouble starting daily routines like going to school or work • is easily distracted from work related tasks by daydreaming or sounds in the environment • cannot read for long periods of time and remember what was read • must frequently reread material to understand and remember • has difficulty keeping up consistent energy and effort for work • often feel bored or sleepy • children are unlikely to complete written work in time allowed • teachers report children perform well in a subject one day but not the next • adults are late with reports or other written work • prone to chronic irritability and frustration • experience chronic discouragement and depression • are highly sensitive to criticism

Difficulties with Memory

• shows forgetfulness in daily routines • children forget gym clothes or homework • adults misplace important items like car keys • has trouble recalling material learned during examinations

Other Causes of Behaviours Suggestive of ADHD Although this chapter has emphasized the importance of early diagnosis and intervention to promote healthy development of people with ADHD, it is important to rule out other possible causes of the type of problems you or your child may be experiencing before initiating contact with a mental health professional. It is particularly important to remember that ADHD is a disorder that is present at birth and is not something that we "catch” or develop at some point in our lives. If you have never observed the problems described in yourself or your child until recently, but now find that many of these problems are present, it is very possible that ADHD is not the cause of these problems.

Symptoms looking like those found in individuals with ADHD can be the result of any of the following factors: • Difficulty with school assignments • Anxiety or depression • Use of some medications ( anti-convulsants and asthma medication ) • Lack of motivation to succeed in school Needless to say, anxiety and depression can be the result of different stressors in a child's life. For example, children whose parents are in the process of separation may be anxious and depressed and will therefore show symptoms like those of classmates diagnosed as ADHD. Similarly, adults may show symptoms of ADHD if they have certain medical conditions or if they have various psychiatric disorders. They too may show symptoms of ADHD as a result of stressful experiences. If you recognize that you or your child have not shown symptoms of ADHD until recently, and you are aware that one of the factors listed above may well account for the present symptoms, referral for assessment of these

problems as opposed to assessment of ADHD would be more appropriate. If the symptoms are likely to be a reaction to stressors in your life or your child's life referral to a professional is probably not necessary although there are steps you can take to help yourself or your child to cope with these symptoms. Even if you feel that the symptoms you or your child are experiencing are probably caused by ADHD, these steps will also prove helpful in coping dealing with the symptoms. These steps involve the three "Ss" .

Structure Structure refers to a set of external controls we put in place to compensate for the lack of internal controls. In other words, if we cannot easily organize ourselves, remember what we should be doing, and keep ourselves on task, we can set up structures to help us to do so. Lists, reminders, appointment books, filing systems are all methods of creating structure for us when we are not able to do it for ourselves.

Schedules Schedules are a method of creating structure for ourselves, which are worthy of special mention. In times of stress it is helpful to schedule regular appointments or activities at specific times during the week. Therefore, attendance at these appointments or performance of these necessary activities becomes automatic and are no longer things we struggle to remember to do or get frustrated with ourselves if we forget to do!

Support If we are inattentive and forgetful as a result of emotional stress, it is important to have the opportunity to express our feelings and get suggestions for coping with our problems.

At the present time there are many support groups available for children and adults who are coping with stressful life events such as divorce. It is important for adults to schedule time to talk about stressors and transitions with their children and to offer their children the chance to express feelings and problem solve

Seeking Professional Help If you recognize that you or your child has experienced the symptoms of ADHD since early in life, and you recognize that these symptoms are causing significant difficulties at home, and at school or in the work place, referral to a mental health professional is

certainly appropriate. Perhaps you wonder what to expect when you meet with a professional. To a certain extent, the assessment will differ depending on the professional you meet. Psychiatrists, clinical psychologists and social workers do assessment and treatment of ADHD. Each of these professionals will attempt to gain an understanding of the history of the problem and will likely have the child's parents and teachers complete standardized questionnaires. These questionnaires are designed to identify the presence of behaviours symptomatic of ADHD and also allow the professional to determine if the behaviours occur more frequently for this child than is normally the case for a child of their age and sex. A clinical psychologist will use the history and questionnaires to diagnose ADHD but will likely also perform tests of intellectual functioning and memory which will indicate if the child has more difficulty with attention, concentration, planning and memory than is normal for his or her age. The psychologist may also administer tests designed to assess emotional adjustment (i.e. tests assessing anxiety, depression etc.) to determine whether the child is experiencing ADHD like symptoms as a result of emotional problems. When adults are assessed, spouses or close friends who know the individual well complete questionnaires. If possible, the parents of adults may be asked to complete questionnaires concerning their recollection of their children's behaviour during childhood. Clinical psychologists will probably administer tests of intellectual functioning and memory and may also administer tests of emotional adjustment.

If a diagnosis of ADHD is made, a number of treatment strategies will be offered by the professional, based on the particular difficulties of the individual. As noted at the beginning of this chapter, some individuals receiving this diagnosis are primarily inattentive while others are primarily hyperactive and impulsive. Still others show significant problems with attention, hyperactivity and impulsiveness. Therefore, it is not surprising to find that individuals with ADHD may differ in terms of the problems that are most prominent in their adjustment. Medication, usually stimulant medication, is often recommended. Many factors need to be taken into account to determine if the prescription of medication is in the individual's best interest. Only a medical doctor is trained and legally permitted to prescribe and monitor medication. Therefore, social workers and clinical psychologists who diagnose ADHD refer children and adults to psychiatrists if they feel that medication may be useful to the individual. Parents are also taught to apply behaviour management programs designed by the professional to cope with the child's problems at home while teachers are helped to design programs to address the child's problems in the school setting. Children whose impulsive behaviours lead to conflicts with peers are often helped to achieve better interpersonal relationships through social skills training groups. Adults who are diagnosed as suffering from ADHD

can also benefit from the use of medication. Therapists can also teach the adult with ADHD time management and self-organizational skills. The teaching of anger management and communication skills may also be appropriate for some adults. Most large urban communities have support groups for parents and adults who suffer from ADHD (i.e. C.H.A.D.D. – a support group for parents, which can be easily accessed). It is important to recognize, however, that involvement in a support group cannot replace professional assessment and treatment.

How to Access Professional Help As explained in the previous section of this chapter, various professionals offer assessment and treatment for ADHD. You can obtain a referral to a health professional practicing in this field through your family doctor, your child's teacher, an Employee Assistance Counselor, or through your state or provincial professional associations for doctors, psychologists or social workers. However, it is important to be aware that in some states and provinces, only doctors and clinical psychologists are legally permitted to diagnose disorders such as ADHD. If an "official" diagnosis is required to access special services within the school system, assessment by a psychiatrist or clinical psychologist would ensure the most comprehensive treatment following assessment.

Similarly, services provided by different health professionals are not always reimbursed by insurance companies or may be reimbursed to varying degrees. As appropriate, indepth assessment and treatment of ADHD is a relatively time consuming process, the wise consumer will take the time to make sure that they will be able to obtain full, comprehensive service prior to taking this important step for themselves or their child.

Chapter 5 Helping Children Cope With Separation and Divorce Dr. Frances Smyth

As the twentieth century draws to a close, separation and divorce have become common events in the lives of modern families. When children are still dependent on their parents, the adults involved frequently approach mental health professionals, expressing concern

about the potential negative effects of this experience on their children. However, research has shown that not all children suffer long term problems in adjustment as a result of divorce, although many children experience adjustment difficulties initially. This chapter will describe the typical reactions to separation by children of various ages, and will offer advice on ways to minimize the negative impact of separation for children of differing age groups. This chapter will also educate the reader as to when parents should seek professional help for their children, will describe the types of services offered by mental health professionals and finally, will give information as to how parents can access these services.

Reactions to Divorce at Different Ages Infants and Toddlers (ages 0 to 3) The cognitive immaturity of infants and toddlers means children of this age are limited in their understanding of events in their world such as separation. Nevertheless, they are definitely affected by this event. At this stage of life, children need to maintain a strong bond with both parents but do not yet have a sense of time. Thus, they can be negatively affected by the longer separations from parents that usually follow when parents separate.

The following are typical symptoms of stress manifested by children of this age.

• Waking during the night, • Bedwetting, • Not eating, • Regression in development – loss of language skills, loss of toilet training • Temper tantrums, • Fearfulness and clinging ; and /or, • Withdrawal

Preschoolers (ages 3 to 5) Like their younger siblings, preschool children have a limited capacity to understand

separation and divorce. As children of this age tend to interpret events in a self-centred fashion, they are likely to feel that they have somehow caused the separation. As they are more capable than younger children of imagining the future, they are likely to express their difficulty in coping with periods of separation from parents by developing troubling fantasies of abandonment and loss of parents. Stress in children of this age is likely to be expressed in the following symptoms • Problems with sleep -i.e. difficulties in going to bed, bedwetting, recurrent bad dreams, • Problems with eating- i.e. eating more or less than usual, refusing foods eaten before, • Lack of interest in activities usually enjoyed • Regression in development in language and emotional independence ; and/or • Withdrawal from peers Early Elementary School Aged Children (ages 6-8) Children in this age group are more capable of understanding separation and its implications for future family life than younger siblings, yet are still highly dependent on their parents. Thus, children in the early elementary school years, more than any other age group, are likely to experience a strong sense of loss and sadness when parents separate. Their increased intellectual abilities means that they are likely to experience more anxious thoughts and fantasies about the future than do younger children. They are concerned about the future of their relationships with each parent and are able to anticipate that they may need to cope with new relationships as a result of the divorce (step-parents, step-siblings) They are concerned about the stability of their lives (concerns re moving, attending new schools etc.). Children of this age group show their distress in the following ways.

• Denial – a refusal to admit to themselves or others that anything is wrong, • Aggression towards siblings or peers, • Physical complaints (i.e. headaches or stomachaches) • Nervous habits such as biting nails

Older Elementary School Aged Children (ages 9-12) The older elementary school child's reaction to separation is in many ways similar to that of children during the early elementary school years. However, children of this age tend to use more defenses to cope with their feelings. Aggression, particularly towards people

other than parents is a primary reaction to separation among children of this age group.

Nine to twelve year olds are particularly inclined to experience loyalty conflicts. As children of this age are more competent and independent, parents may begin to rely on their children’s help with their problems. Children of this age are likely to display these conflicts in the following ways: • If parents have new partners, they may feel that they are being disloyal to the other parent if they allow themselves to like the new partner.

• Children of this age are more inclined to develop alliances with one parent.

• If parents begin to rely excessively on their children for help with their own problems, children may withdraw from involvement with friends and community activities, which is normal and necessary for healthy development at this stage in their lives

Adolescents The increased independence and sophisticated thinking of adolescents enables them to be more aware of tension between parents prior to separation. Nevertheless, most do not expect that their parents will actually separate. As a result, they frequently express shock and disillusionment with their parents when separation occurs. Like the elementary school child, they are inclined to express anger at the effects of separation on the family.

However, their anger is expressed in a greater variety of ways than is the case for younger children. In addition to aggression towards siblings and peers adolescents may express anger with the following behaviours.

• Destruction of property, • Drug and alcohol abuse, • Poor grades, • Truancy, • Stealing, • Poor health care i.e. poor eating habits and lack of sleep) Unfortunately, adolescents may not be aware that anger is motivating these selfdestructive behaviours. Like the older elementary school age child, the adolescent may experience loyalty conflicts and a tendency to become overly involved with the concerns of the parent with whom they live. The sexual maturation of adolescents makes it particularly difficult to cope with stepparents, as they are aware of, and uncomfortable with the sexuality in the relationship. The strong drive towards independence that is

normal in adolescence makes it particularly difficult for the adolescent to avoid compromising his or her own development if they become overly involved in helping the custodial parent.

Ways to Help Children Cope With Separation and Divorce As indicated previously in this chapter, children are likely to experience stress during the process of separation regardless of their age at the time of separation. It should be clear that the nature of the stress and the child's ways of expressing distress differ to some extent according to the child's age. Therefore, the caring parent needs to take this into account in helping their child to adjust to the separation. Although children will likely show signs of stress during the divorce process, long-term research has indicated that it would be overly pessimistic to conclude that separation means that your children will definitely have long term adjustment problems. The following section of this chapter offers advice as to how parents can promote healthy adjustment in children who are at different stages of development when parents separate.

The Infant or Toddler (ages 0 to 3) The previous section of this chapter describing the reactions of infants and toddlers to parental separation suggested that the very young child's limited sense of time make lengthy separations from parents difficult. The following arrangements have been found to be helpful in facilitating a close bond with both parents: • Try to arrange contact with your child so that neither parent is out of contact with the child for long periods. Time spent daily with each parent is optimal but may not be possible. However, it is important to bear in mind that your young child will benefit much more from several short, predictable contacts each week than from long visits which are a week or weeks apart (i.e. the common arrangement of non-custodial parents seeing children for the entire weekend every other weekend.). • If face to face contact is not possible, a short phone call to a toddler can be helpful.

•

Pictures of parents are also useful in reinforcing bonds with parents.

The Preschool Child (ages 3 to 5 ) Since the preschool child has trouble understanding separation, may be inclined to feel that they have caused the separation, and are likely to become preoccupied with concerns about abandonment and loss, communication with children becomes important at this stage. Effective communication with children of this age includes: • A brief, clear explanation of what is happening at the time that parents separate. Children should be told that the family will not be living together but that they will still be seeing each parent. Visiting arrangements should be clarified as soon as possible for the child so that they can feel a sense of predictability and security in their relationships with their parents • Children need to be told very clearly that they are not responsible for the separation and that there is nothing they can do to change the family situation • Children need to be given the opportunity to discuss their concerns about their future relationships with parents. They may need repeated reassurances that they will still be seeing non-custodial parents on a regular basis

The Early Elementary School Aged Child (6 to 8) The previous section of this chapter identified the early elementary school aged child as experiencing a greater sense of loss and more anxiety about the future than other age groups. Thus, communication regarding the future is extremely important in reducing the feelings of sadness and anxiety of children of this age. Children can benefit from information from parents and from other sources (i.e. friends whose parents have separated and from books addressing experiences common to children of divorcing parents). Information involving the following areas can be helpful in relieving stress: • Children of this age need detailed information as to how the separation will affect their relationship with their parents and siblings. They need to know about visiting arrangements – not only when and where they are visiting but also whether their siblings will also visit and if others will be present (i.e. new partners and their children). They also need to know if the schedule of one or both of the parents will be changing in a manner, which will affect their relationship with the

child. A return to the work force or increased work hours is the most common example of factors leading to changed schedules.

• Relationships with extended family members need to be discussed. Children need to know if these relationships will continue regardless of the separation.

Hopefully, parents will attempt to maintain civil relationships with former in-laws so that children do not experience the additional loss of relationships with grandparents, aunts, and uncles etc.

• Information regarding changes in the environment which are likely to occur such as moves to new neighbourhoods and schools should be communicated, preferably in advance, so that the child has the opportunity to prepare for these changes.

The Older Elementary School Aged Child (9 to 12): Since children of this age are inclined to develop loyalty conflicts and are also inclined to become overly involved with helping parents, the parents' manner of relating to one another and to the child becomes extremely important in helping the child to avoid these reactions to the separation. Parents are advised to keep the following ideas in mind in their dealings with one another and with their child at this age: • While obvious hostility and conflict between parents are always detrimental to children of separated parents, children of this age can be particularly damaged by parental discord. Conflict between parents facilitates the tendency of children this age to resolve their loyalty conflicts by developing an alliance with one parent.

• Parents should strive to avoid leaning on their children for emotional support and/or extensive help with household tasks as children of this age are at risk of becoming "little adults”. Parents who lack nearby relatives or friends with whom they can discuss their problems in coping with the separation should recognize that support groups for separated parents are available in most communities.

• Children should be supported in their involvement with sports and extracurricular activities in the community. Parents who provide this support are encouraging normal development and giving their child a clear message that they are not responsible for their parents' happiness and well being.

The Adolescent: In many ways, the older elementary school aged child and the adolescent react similarly to parental separation and divorce (loyalty conflicts, over involvement with helping a custodial parent). However, the greater maturity of adolescents leads to additional difficulties. As noted previously in this chapter, adolescents have difficulty in coping with the sexual aspect of their parents' new relationships. The following points should be kept in mind in helping adolescents to cope with their parents divorce: • Gradual introduction to new partners and limited expectations regarding intimacy in the relationships between adolescents and their parent's new partners will make it easier for the adolescent to accept the new relationship. • Awareness of and sensitivity to the adolescents discomfort with adult sexuality will also facilitate the adolescent's acceptance of new relationships.

Adolescents need to be discouraged from assuming an adult role. This can be achieved in several ways. Parents should avoid involving the adolescent in their own emotional difficulties and problems in running the household and should encourage the adolescent to maintain friendships and involvement in community activities. Another way to help the adolescent to see that they are not expected to assume an adult role is for parents to set expectations and rules that are normal for individuals of this age category (i.e. curfews etc.)

Seeking Professional Help Mental health professionals can be helpful to families experiencing separation and divorce in different ways. If your child has not been showing symptoms of distress at the point of parental separation, but you anticipate that your child will be undergoing significant, stressful changes, you may wish to take advantage of mental health services which are preventative in nature. Preventative intervention is usually offered through time-limited group experiences. The prevalence of separation in recent years has led to the development of group programs for children of different age groups. These programs are educative and supportive in nature. Generally, each meeting involves discussion of

one of the issues confronting children whose parents separate (i.e. coping with parental conflict, dealing with visits to non-custodial parents, meeting step-parents etc.). The group format is useful in helping children to recognize that other children have faced the same difficulties and have learned to manage these problems. Consultation is often offered in-group sessions to the parents of children involved in these groups. If, however, your child or adolescent is experiencing significant problems, as indicated by concerns about their ability to function academically or socially in school, or severe conflicts with family members, involvement with a mental health professional on an individual basis is indicated.

What to Expect When You Meet with the Therapist/Counsellor Psychiatrists, psychologists and social workers specializing in work with children all provide services to children whose parents are separating. Usually, the therapist will want to meet with the child and family initially to develop an understanding of the circumstances leading to the separation and the stressors that are confronting the particular child or adolescent. Therapists generally recognize that meeting with the exspouse may be too difficult for the parent and will therefore meet separately with each parent. The therapist will probably interview the child separately in assessing their difficulties as children often feel inhibited in expressing their feelings if they feel that open expression of their emotions may be hurtful to other family members. Psychologists may use personality testing to better understand the feelings of children who are reluctant or unable to express themselves. All mental health professionals may observe the play of younger children to better understand their feelings and reactions. If the therapist feels that individual therapy would be useful to the child, it may be offered using a variety of techniques from discussion (most likely with adolescents) to structured pencil and paper activities designed to elicit feelings and conflicts in elementary school aged children to play therapy with preschool and early elementary school aged children. The therapist will likely wish to consult with both parents periodically to advise them of changes they can make to facilitate a better adjustment in their child or adolescent.

How to Access Professional Help The groups, which offer preventative intervention, are found in community mental health

centres and other social agencies. In some instances they are offered through the psychology or social work departments of school boards and are held in schools.

Individual help can be accessed through community mental health centres, children's outpatient clinics in hospitals and through state or provincial professional associations, which provide referrals to private practitioners in psychiatry, psychology or social work.

If you have an employee assistance program in your work place, you may be able to obtain an appropriate referral through an EAP counsellor. In some instances, a referral from your family doctor may be necessary to be seen in a hospital setting, or by a psychiatrist. You can request services yourself from a psychologist or social worker in private practice. Payment is required when psychologists or social workers are seen in private practice settings. However, some health insurance plans offer reimbursement for some of the costs of this service.

Chapter 6 Helping Children Adjust: Custody and Access Issues When Parents Separate or Divorce Dr. Alex S. Weinberger When families break-up parents are rightfully concerned about the welfare of the children and the continuity of the parent-child relationship. Parents may choose not to live together, and to no longer love each other, but their differences reside with their partner, or former partner, not their children. The ties that bind parent to child, and child to parent, remain, and need to be nurtured, probably even more so when parents separate or divorce.

Common questions that arise are, with which parent should the children live, when, and for how long, and which parent is to make decisions related to the child’s education, health and welfare, and religious upbringing, and the like. These questions are known as custody and access issues, and they are very important, because the quality of a child’s relationship with the parents as well as their influence on a child’s life and activities are at stake.

Not uncommonly, parents who separate or divorce are in conflict and have experienced a breakdown in communication. Not surprisingly then, they often cannot come to an agreement between themselves on the tender matter of the custody and access of their

children. In these instances, parents may consult lawyers to help them negotiate a formal and legally binding agreement with regard to custody and access matters. In some instances, when a mediated settlement becomes impossible, the court will need to be involved so that a judge can make the decision. As well, by either parents themselves, or through their lawyers, or as a result of a court order, a psychologist may be called to conduct a comprehensive custody and access assessment. In this assessment the assessor gathers a host of information, from parents and the children as well as other professionals such as teachers and doctors who have dealt with the family. Interviews, testing, and observation of the parents and their children, are some of the methods employed to collect the information from which recommendations are then developed. These recommendations are intended to help break the log-jam between the parents by considering first and foremost what is in the best interest of the children, while at the same time being sensitive to the rights and wishes of the parents and what strengths and love they bring to their parenting.

SENSITIVE ISSUES AND WHAT TO DO However decisions are made about custody and access, parents can expect to deal with a number of delicate issues. Children are often emotionally attached to both parents and, sensing that the parents are not getting along, a child often feels a pressure to take sides and can become anxious and ill-at-ease as a result. This pressure, whether intended or not, is due to the child feeling that loyalty to both parents may be impossible. Indeed, the child may feel that showing any preferential treatment to one parent in the form of affection, closeness, or respect, may alienate the other parent. The child may therefore be unnaturally on guard and defensive when in the company of both parents or when speaking about one parent in front of the other. In these instances, parents will need to let the child know that it is possible, and entirely permissible, for the child to have fond feelings for both and that the parents are not in competition and will not think or feel less of the child for having both parents in his or her life. Just like the parents each wish to share in being with and raising the child so too the child can share himself or herself with each parent.

Children often do not understand, and can not know, all the reasons why parents decide to live apart. As such, they are often confused. In trying to make sense of a troubling situation children may be unable to see beyond themselves, and because of a desire to protect and preserve the relationship with parents may be reluctant to find fault in them.

In consequence, children may wind up blaming themselves for the parents problems and separation.

Anger, resentment, irritability, depression, guilt, and loss of desire to do well in school, may be some of the symptoms of such an upsetness with oneself. Parents need to be aware of this possibility and explain to the child that they, as adults, are responsible for the decision to live apart, just as they were responsible for getting together in the first

place.

Children, however easy or difficult their behaviour may have been all along, need to know that they are not the cause, they are not at fault, and they should not assume otherwise. Parents need not, and should not, expose the child to the dirty laundry behind the family break-up. They should, however, convey only what needs saying and in a manner that the child can understand considering the child’s age and maturity level.

Younger children will need less explaining; older children generally need more, and may have specific and probing questions. Obviously, good judgment must prevail in addressing both what needs to be said and in what manner and tone, so that children are not set against either parent.

Stability and continuity are comforting for most individuals, because of the sense of security that comes from being around what is familiar, from having one’s routines, and in being where one has set roots. This is more pronounced when it comes to children.

Therefore, when parents live apart, there is great value in doing what one can to minimize the disruptions that can ensue and affect children. Younger children are often more adaptable and after a period of adjustment they can more readily bounce back. Older children however are often more self-conscious, and because of their strong need to be socially involved and accepted within their peer group they often find the loss of old friends and a need to get into a ‘new crowd’ more troubling. Children’s lives can be dramatically affected through a change in where one lives, a change of schools, a downgrade change in lifestyle because of economic pressures, not being able to continue with one’s sports team or dance group or cherished piano teacher, and not having both mother and father together, or always together, for major family celebrations and events.

These are some examples of how children’s lives can be affected, with old bridges cast aside and new ones to be built. Such change may not be easy, and children can rebel against parents for having put them through such misery. Parents will therefore need to prepare for custody and access agreements that can either protect as much of what stability has been in place for the children, or that will foster a re-stabilization as soon and as positive as possible.

Few people’s lives go completely according to plan. Flexibility and adaptability are often essential to making things work. Similarly, custody and access agreements where it is clearly stipulated who has the children and when and between what times, and when pick-up and drop-off is to occur, may not always anticipate unexpected developments or new requirements that need special consideration. For example, one parent may have the children say every second weekend between Friday at 5:00 p.m. to Sunday at 5:00 p.m., and it comes to pass that the other set of grandparents who are rarely seen and live far from town can only come a particular weekend when access is with the other parent.

In this case it may well be in the children’s best interest to be able to see these grandparents and for the access visit to be re-scheduled with time compensated for the contact that was foregone or sacrificed. Similarly, if children would miss an important occasion such as a much desired camping trip, or a birthday party with close friends, or a

marriage in the extended family unless the access visit was changed, this too would require parents to be flexible in the name of putting the children first.

Clearly worded and structured custody and access arrangements are often necessary in order to set the ‘rules’ and avoid unnecessary conflict between parents. As well, parents and children can then organize their lives and personal commitments in context of knowing where they will be and when. The children themselves can, if of sufficient age, know ahead of time and plan their involvements and activities accordingly. As good as such clarity and consistency is, the best plans however are those that provide elbow-room for change as unforeseen or special circumstances may require from time to time. And as vital as it is for parents to keep to the agreement, it is also critical that they communicate with one another, that they compromise and adjust on those exceptional occasions as called for.

Yet another sensitive issue that can arise in custody and access arrangements is that of a child resisting or refusing to visit a parent. The child may be downcast, show anger toward the parent who is seen to be ‘forcing’ the visit, or even cry and throw a temper tantrum. What to do? The parent who has the child may certainly wish to abide by the agreement but questions at what emotional expense to the child if this is what happens.

The parent ready to receive the child may begin to wonder if the other parent is doing something ‘to turn the child off’ from visiting and thereby deliberately undermining one’s own role and involvement. In dealing with this type of child reluctance, the first course of action is to determine why the reluctance exists, bearing in mind that the more intense the opposition, the more likely it is that forcing the child will be counterproductive. It is therefore critical to take the time to get to the bottom of why the child feels as he or she does. Intense reactions can hide very genuine fears, from being afraid for whatever reason of leaving a parent upon which the child is overly dependent, to having expectations of harsh or abusive treatment at the hands of the receiving parent or the environment that one is being sent into. Once the reasons for reluctance have been explored, and if untoward elements have not been found, it may well be that the child’s temperament is such that more explaining needs to be done to help the child understand the purposes behind the scheduled visits. A more graduated visitation schedule may also need to be adopted, at least initially, to help the child ease into the visits at a pace more in line with his or her readiness. Counseling of course can also be helpful here as in every other instance where a child’s unhappiness becomes evident and does not respond to more usual efforts.

Finally, custody and access issues can unfortunately occur in context of more disturbing circumstances. Violence, intimidation, threats, and abuse may either have originally led one parent to leave the other or come to characterize the parent to parent relationship after the breakup. A restraint order may need to be pursued prohibiting the offending party from harassing or otherwise interfering with the other parent or the children. In such instances even telephone access to the parent and the children may need to be denied, and the address and residence of the parent and children may similarly need to be

withheld.

If despite friction and conflict children are to see and be with each parent it may help to utilize third party or neutral intermediaries such as a relative or staff from a community access visit agency, to act as a go-between so that direct contact between the parents is avoided without stopping access to the child. Nonetheless, parents should not hesitate to report to the proper authorities as well as one’s lawyer when the other parent is stepping beyond the line and putting the child in jeopardy. By the same token, if a parent with a history of improper conduct such as anger displays or an addiction can demonstrate effective change via, among other things, having completed a recognized treatment program, it behooves the other parent to be open to working toward finding how custody and/or access can be allowed or restored if this would in fact be in the best interests of the child. Professional help will be of particular value in assisting parents, children, and the court in determining how best to proceed in such truly challenging situations.

CUSTODY AND ACCESS: WHAT THE TERMS REFER TO, AND THE DIFFERENT FORMS When speaking of custody and access arrangements, it is helpful to note that there are different forms of each, and that custody and access are not the same. A brief description to clarify this follows: Custody - This refers to having formal and legal authority over a child. Custody may be either sole, or joint.

Joint Decision-Making Custody - Each parent possesses legal authority to have a say and to participate in the approval of any major decisions in a child’s life. Unilateral decision-making, that is a decision taken by one parent either without the approval of or against the express wishes of the other parent, can be null and void.

Joint Physical Custody - The parents share in having ‘physical’ care of a child, that is in having the child live with them, say a week at a time with one parent and then the other.

The sharing however need not necessarily be exactly half and half; more so, it is the principle that the child lives with both parents on some regular basis.

Sole Custody - One parent, and one parent only, has legal guardianship over the child, and can make decisions on behalf of that child.

Permanent Custody - Custody is finalized and set.

Interim Custody - Custody has yet to be finally determined; what custody exists is for now and can be changed after further review.

Access - This refers to having contact and time with a child, on specified days and times.

Access, as with custody, can come in different forms.

Supervised Access - The parent is only permitted to be in the presence of, or to speak with, a child when in the company of a responsible adult, or list of adults, designated and approved of in advance, usually by the court. This type of restriction is generally instituted when legitimate concern exists as to the welfare of a child when in the company of the noted parent, because of either proven or alleged behaviour by that parent, such as abuse, addictions, emotional instability, or a threat of abduction.

Unsupervised Access - The parent can have access on one’s own, without being required to have anyone monitoring the visit.

Interim Access - Access that has been granted for now, or for a defined period, but being subject to review before a final decision is made. As with an interim custody order, the purpose here is to do what appears to be appropriate for the time being, usually allowing only limited access, while giving opportunity for the arrangement to change after further review if indicated.

Parenting Time and Parenting Time Arrangement – Sometimes, parenting time and parenting time arrangement, are the terms used in preference to custody and access. This is to try to convey a more benign process and to get away from the sense of who ‘controls’ and who ‘visits’. Whatever the term used, the fundamental issues are the same and require the same sensitive consideration.

NOT SET IN STONE Parents may appreciate knowing that custody and access arrangements or agreements are not necessarily etched in stone. Understandably, it may be quite time-consuming, stressful, and expensive to keep changing or trying to change the terms and conditions of custody and access, and as already noted there is value in having stability in children’s lives. However, when circumstances change substantially and are clearly relevant to the care and welfare of a child, modifications to custody and access may be warranted. Such changes may relate to for example, a parent’s changed ability to exercise due diligence and responsibility, a parent’s changed availability to the child due to moving or a job, the parent having entered a highly questionable relationship, or a child having identified special needs for educational programming or medical treatment. When circumstances change substantially, parents have a right to bring this to the attention of those who can review these developments and see what, if anything, can and should be modified in the existing arrangement.

A BEGINNING, AS WELL AS AN END

No matter what has been decided regarding custody and access, parents need to be mindful that the terms and conditions are not substitutes for, or guarantors of, quality parenting. Parents will still need to set aside their differences, however steadfastly and painfully felt, if their children are to benefit from the best that each has to offer. Parents should parent, and do so properly, not live to fight another day through the hearts and minds of the children. And, when parents can handle themselves well, children can often adapt remarkably well.

The worst danger to children in custody and access disputes occurs when they are exposed to a continuing psychological war zone between the parents, with pitched battles over the most minor of issues. Children deserve more from their parents, and both children and parents can often move on with their lives if they can let go of what no longer exists, and concentrate on creating a new beginning.

Chapter 7 Managing Stress at Work and at Home Dr. Sandy Ages Stress is a fact and a reality of life. It is the pressure we feel at work to meet deadlines, to handle conflict, to perform our best in front of colleagues, clients or our supervisor. It is the pressure we feel at home to meet the everyday challenges coping with family issues, bills etc. Stress affects everyone.....child and adult.

Dr. Walter Cannon identified the body’s immediate reaction to a threatening situation as the “fight or flight” response. In the early evolution of humanity these reactions were critical to survival for hesitation could be fatal. There was a need to respond quickly to the threatening situation and either fight or flee.

The body’s physiological changes to stress occur rapidly. What happens to the body in a stressful situation?

Reaction to Stress

• adrenaline secreted • respiration increases • muscles tense • heart rate increases • blood pressure increases • sugar production increases • blood vessels constrict • muscles prepare for action • immediate surge of energy

Hans Selye in his research on stress, coined the term General Adaptation Syndrome which is characterized by three stages. In the first stage, alarm, the body mobilizes for action; the second stage, resistance, where the part of the body or system attacked takes action; the third stage, exhaustion, occurs as resistance wears down. This last stage is a reaction to the first two stages. It either allows the body to recover from the stressful reaction or once again prepare for the first stage, alarm to reoccur. If an individual continually responds to stress in this heightened manner, the individual becomes weakened and vulnerable or susceptible to illness.

A stressor is any stimulus that is internal or external to an individual and has the potential to set off a physiological response. Our individual stress reactivity is our tendency at a particular time to be vulnerable to stress. Our stress reactivity is based on several factors

• • • •

our personality our cognitions our emotions our behaviour patterns

Stress is viewed as the interaction of a stressor ( an internal or external event to an

individual ) and the individual’s stress reactivity. Stressors can be positive and challenging to promote action or motivation to perform a specific behaviour. Stressors can be negative and create distressful physical or psychological reactions.

The following formula explains the relationship between stress, stress reactivity and the stress response. stress + stress reactivity = stress response

Case examples: The examples are fictitious due to client confidentiality.

At work, John (41 yrs.) views a computer problem as a challenge. He is energetic and highly motivated to plan his strategy. He spends time working late at the office and frequently brings work home.

Dave (52 yrs.) constantly faces deadlines to meet at the office. He is upset by computer problems and sees them as set backs. These cause him distress, frequent headaches and difficulty sleeping. He is irritable with his wife and children.

Ann (9 yrs.) is complaining of stomach aches and is reluctant to go to school. The doctor does not find any physical/medical explanation. At school the teacher notices that Ann has difficulty concentrating on her work. Ann’s parents separated recently.

Mary (39 yrs.) works full time and is also caring for her mother who has serious health problems. Mary has gained 15 pounds, and is experiencing problems concentrating on work.

Janet (47 yrs.), a manager of her department in a large company, is demanding of herself and the workers around her. She easily loses patience with her staff for the smallest error.

Do you see yourself in any of these situations? Are there any similarities with the way you cope with stress and the examples that have just been described?

The symptoms of stress can take several forms: physical, emotional, intellectual, spiritual, and interpersonal. How does stress affect you? Examine the following checklist.

Physical

Symptoms of Stress Emotional Intellectual Spiritual

cardiovascular symptoms respiratory symptoms gastrointestinal symptoms muscular symptoms skin symptoms

apathy

forgetfulness

depression

poor concentration confusion

immunity symptoms

panic attacks

nervousness mood swings impatience

frustration metabolic symptoms

frequent anger excessive worrying

lack of confidence memory blank

Interpersonal

loss of purpose blaming others and meaning feelings of nagging despair feeling alienated using people full of doubt

no time for friends/family cynical attitude overly argumentative closed lack of putting others mindedness forgiveness down pessimistic need to prove overly outlook oneself competitive negative self-talk loneliness too defensive losing train of lacking serenity self-absorbed thought

What are your symptoms of stress?

What life events may create stress? Marital separation, divorce, death, birth of a baby, change of a job, change of a school are just a few examples of life changes that can impact on your level of stress. What changes have occurred in your life over the past year?

How do you cope with your stress?

Do you have positive or negative coping strategies to handle stress?

Let us first examine some negative coping strategies to stress.

Negative Coping Strategies Alcohol Denial Drugs Eating Fault-finding Illness Indulging Passivity Revenge Stubbornness Tantrums Tobacco Withdrawal

Worrying Changing

Self-Abuse

Drink to change mood: use alcohol as your friend Pretend nothing is wrong: ignore the problem Abuse medications and/or take illegal drugs Eat food to console you: binge/diet Have a judgmental attitude: complain and criticize Develop headaches, nervous stomach Stay up late, sleep in, buy on impulse Procrastinate: wait for a break Get even: talk mean or sarcastically Be rigid: demand your way Yell, mope, pout, swear, throw things, drive recklessly Smoke to relieve tension, smoke to be “in” or adult Avoid the situation, skip school or work, keep your feeling to yourself Imagine the worst, play the “what if” game Change jobs, residences, spouses, having unnecessary surgery Cutting, picking at skin

As you read through the list do you recognize some behaviours that you practice to cope with your stress? How beneficial do you feel these behaviours are in successfully

alleviating some of the pressure that you are feeling? Are there some behavioural changes that you would like to implement? My professional advice to you is to try to eliminate these negative strategies.

Look at the following checklist of positive coping strategies to stress. How many do you practice? Are there some new behaviours that you can try that will be helpful to you?

Positive Coping Strategies Interpersonal Assertiveness Affirmation Expression Contact Limits Linking

State your needs and wants; learn to say “no�

Believe in yourself; trust others Show and share your feelings Make new friends; touch; listen to others Develop your personal boundaries; accept your own limits; drop some involvements; accept others limits Share problems with others; ask for support from family and friends

Mental Problem-solving Time management Organizing Life planing Re-labeling Imagination

attack the problem not the person; seek help if necessary work smarter than harder; focus on priorities Do not let things pile up; make order; do not get sidetracked Set clear goals; plan for the future Change perspective; change dysfunctional thoughts Anticipate the future; look for the humour; practice guided imagery for relaxation

Physical Exercise Relaxation

Self-care Nourishment Biofeedback

Pursue physical fitness; walk, jog, swim, bike Learn gross motor relaxation: tense and relax the muscles; learn yoga; take a warm bath; get a massage; breathe slowly and deeply Strive for self-improvement; look your best; keep neat and clean Eat healthy; limit fatty foods and alcohol Listen to your body; know your physical limitations; get enough rest

Balancing Conflict resolution Cooperation Togetherness Flexibility Esteem-building Networking

Balance time at work and at home Learn to communicate, to accommodate, to compromise, to negotiate Family members share in household responsibilities Take time to be together; build family traditions, express affection Stay open to change; take on new family roles Focus on personal strengths; build good family feelings Make use of community resources; develop friendships with other families

Diversions Hobbies Learning Getaways Music Play Work

Develop interests; gardening, painting, writing Take a class; read; join a club, Spend time away from home and work; see a movie; daydream Listen to music; sing; play an instrument Play with your child; go out with a friend; play a game or sport Tackle a new project; volunteer

Spiritual Meditation Worship Surrender Prayer Faith Commitment

Set sometime each day for reflection and thought; Share beliefs with others Let go of problems; let go of the past; learn to live with the situation Confess; ask forgiveness; pray for others; give thanks Find a purpose and meaning; trust God Take up a worthy cause; invest yourself meaningfully

Are there any suggestions in the list above that you may adopt to better cope with the stress in your life? What goals can you set for yourself? There are concrete steps that you can take to alleviate some of the tension in your life. Learning to develop a healthy

lifestyle to handle stress will have a positive impact on your life.

When would it be advantageous to seek professional help?

It is important to look at the effect or impact that stress has on your work and home life.

A professional therapist – psychologist, psychiatrist, social worker or counselor can assist in this process. Being able to learn appropriate strategies to handle the various stressors is an important function of the role of the professional. Because you are feeling stressed and vulnerable, the professional can offer different perspectives on the situation and work with you to learn how to better cope with the stressors.

What to expect when you meet with the professional therapist?

After a comprehensive initial assessment, you will have an understanding of the symptoms of your stress: physical, emotional, intellectual, spiritual, and interpersonal.

Examining the changes within the last year and the anticipated changes in the next year will give you an appreciation of the various issues that have had an impact on you.

Sometimes a therapist will tell you that your feelings, thoughts, and behaviour are quite normal. This can be reassuring to you. This is particularly important if you have sometimes reflected that you thought you were “going crazy”. The therapist will work with you to develop a treatment plan. This plan utilizes the behavioural, emotional, and cognitive processes to handle stress. The plan may include: • • • • • • • •

relaxation ( gross motor and imagery ) assertive communication skills conflict resolution anger management organizational skills for home and work exercise program cutting back or eliminating caffeine rich foods/drinks cognitive restructuring

If the therapist is doing psychotherapy using a cognitive behavioural framework, you will learn how your cognitions or thoughts can effect your emotions and behavioural responses. Learning productive thinking strategies can effect both the body, the mind, and the emotions. You will begin to feel that you have more control. You will develop a

sense of well being and self-empowerment. The techniques are not complicated but do require you to “unlearn” old thinking patterns. Negative self-statements are an accumulation of self-limiting mental statements that are unconstructive and can create and maintain stress.

One of the case studies described Janet, a perfectionist. She is hard-driving and intolerant of mistakes made by herself and others. Stress is generated by the continual self -thoughts that “my efforts are not good enough”, “I should be working harder, “I can’t make a mistake”.

The favourite expression of this type of person is “I should”, “I have to”, “I must”. The most effective way to handle negative self-talk that effects your stress is to counter the statements with positive supportive statements. Countering involves writing down and/or mentally rehearsing positive statements which refute the negative self-talk. Since stress can be created through negative self-talk, you can change the way you feel by substituting positive self-talk. This takes practice, lots of practice and, of course an awareness of how your thoughts affect your stress. When you become aware of when you are engaging in negative self-statements and then counter with alternative positive supportive statements, you are on the track of turning your thinking around. With practice and consistent effort, you will change not only the way you think but also the way you feel.

How to access professional help?

To find a professional therapist contact your employee assistance program or your family physician. There is a list of counselors or therapists that are registered with your provincial or state professional associations. This office can give you the names of appropriate professionals in your geographical area.

Chapter 8 Overcoming Depression at Work and at Home Dr. Peter Judge

The purpose of this chapter is to provide a guide to the signs and symptoms of a major depressive disorder. To keep things simple, manic-depressive, or bipolar illness is not included in the discussion. You can use the information in this chapter to help identify signs of depression which you may be experiencing and to help you take charge of your illness and formulate the best treatment plan.

All of us feel sad and low at times. Perhaps the stress of work is wearing us out, or a valued relationship has gone sour, or perhaps a loved one has passed on. These are normal events of life to which each of us reacts differently. We may want to seek the counsel of friends, family, or professionals to help us through these times. It is important to distinguish these normal and short-lived reactions of grief and sadness from major depressive disorder or clinical depression.

How do we know when we are clinically depressed? Although the actual diagnosis of a major depressive disorder must be made by a diagnosing mental health professional, such as a psychologist, psychiatrist, or family doctor, there are a number of symptoms characteristic of clinical depression. Although feelings of sadness are certainly a common feature of depression, clinical depression is often characterized by strong feelings of loss of control, hopelessness, high anxiety and sometimes thoughts of self-harm.

It is important to remember that depression is not a weakness and it is not your fault. It is a treatable illness.

Case Vignette To protect our clients' confidentiality, all case examples are fictitious.

Brian had worked long hours in the high-technology industry, sometimes six or seven days a week in order to meet the anticipated release date for the product he was working on. Initially, he saw this as a temporary situation for which he would make an extra effort over a period of about six months. He would put his family on hold temporarily, while he made his mark at work. Brian did make a good impression at work and was immediately given another urgent project to work on.

Two years seemed to go by very quickly when Brian suddenly felt that work did not hold the same interest for him as it used to. In fact, he felt dull and disconnected at work. He had been out of touch with the daily activities of his wife and children for so long that he

felt distanced from his family and although he missed their warmth a great deal, he had forgotten, it seemed, how to get close to them again. His friends and fun activities had long since been replaced by work-related projects. He found it difficult to concentrate at work and felt his thinking was slow and muddled. He was sometimes embarrassed when he was unable to follow the train of events during meetings. Alone in his office, he sometimes felt tearful, his heart would pound and he found himself sweating and trembling.

Over the next few months, Brian tended to withdraw from his family even though part of him desperately felt the need to be close. He was no longer interested in sex with his wife and the tenderness and intimacy that he used to experience with her seemed absent. In fact, he found himself arguing with her over little things. Sometimes he would just leave the house in a fit of temper. He seemed to be always angry with the children; and then berated himself for being so intolerant. Although he never was a big breakfast eater, now he was no longer interested in dinner and had no appetite. He was alarmed to find that, over the last six months, he had lost 20 pounds.

At work, his usual high-level of productivity was noticeably lacking and associates began to comment on his flagging performance. During the day Brian felt preoccupied with awful thoughts that would race through his head and which he could not shake off. He felt that it took a great deal of effort to stay at work the whole day. One afternoon, alone in his office, Brian burst into tears unexpectedly and was frightened by the fact that he couldn't stop crying easily. He left work right away and arriving home that afternoon he longed for a release from his painful feelings and whirling thoughts. The next day, his wife made an appointment for him with their family doctor.

Causes of Depression The causes of mood disorders can’t be traced to one unique factor. Instead, depression is likely the result of a combination of biological, genetic and psychosocial factors. In some people, depression occurs even when life is going well.

Biological There are a number of medical ailments which can give rise to clinical depression.

These include interacting medications; family history and genetics; chronic health problems; substance abuse; and thyroid and other endocrine dysfunctions. Low levels of thyroid hormone can produce symptoms of depression including slowed thinking and low mood. This condition is easily treated with a thyroid supplement

and the depression resolves as a result. Neurological conditions can also result in symptoms of depression. Traumatic brain injury, stroke, Parkinson’s Disease, Multiple Sclerosis, brain tumors and other conditions can provoke a depression as these diseases affect different parts of the brain and disturb the balance of neurochemical action in the brain.

There is biological evidence that changes in the neurochemical balance of the brain are associated with depression, and this research has been used to develop antidepressant medications.

Genetic Research indicates that genetic predisposition can be a significant factor in the development of depression. Of course, it is impossible for these studies to separate the effects of the subjects’ psychological and social environment as they grow up, from the effects of genetics. Nevertheless, family studies suggest that close relatives of patients with depression are two to ten times more likely to have had an episode of depression themselves. Adoption studies have lent support to the notion that there is a genetic basis for the inheritance of mood disorders and there is a 50% likelihood that one identical twin will have an episode of mood disorder if the other has had an episode.

Psychological Life events and environmental stress also contribute to the development of mood disorder, and stressful life events most likely precede a first episode of depression.

Common psychological problems that can precipitate a depression are chronic stress, relationship and marriage difficulties, lack of social contact, the unexpected death of a loved one and failures or other setbacks such as 'burnout' at work.

Prevalence of Depression Depression is estimated to occur in about 5-10% of Americans. It is almost twice as likely to occur in women than men and while this may be due in part to the willingness of women to present themselves to physicians and the reluctance of men to do the same, it is also likely due to biological differences. The average age at which depression occurs is 40 years old and half of all patients have an onset between the ages of 20 and 50 years old. Major depressive disorder occurs most often among those who have no close

interpersonal relationships, or are divorced or separated. Interestingly, the incidence of depression does not differ among different classes of people.

Symptoms of Depression Depressive symptoms can be feelings, thoughts or physical signs. Sadness, hopelessness and despair are typical depressive feelings. These are often accompanied by harsh, selfcritical thoughts. These feelings and thoughts often occur in the presence of physical symptoms such as changes in appetite (compulsive over or under-eating), accompanying weight changes and sleep disturbances.

How Will I Know If I’m Depressed?

Symptom Checklist Feeling low or sad

Tense or agitated

Fatigue or apathy

Difficulty sleeping

Quiet and withdrawn

Fearful and anxious

Disorganized

Compulsive eating

Reduced appetite

Feeling guilty

Easily tearful

Feeling hateful

Feelings of hopelessness

Hoping to die

Helplessness

Self-critical

Body aches and pains

Anger

Worthless

Feel alone

Difficulty concentrating

Preoccupation

Feelings of loss

Planning to kill self

As well, there are often physical symptoms of depression. Some people express their depression physically and suffer headaches, aches and pains, digestive problems and sexual problems.

Diagnosis Major Depressive Disorder

When someone is depressed, they may have several of the symptoms listed below nearly every day, all day, that last at least two weeks.

•

Loss of interest in things you used to enjoy, including sex**.

•

Feeling sad, blue, or down in the dumps**.

•

Feeling slowed down or restless and unable to sit still.

•

Feeling worthless or guilty.

•

Changes in appetite or weight

•

Thoughts of death or suicide; or actual attempted suicide.

•

Problems concentrating, thinking, remembering, or making decisions.

•

Trouble sleeping or sleeping too much.

•

Loss of energy or feeling tired all the time.

Other symptoms include: •

Headaches

•

Other aches and pains

•

Digestive problems

•

Sexual problems

•

Feeling pessimistic or hopeless

•

Being anxious or worried

If you have had five or more of the symptoms, including at least one of the first two symptoms marked with an asterisk (**) for at least two weeks, you may be experiencing a major depressive disorder.

Symptoms of depression may be mild, moderate or severe.

• Mild depression is when a person has some of the symptoms of depression and it takes extra effort to do the things they need to do.

• Moderate depression is present when a person has many symptoms of depression that often keep them from doing the things they need to do.

• Severe depression is present when a person has nearly all the symptoms of depression, and the depression almost always keeps them from doing their regular day-to-day activities. Some symptoms of depression may be mild but persistent, and these chronic symptoms of depression also need treatment.

What To Try First In some cases, mild depressive symptoms can result from difficult decisions about your life that you may have avoided dealing with and put aside until later. In these situations, the first step is to identify the problem. Are you holding yourself back at work because of a misunderstanding or a belief which may not, in fact, actually be valid? Does the manner in which you relate to others, at home or at work, require a small adjustment to let you feel more comfortable with yourself and less constrained by what you feel others’ want from you? Some self-analysis and corrective action can go a long way to improving the way we feel about ourselves. In many cases however, this type of action alone is not sufficient and depressive symptoms persist.

What To Try Second Visit your family doctor to rule out a medical cause of depression. This would be a good time to discuss your symptoms with your doctor and to formulate a plan of action. Your doctor may be able to suggest an appropriate referral to a mental health professional such as a psychologist or psychiatrist who can make a diagnosis and formulate a treatment plan.

When to Seek Professional Help If you feel that you are having difficulty coping with your symptoms by yourself, then this is a good time to seek professional help. You can use professionals, not just for major problems, but as a sounding board for decisions that you want to make or to troubleshoot minor problems. Visiting a professional is particularly important if you have experienced a loss of control, or felt hopeless, or if you are struggling with suicidal thoughts.

Who are the Treating Professionals?

Family doctors (M.D.) Family doctors are not specialized in mental health disorders and not usually trained in psychotherapy. They are able to diagnose and treat depression. Medical doctors are members of the College of Physicians and Surgeons, which legally regulates the profession. They have an undergraduate degree, a 5-year medical degree and 1 or 2 years as a resident in family practice. Medical doctors are also authorized to admit their patients to hospital. They can prescribe medications such as antidepressants.

Psychiatrists (M.D.) Psychiatrists are medical doctors who are experts in the pharmacological treatment of depression and other mental health disorders. Modern psychiatric training is oriented around a biological model of depression in which treatment by medication plays the primary role. Psychiatrists usually have heavy caseloads and long waiting lists. Psychiatrists rely on the clinical interview to provide them with the information they need to make a diagnosis. Psychiatrists receive the same education as a family doctor, but instead of spending 2 years as a resident in family practice, they spend 4 years as a resident in the psychiatric unit of a hospital.

Psychologists (Ph.D. or Psy.D.) Psychologists are mental health professionals who have received their doctorate degree (Ph.D. or Psy.D. • 4 to 6 years after an undergraduate degree) before taking a one year supervised, post-doctoral internship to meet the certification requirements of their regulatory body. Psychologists are trained as research scientists as well as clinicians and bring an understanding of the scientific method to their professional duties.

Psychologists study human behavior and are trained in a variety of psychotherapeutic and assessment techniques. As well, they are permitted by law

to diagnose mental health disorders and to use psychological assessment tools to help make diagnoses. Psychologists do not prescribe medication. Extended health plans cover a portion of psychological assessment and treatment. Psychologists often work in close consultation with referring physicians and use this connection to facilitate admissions to hospital, if necessary.

Social Workers (M.SW) Social workers hold a Master’s degree in social work, an applied discipline which is not research oriented. They often work in community health centres and school boards. They are trained to provide a supportive role and they may not have extensive training in a systematic form of psychotherapy. However, they are often experienced at crisis intervention. Typically, their scope of practice does not include diagnosis.

Treatment of Depression Depression can be treated with antidepressant medications, psychotherapy or both.

Treatment is often most successful when antidepressant medication and psychotherapy are used in conjunction with each other.

Medications Medications work by altering the balance of specific neurochemicals in the brain. All of the antidepressants mentioned below take about three weeks to reach maximum effectiveness. For this reason it is important to take the medication regularly, even if there are few immediate changes in symptoms. Taking an antidepressant medication increases the chances of depression resolving within one month by 50%. It is important to continue taking the medication even after you begin to feel better. This strengthens the likelihood that the treatment will be successful and helps guard against a relapse.

Tricyclic Antidepressants These effective antidepressant medications have been available for the past forty years. There is a great deal of research available on the effectiveness of this medication. Tricyclics are often used when a sedating effect is required for

symptoms of sleep disturbance resulting from depression. However, these medications can be toxic in overdose and have adverse side effects.

MAOIs These antidepressants are called monoamine oxidase inhibitors (MAOI). They have significantly harmful interactions with certain foods and can cause changes in blood pressure and so are more difficult to prescribe and monitor. They are not usually the first choice of prescribing physicians, but tend to be used when other medications have not proven to be effective.

SSRI These antidepressants are perhaps the most popular antidepressant medications used today. Examples include Paxil, Zoloft and Prozac. These antidepressants are significantly safer than the older medications described above and have fewer sideeffects.

Management of Depression Managing depression increases your sense of control and puts you on the right track towards a return to good health. This is the time to try to become more aware of your feelings, to open yourself to the idea of treatment, and to make a commitment to follow through. It is important to examine your lifestyle and make a plan that will facilitate your treatment. The plan should include elements of structure to help provide a framework for taking care of yourself. Examples of this type of structure are getting up and going to bed at regular times and making sure you get proper nutrition and exercise.

There is a tendency in depression to become isolated and withdrawn from others and it is important to try and minimize these tendencies. Ask friends for their support, understanding and patience during your depression. It can be helpful to talk to your friends about your feelings and treatment and to spend time with them in social activities.

Some people find it very difficult to be with others during this time. If you feel this way, do what you need to lift your mood and make yourself feel better. Many people find that family members are very supportive and helpful, but if you find yourself alone and unable to be with others, tell your therapist.

Try to maintain a positive attitude. Although this is easier said than done, it is useful to

try and be aware of any negative thoughts that might occur. Remind yourself that depression is a temporary emotional state. Live one day at a time without worrying too much about events from the past or things that may happen in the future.

What to Expect When You Meet with the Therapist Treatment of depression usually has three components. The first is to make an assessment. This can take between one to three sessions and will consist of an interview with the therapist as well as possibly a psychological questionnaire if the therapist is a psychologist. During the interview the therapist will ask questions about your history. He or she will want to know about your family origin, your schooling and work history, as well as your attitude and feelings about them. The therapist will also want to know about your medical history, to be sure that medical causes for depression have been ruled out.

After the assessment portion of therapy, you and your therapist will work together regularly, usually for about 1 hour per week until you are feeling better. It is important that you plan regular sessions, and not just when you feel a particular need. This is because therapy is a systematic process of discovery and you don’t have to be in acute turmoil to benefit from it.

Be prepared to spend some time in therapy. There is no instant cure for depression and now is the time to give yourself the gift of time to truly work through issues that are standing in the way of feeling normal and healthy again. After you are feeling better you should continue therapy for a period of time. Some clients like to lengthen the time between visits, but it is important to continue therapy on a regular basis even when you are feeling better, to prevent relapse and to maximize the effectiveness of the treatment.

Crisis Intervention The therapist may postpone the assessment component of treatment if you are in an acute crisis and need immediate intervention. In this case, therapy will focus on the immediate issues of concern and provide emotional support for your well-being that will help ease your state of mind and facilitate positive action. The therapist can work in conjunction with your family or others to help ensure a continuity of support. As well the therapist will work closely with your family doctor regarding medications and the need for hospital admission if there is a serious likelihood of suicide. If you are admitted, the

hospital will take over your treatment until you are discharged; then your therapy can resume.

How To Access Professional Help People usually present themselves to their family physician first, as they already have a relationship with their doctor. Psychologists can certainly be contacted directly, but it is often useful to have a referral from your family doctor, or a friend. In either case, the physician will conduct or be asked to conduct an assessment to rule out physical causes of depression.

Although some family doctors restrict their practice to psychotherapy and have received intensive training in psychotherapy • this is not often the case. The biological model of mental illness is an important element in psychiatric training and psychiatrists are well positioned to choose among a variety of antidepressant medications to fit the patient’s particular needs and situation. Psychologists are able to provide psychotherapeutic intervention but not medications.

If you are a student there are psychologists and social workers available in the school boards and universities to whom you can turn in times of need.

As well, there are community health centres which staff doctors, psychologists and social workers. These services are usually made available at no charge to the community.

Finally, hospitals are available in times of crisis and psychiatrists and psychologists will be available to determine if an admission is appropriate.

Chapter 9 Managing Anger at Work and at Home Dr. Iris Jackson Anger is one of the most powerful emotions that we feel. It is as powerful as love.

Many people view anger as a negative emotion, mainly because it is an extremely uncomfortable emotion to most people. However, I don’t believe that any of our emotions are inherently negative. Anger is very energizing and when it is well directed,

it can change whole societies. One of the best examples of anger changing society is seen in the revolution of attitude that the Black Pride movement in the United States initiated. In our personal lives, anger can also motivate us to make changes that improve the quality of our lives and make our relationships fairer and more just.

Anger is usually a secondary emotion. It often comes after we feel something else. We may get angry after we feel frustrated, hurt, rejected, sad, embarrassed, manipulated, wronged or even guilty. Some people go through the first emotion so quickly that they are unaware of what they felt just before they felt angry. If we can slow down our emotional reactions, we can come to see what it was that we were feeling just before we got angry. This helps us understand ourselves better, gives us something other than our anger to talk about and helps us make the changes necessary in ourselves or our environment that can reduce the incidents that create our anger.

Anger is also a choice. Although it rarely feels like it, we choose to allow ourselves to get angry by how we interpret a situation. Usually our anger follows other emotions which are created by how we think about a situation. (There are exceptions but they are rare, such as temporal lobe epilepsy or drug induced physiological states which we interpret as anger.) Therefore, if we analyze the situation, our thoughts, and our interpretations of events, we can control, to a large extent, how angry we get. For example, a person who believes that his/her spouse is on his/her side and is well intentioned will think differently about his/her spouse’s actions than someone who believes that his/her partnership is adversarial and his/her partner is out to dominate him/her.

There is a sequence, or continuum, from mild to very strong experiences of anger: assertiveness à annoyance à anger à aggression à abuse Standing up for yourself in a firm but civil (or even pleasant way) is assertive. We can reveal annoyance verbally by commenting on whatever has irritated us, with an expressed wish for things to change. Anger is a stronger emotion. It is a strong feeling of displeasure and irritation.

When we get aggressive, we press energetically for what we want without much concern for how the other person is feeling. We attack, verbally or physically. Abuse is damaging to the other person. It is an extreme form of put down, either physically, mentally or emotionally.

Some fictitious examples of anger: the good and the bad Please note: we respect the confidentiality of our clients, so our examples are not of real clients, but, rather, are fictions based on combinations of people we may have known in our personal or professional life.

Joan felt very hurt when her friend, Betty, forgot her birthday. She had always been very thoughtful about Betty’s special occasions and over the years they had celebrated many events together. Betty had been away on vacation, and did not phone Joan when she returned. What, thought Joan, is becoming of our special friendship? Well, she considered, I sure won’t be the first to call! That was the beginning of three weeks of the silent treatment while Joan stewed in her anger alone and Betty wondered if Joan would ever return her phone messages.

Bruce paced up and down his living room. Where was his wife? She had gone to Bingo with her mother, but it was already 9:15 and she wasn’t home. She knew she wasn’t supposed to stop for coffee and “loiter” as he liked to put it, when she knew he was home with nothing to do. How could she be so inconsiderate? Maybe, he thought, she is chatting with that good-looking neighbor down the road. Well, she’d sure have to account for her whereabouts when she got home. He wouldn’t let her get a minute of sleep until she told him exactly what she had done and with whom. And, boy, if she lied to him, he’s push her up against the wall like last time until she understood that he needed her with him and had to know where she was all the time.

John felt very frustrated with his teenage son. After letting him borrow the car, young Jack brought it back full of fast food cartons, empty soda cans and no gas. If John was going to use it for his business sales call tomorrow, he was going to have to clean it up and get gas at the all night gas bar. He went up to Jack’s bedroom and knocked on the door. Jack turned down the rap music and told his dad to come in.

“Jack, I’m really disappointed with the condition the car is in. You left a mess in the car and it is out of gas. Now, I have to undo all that to use it tomorrow. I really find your thoughtlessness annoying.”

“Come on, Dad! Weren’t you ever young once? It’s not so bad. I’m sure you’ve got enough gas to get downtown.”

“Jack, you’re not hearing me. I’ve told you a million times that with every freedom comes a responsibility. I’m angry with your attitude. You’re minimizing the problem and not offering to solve a situation you created! If you can’t bring the car back clean, control the mess your friends make in it and put a few bucks of gas in it when you see it’s near empty, then maybe you’re not mature enough for the freedom of the car.”

“Gee, Dad, I didn’t know it was such a big deal. I know I never look at the gas tank because it always seems to be full. I’m sorry and I’ll try to remember. But, just realize I’m not perfect.”

“Yeah, well, I guess none of are. I’m glad you get the point.”

I bet all of you can guess that I think John handled his anger better than Joan and Bruce!

Dealing with Anger Constructively Anger can be a useful emotion because it makes us aware that something in our life is not right for us. It provides us with energy and motivates us for change. Following are some ideas for channeling anger constructively: 1. Awareness helps. We cannot control anything of which we are unaware. Once we are aware of our anger we can ask ourselves questions to identify the causes and the remedies.

2. We must own our anger. That is, we must recognize it, admit it and accept it.

3. We must work on self-acceptance and self-esteem so that we have less about which to feel angry.

4.

We must work on trust - of ourselves, of others and of the future.

5.

We must accept our human limitations.

6.

We must stop inviting other people’s pity and criticisms.

7. We must discover the non-verbal messages that we give others; this will help us better understand others’ reactions to us.

8. No matter how hard, we must give up the pouting silent expressions of anger; we must talk.

9. No matter how hard, we must give up the violent, abusive expressions of anger, whether they are temper tantrums, verbal or physical abuse or bingeing (compulsively over-eating or over-drinking).

10. We must learn new ways of expressing anger without becoming selfor other-destructive. We must expand the number of ways we express anger.

11. We must learn how to ask for love and to give and take in relationships.

12. We must learn to live in the present.

13. We must learn to argue amicably.

14. We must learn how to play and relax.

15. We must learn how to let go – of the past, of the uncontrollable, of the anger.

16. We must learn how to forgive and forget – parents, children, exwhatevers; we must give up yearning for what can never be.

How to Argue Amicably

• don’t avoid an argument or just give in • be brief • give accurate feedback • don’t name call • argue by appointment: set up a time to meet to discuss and argue about the issue • stick to the topic • stay in the present • no second guessing (mind reading) • level (be honest) • speak up for yourself • don’t let issues accumulate • don’t argue when tired • don’t use the silent treatment (not talking or reacting to the other person)

• be willing to change • be willing to say “good point” • don’t hit below the belt • allow intermissions • allow the other person to sleep • don’t over dramatize • never use sarcasm • try not to yell • don’t use your size to intimidate • don’t crowd the other person • allow the other person to save face • allow the other person to leave, to take an intermission – do not pursue them • try not to be deliberately provocative • never argue in bed

Managing Other People’s Anger The following ideas will help you “talk or walk”. Too often we believe that we must match someone else’s anger with our own. However, just because someone else is angry with us does not mean we have to be angry back. Some of our best discussions can come from listening closely even when the other person is clearly angry. If we really try to listen, very often the other person relaxes as he or she realizes that he/she is being heard, and the discussion can proceed calmly, even to a resolution.

Other Person’s Problem Behaviour

Your Strategy

Excessive Anger

Ø silence: keep eye contact, keep relaxed, disarm through rapport; Ø paraphrase, reflect back what you hear; ask questions; Ø finally, give a warning, then leave the situation, if it continues and no rational discussion seems likely.

Personal Put-downs

Ø Don’t become defensive and don’t defend yourself; use assertive techniques; paraphrase and ask questions; Ø Tell the person your feelings are hurt, and if the put-downs don’t stop, you will leave the situation.

The Silent Treatment

Ø Stay silent; wait for him/her to talk Ø Ask open-ended questions. Ø Make it clear that you are available when they are ready to talk.

Kitchen Sinking – Gunny Sacking (brings up irrelevant issues)

Ø Sort issues; re-focus on the current problem; Ø Paraphrase, ask “what”, “who”, “when”, “where” and “how” questions. Ø Never ask “why”

Remember

Ø The closer you are to someone the more difficult it may be to use these strategies on important matters. Ø When core values are involved, it is essential to make the other person aware of this. Ø Some things are non-negotiable. Ø Sometimes you have to agree to disagree.

What else to try Sometimes, we are too angry or the issue is too big so that we feel like we can’t discuss it with the other person. At those times, we must siphon off the anger to reduce it to manageable proportions. Writing angry letters that we do not mail, hitting pillows or punching bags, going for a jog or some other aerobic workout, or doing a ritual such as burning a photograph can help. In some situations, getting a third person to mediate or facilitate (referee) can get a discussion going in which anger can be expressed and each party to the dispute can be heard in a controlled and safe way. However, the third person needs to be someone both people respect and someone who can remain neutral and objective.

Assertiveness Rights It helps to realize that we inherited certain rights just because we were born. The first step in becoming assertive rather than aggressive, especially when we are angry is to realize the following: You have the right • to exist, to take up space, to be here • to love and appreciate yourself • to make your own decisions • to judge your own behavior, thoughts and emotions and to take responsibility for their consequences • to offer no reasons, excuses, explanations or justifications for your behavior.

• to decide if you will help solve others’ problems.

• to change your mind • to make mistakes, to take responsibility for them and to learn from them • to say, “I don’t know”.

• to reject other people’s help • to be illogical • to say, “I don’t understand”.

• to say, “I don’t care”.

• to say “no” without feeling guilty • to stretch and reach for the highest in yourself: the right to grow as a

person • to forgive yourself for your human limitations • to dream and fail and to dream and succeed • to do what is necessary for your continuing health and growth.

Assertiveness Skills The more tools we have when we face conflict situations, the slower we are to anger.

You can try these tools when you need to be assertive: Broken record:

Calmly and politely say what you want over and and over again. This skill helps you avoid argumentative baiting, irrelevant comments and side issues, while sticking to your desired point.

Fogging

Calmly accept the comments of the other person as having some merit or truth, while you still maintain your own perspective or plan. This skill allows you to receive criticism or feedback without becoming defensive or making any change you do not want to make.

Free Information

Making small talk to draw out the other person to build rapport and figure out what is important to the other person can be a useful way to discover how best to present your side of things.

Negative Assertion

Sympathetically agreeing with a negative criticism takes the wind out of your critic’s sails and can deflect hostility. This skill allows you to look more comfortable with your human limitations and not be defensive. Sometimes you can learn more about how you appear to others, which can increase your self-insight and lead to self-improvement.

Negative Inquiry

This is actively prompting another to give you critical feedback in order to use the information if it is helpful or to exhaust it if it is manipulative. This skill allows you to be in control of the interaction and can “clear the air” by getting problems out in the open. An example is asking “what don’t you like about….” an issue, event or person.

Self-Disclosure

When you share aspects of yourself that allows the other person to understand you or your situation better, you usually develop rapport and cooperation.

Workable Compromise perfect)

This is finding a mutually acceptable (but not solution to a conflict or goal. This skill allows both people to feel heard and understood, and a resolution to the problem situation can be found.

What is Physical Abuse?

When anger becomes rage, people get abusive. We all think we know what physical abuse is, because it seems obvious. People who hit others, who push, shove or punch others are easily seen to be abusive. Did you realize that it is also physically abusive to abandon someone in an unsafe place, to drive recklessly with a passenger in the car or to threaten someone with a weapon or by throwing an object in his/her direction? Physical abuse is not only unacceptable and damaging to the relationship, but it is against the law.

Furthermore, it hurts not only the wounded individual but also the abuser, whose selfrespect is badly damaged by such out of control behavior. The guilt is hard to live with, too.

What is Psychological Abuse?

Psychological abuse is much more subtle than physical abuse. Indeed, many people do not realize that they are being abusive or abused when the abuse is psychological. The following guidelines will help you realize if you are giving or receiving psychological abuse.

• Explicit threats of violence, such as “If you say another word, I’m going to punch you out.”

• Implicit threats of violence, such as, “If you say another word, I don’t know what I might do”. This may be coupled with body language such as making a fist or perhaps stepping toward the other person in an aggressive manner.

• Extremely controlling behavior, such as telling her/him who he/she can see and which friends he/she can go out with. Essentially, it is controlling all aspects of the other person’s life • Excessive jealousy, which takes the form of frequent questioning about where he/she has been, with whom the other has been, accusations about his/her attraction to others, suspiciousness about sexual activity with other people.

• Mental put downs, such as continual name calling, telling him/her he/she is no good; that he/she cannot survive without her/him. On a daily or even weekly basis this behavior corrodes the self-esteem of the receiver.

• Imitating the other person in an exaggerated way.

• Isolating behavior: Although part of controlling behavior, this is a type of psychological abuse that warrants separate discussion. An abuser, because of his/her dependency, jealousy and shame will put strict limitations on whom his/her partner can see and when he/she can see those people. The partner becomes isolated and mutually dependent. The partner is likely to submit to the abuser because of his/her own low self-esteem, shame, guilt and to keep “peace at any price”. Also, the more isolated the couple gets, the fewer external “reality checks” there are about what is going on in the relationship. The partners forget what normal is. Both partners have no close friends with whom to talk and share feelings. The more isolated they feel the more dependent they become and the less flexible they are.

• Teasing: ridicule and joking about the partner in a negative way. Teasing corrodes self-esteem.

• Hitting objects or walls, throwing objects even when he/she says, “But I’d never really hit you.”

• Filling up the door way, not letting the other pass or get away. Pursuing the other, even when the other wants a “time out” period.

• Standing over and watching the other person sleep is a method of intimidation and reminds him/her of his/her vulnerability.

• Sexual assault, even when not accompanied by extreme physical injury.

• Not taking no for an answer; not stopping something, like tickling or an annoying

noise; continuing the argument for hours and not letting the other person sleep.

• The silent treatment: not talking for long periods (hours or days) • Depleting the couple’s resources: such as spending money foolishly, thus leaving the partner to pay for essentials or liable for debts. Refusal to change spending habits leading to bankruptcy.

What To Do When I’ve Tried Everything: Seek professional help. Psychologists, psychiatrists and clinical social workers are all trained to help people understand and manage their anger. Call the provincial/state organization for the profession you would like to see to get some names of professionals in your area. Also, ask friends who they know to be good in your community. Family physicians are often a good source of referral to a psychologist, psychiatrist or social worker. It is sensible to get help before anger causes turmoil and damage in your life.

Chapter 10 Workplace Diversity: Cultural Differences Dr. Qadeer Ahmad In the next millennium most work environments will consist of people with different cultural backgrounds. In such a workplace, the potential for cultural misunderstanding will naturally be present. If we can gain a better understanding of the potential sources of such misunderstandings and what to do about them, we can enhance the enjoyment and satisfaction necessary to a healthier working life.

In the past decade, the words Cultural Diversity have been used to sensitize people to the many influences cultural issues can have upon the work

environment. The purpose of this chapter is threefold: 1) To introduce you to what Cultural Diversity means; 2) To help you gain a greater understanding of some of the issues that can arise in the workplace when culture(s) is misunderstood and ; 3) To give some suggestions as to how to create a culturally sensitive workplace.

Before beginning, it is important to note that when examples and case studies are used in this chapter, the names have been changed to maintain confidentiality and protect the identity of individuals. Also, throughout this chapter, examples of cultural misunderstanding will be used. At times, these examples will be pointed and may produce discomfort in the reader. I believe this is unavoidable given the controversial nature of cultural misunderstanding.

What is Cultural Diversity?

It is important to gain an understanding of what Cultural Diversity means.

Overall, culture can be defined as a system of shared ideas and meanings. More specifically, culture can be better understood if it is described in two ways, namely personal and social.

The following example will assist you in understanding culture as social.

In my recent travels, I was told that, in the culture I was visiting, a man is greeted with a handshake and a pat on the shoulder, a woman is greeted with cheek kisses, right cheek first and then the left. Moreover, in some cultures it is considered rude if a man shakes a woman’s hand or vice-versa. In other cultures it would be rude if you did not greet a woman the same way you would greet a man.

In the above example, there is both a personal level to culture and a social level. The personal level refers to what goes on inside the person. Therefore, the rules of the culture are so much a part of the person that if the rule is not carried out it causes discomfort in that person. These rules are often taught to the person from the time they are very young and as a result, the rules are associated with comfort and familiarity in behavior. Going against the rule can relay personal messages, I won’t shake your hand because; I don’t know you, or like you, or trust you. Often these rules are referred to as customs. In this way, culture is a personal code by which a person’s internal world (how

you feel about another person) can be relayed from individual to individual.

Culture is considered to be social when it is a result of how an action is understood by the public or the society you live in. For example, consider a wink as opposed to an involuntary eye twitch. In some cultures such an action is a signal which carries a meaning. In other cultures it means you might have something in your eye. In other words, it is how the action is interpreted by the public. The cultural act is understood publicly and therefore does not need to be openly explained every time it is used. In the example given above, it can be seen how there is both a social and personal aspect to each of the actions described. A handshake has both a personal and social component to it. On a personal level it is taught at a very young age as a custom of acknowledgement towards another person. In ancient times it was not only a gesture of trust and respect but also safety. You could not strike each other with swords or knives if both your right hands are clasped together. On a social level, certain societies recognize that the clasping of hands means there is personal acknowledgement occurring. In other societies it may be considered rude or completely misunderstood.

Exercise 1) Try and identify ways in which people you work with relay personal cultural messages.

2) Try and observe culture as social in your everyday work life. For example, if you drive to work, try and notice the many cultural signals communicated when driving.

The personal and social components of culture are also related to and affected by two other factors, diversity and commonality.

Diversity can refer to variety and variability in events, items or people. It is diversity that increases our cultural inventory (new customs brought by people of different cultures can add diversity to the host culture). Perhaps, the easiest place to observe cultural diversity in a community is in food. Often the only place people are exposed to diversity is when they eat at a restaurant which serves food traditional to another country. In many cases, people will attempt to prepare the different food they have eaten in their own homes. This adds some cultural diversity to their lives.

Commonality allows for communication and coordination within a culture. Growing up in a similar culture results in a shared understanding of the same customs and cultural

traditions. For example, for many people, Christmas is a cultural tradition in North America. It is generally understood to be a Christian holiday celebrating the birth of Jesus Christ. It is a tradition that children will typically be raised with from the time they are young. A tradition that is commonly understood at Christmas is the exchange of gifts.

There is even a greeting which is typical of Christmas time, “Merry Christmas”.

Christmas time provides a sense of commonality amongst many people in North America. In countries where Christianity is not the primary religion, there are also celebrations each with their own unique set of customs, greetings and behaviors, which have, been passed down through families. These times of celebration often serve to bring about a sense of commonality amongst people.

Exercise 1) List three ways in which you have experienced cultural diversity in your workplace.

2) List three ways in which you participate in cultural commonality in your workplace.

Culture as a Process Diversity and commonality are both affected by a process called culturation.

Culturation refers to the process by which we acquire culture. There are two basic ways to acquire culture; 1)Enculturation refers to learning about your own personal cultural background. This is typically done through your family traditions and history. We are taught to value our cultural heritage through traditions which are passed down to us from relatives. For example, if your heritage is Scottish, you might learn to play the bag pipes or to highland dance. Sometimes we are taught to make proud statements about our heritage as a way of identifying with how we have been enculturated. A humorous example of this was evident in the television show Saturday Night Live where a Scotsman stated that, “if it’s not Scottish, it’s crap!”.

2)Acculturation in contrast, refers to an exchange of cultural information between people or societies of different cultures. In this case, one culture can influence another.

We acculturate in the simplest way when we bring food, clothing, music and habits from a different culture into our lives in such a way that it affects the traditions with which we have been raised with. A most obvious form of acculturation occurs when a person of one

culture marries a person of another. Other ways include friendships with those of culturally different backgrounds. These events usually results in a sharing and combining of cultural traditions.

Exercise 1) List the culture(s) have you have learned and been raised with.

2) List three ways in which you bring this heritage to your workplace?

3) List how you have experienced or have been affected by other cultures.

4) How do you think contact with other cultures has affected you at work?

Culture in the Workplace Throughout the previous sections you have been given a basic understanding of culture as a process. Because culture is a such an important component to our everyday lives it is not surprising that culture as a process affects us not only at home but also at work. As a matter of fact, workplaces in North America have begun to make a strong effort to become culturally sensitive. The workplace of the nineties and into the next millennium will most certainly be culturally diverse. With advancements in technology the world has become a Global Village. Which means that more than ever, our daily work lives will bring us into contact with different cultures.

As the increased contact between peoples of different cultures occurs, be no doubt cultural misunderstandings will happen. If these misunderstandings go unresolved for any lengthy period, Culturative Stress may occur.

What is Culturative Stress?

This form of stress is, in the simplest sense a feeling of being culturally misunderstood.

This misunderstanding is typically the result of a clash between the processes of enculturation and acculturation. It is not uncommon for people to experience culturative stress at work. Everyone brings into their work lives the enculturation they have received throughout their lives. The chances of this enculturation being challenged by acculturation at work has increased significantly in the last decade. Because of this, it is important to discuss with you the nature and possible outcomes of the challenges.

How we are enculturated usually results in the development of certain beliefs about what is acceptable behavior and what is not. It can also result in the belief that certain customs are right and therefore others are wrong. In its most severe forms these beliefs are sometimes used to justify that some cultures are naturally superior to others. How rigid

or inflexible these beliefs are, usually determines whether or not culturative stress will be present in our workplaces. In the following, a list of unhealthy cultural attitudes/beliefs which I believe are major causes of culturative stress will be presented. This will be followed by a series of case studies with which you will be asked to identify the existence of these unhealthy attitudes/beliefs.

Racism: The word “race” first occurred in the English language at about 1500 AD The initial use of the word was to indicate that a group of persons with some commonality.

By the eighteenth century the word race was being used to divide humans into categories based on physical characteristics such as skin color. By the mid-nineteenth century race also included divisions based on culture.

Racism can occur when a person is denied the same rights and freedoms as everyone else in a society because that person is different in terms of color, physical characteristics, nationality, or cultural heritage. Racism is considered to by many to be the most severe form of cultural stress.

Prejudice: This is an idea, belief or prejudgment towards a specific group of people because they are different culturally, physically or behaviorally. Prejudice is the act of making judgements or decisions about somebody even though you may know very little about that person or peoples. In fact, you may have never even met a person with such a difference. For example, a growing child may have never met an Aboriginal person but through the teachings of their parents they may come to believe that Aboriginal people are lazy, alcoholic and untrustworthy. As a result the child will grow up with a prejudice toward Aboriginal people.

Discrimination: This occurs when someone acts out his/her prejudice(s). For example, if the child who has a prejudice against Aboriginal people carries this belief into adulthood, they may be in a position one day, to deny an Aboriginal person a job based upon their prejudice. In North America, there are laws in place to combat discrimination.

However, the prevention of discrimination is still proving to be a difficult task.

Ethnocentricism: Is the widespread practice of favoring (to different degrees) your cultural heritage over others. In the extreme sense, a person is ethnocentric when they place their culture the highest and then rank all others in stages below. Ethnocentricism produces a “we versus they” atmosphere. Many cultures throughout their histories have

promoted ethnic preference. Ethnocentricism can lead to terrible misunderstandings amongst people and can also result in the isolation of some people due to the “we versus they” mentality. In Canada, ethnocentrism can be observed when English speaking Canadians and French speaking Canadians divide out mostly because of language. I have had the opportunity to observe this occurrence in many workplace settings, usually during breaks, lunch hours or social occasions. Often a clear sign of ethnocentrism occurs when members of one ethnicity look upon another as outsiders.

Stereotyping: This occurs when a person(s) develops in their mind, a simplistic, and unrealistic picture of a particular culture. Examples of this might be the; drunken Irishman, the Jewish nose, or the smiling china man, or the stingy Scotsman, or the greasy Greek. These stereotypes are designed to establish in-groups and out-groups. An in-group is one to which you belong and an out-group is a group of people that, for various cultural reasons, you would not include as part of your group. In one particular work setting I heard the following statement, “Don’t hire French speaking women, they talk too much, hire Polish women they are always hard working.” This statement illustrates a judgement based upon a very simplistic notion.

Social Distance: Is a measure of how much communication or actual contact occurs between different cultures. If social distance is far, the type of communication is very formal and not very intimate. If social distance is near, there is a lot of contact on a personal level often leading to comfortable conversations and sometimes friendships.

When social distance is far there is not much of an opportunity for the different cultures to challenge the myths or stereotypes they might have about each other nor is there much opportunity for acculturation to occur. In a recent conversation with a high school student it was explained to me that due to the high degree of ethnic diversity, social distance was very near. This often resulted in conflict, which forced an understanding between the different cultures.

Xenophobia (Zenofobea): Can be defined as a fear or hatred of foreigners or strangers.

In its simplest sense it can be a fear of something new, unfamiliar or strange. Sometimes people fear someone simply because they look different or dress differently or even smell differently. In some cases the fear is explained by not wanting to change your ways to the ways of others. This change, it is thought, might make a person different and as a result this might lead to unacceptance by the majority culture. I had the opportunity to observe a young child staring at a tall slender of woman of color, dressed in flowing robes, while his mother was watching for the bus. When she noticed her child, she quickly grabbed his

hand and moved further down the street away from the woman. It is possible that in this situation, the mother could have been reacting out of cultural unfamiliarity.

Perhaps you relate to the previous examples. Perhaps you have been a victim of some of the behaviors/attitudes/beliefs that have been described. Perhaps, you recognize some of these behaviors/attitudes/beliefs in yourself. Although the majority of people attempt to avoid culturally harmful attitudes, we have all experienced or been a part of them to varying degrees. It is a fact of human nature to struggle with differences. It is important, however, to strive to accept the differences through understanding. We need diversity to survive as humans.

The following, examples are presented for your analysis. The purpose of this exercise is to help you specifically identify unhealthy cultural attitudes/beliefs/behaviors.

Example 1 Mohammed Iqbal is a South Asian man working as a clerk in a corporation. Every year, the corporation holds Christmas parties in its various sections. Mr. Iqbal chooses to participate in these occasions despite being a non-Christian. Mr. Iqbal does not drink alcohol because of religious reasons. He has shared his beliefs with his coworkers on many occasions, but some still continue to offer him alcohol saying, “if you try a little you will really enjoy it” or “you just don’t know what you’re missing”. His coworkers do however make available to him various other nonalcoholic beverages. On this particular occasion, some of Mr. Iqbal’s coworkers decided to play a joke on him. One coworker asked him to hold his drink for him (an alcoholic cooler) while another took a picture of Mr. Iqbal from a distance. The following week, the picture of Mr. Iqbal holding the bottle of alcoholic beverage was posted on the section bulletin board for all to see.

Question: In the space below, identify whether or not the following unhealthy cultural attitudes/beliefs and behaviors are present; Discrimination, Stereotyping, Social distance, Ethnocentricism.

Example 2 James, a Christian African-American man, was just hired by a company. During his training period, he was paired up with Sarah, a Muslim woman of color who immigrated from Nigeria 15 years ago. Management decided that the two individuals have similarities and therefore, the training would be easier and perhaps more comfortable for James. Sarah’s opinion on the matter was never obtained. James desk was placed beside Sarah’s prompting comments such as how, “nice it is to see the two of them together”.

Despite coming from very different cultural backgrounds, it was often assumed that the two shared similar customs and beliefs.

Question: In the space below, specify where in the example the following are present; Racism, Ethnocentrism, Social Distance, Stereotyping, Prejudice.

Example 3 Mary-Lynn is a woman of Latin American heritage. She is a manager in a medium sized corporation. During meetings with other managers, she often expresses her opinions with much passion and sometimes emotion. When speaking, she occasionally stands up and moves her hands around to make her point more obvious. One day, she received a memo from the other managers stating that it was obvious she found the meetings very upsetting and they would understand if she no longer wanted to attend them. As a matter of fact, it was strongly suggested to her that she sign up for a course on communication in order to improve her conduct during meetings.

Question: As with the other examples, identify in the space below where the cultural misunderstanding exists.

Each of the examples given were actual occurrences. The names were changed for the sake of confidentiality. Each example represents a situation where there are cultural misunderstandings on a variety of levels. In the following, ways of creating a better understanding culturally will be discussed.

Steps Toward Being more Culturally Sensitive Racism, prejudice and discrimination are often the result of a process whereby these attitudes/beliefs/behaviors are passed from generation to generation from the time we are very young. Challenging these attitudes, both from within ourselves and amongst our fellow humans is not easy. This challenge requires being able to develop new skills.

These skills will assist in being flexible and adaptable in our beliefs about other cultures.

Because culture is so complex, with so many different rules, customs and practices it seems very difficult to avoid misunderstandings between one another. With this in mind, it is important to remember that misunderstandings are bound to happen. It is how we resolve these misunderstandings that makes a difference. Cross-cultural communication (how we communicate with other cultures) is a key factor to gaining a better understanding of different cultures. Many years of research on culture has lead to certain understandings about how to communicate effectively across cultures. If used, these understandings can greatly reduce cultural conflict at work. This can ultimately lead to a reduction in culturative stress. First let’s review some general symptoms (characteristics) of a culturally insensitive and a culturally sensitive workplace..

Characteristics of a Culturally Insensitive Workplace 1) Withdrawal from communicating with other coworkers.

2) Angry statements about coworkers (i.e. damn Frenchman!).

3) Attempts to form in-groups and out-groups.

4) A different set of working rules for one person compared to others, based on cultural differences only.

Creating a culturatively sensitive workplace requires the following general rules.

Characteristics of a Culturally Sensitive Workplace 1) Be aware of attempts to discuss cultural occasions or customs by a coworker.

2) Take the opportunity to openly discuss your cultural heritage with others.

3) Avoid making assumptions by asking questions. Remember culture is complex and diverse and there is always something new to learn.

4) Create occasions to discuss culture at work. Such as a day where people can share their culture with others.

5) Take the opportunity to participate in diverse cultural activities in your community

Non-Verbal Communication In the field of cross-cultural communication, studies of the non-verbals has proven to be helpful in enhancing understanding between cultures. Non-verbal communication refers to what we say to each other without the use of words. A gesture, posture, tone of voice may make a message clearer or more confusing. For example, when a man raises his voice, stands up and pounds on his desk saying, “I’m not upset” it is confusing because his verbal and non-verbal messages are opposites. Communication specialists believe that only 30-40% of what is communicated conversationally is verbal (i.e. what is said using words). Therefore, between 60-70% of what is communicated involves the non-verbals.

This is particularly important when communicating across cultures. The same non-verbal may mean something completely different to people of different cultures. As I described earlier, a blink of the eye done purposely may mean, “I like you” in some cultures and absolutely nothing in others. There are three aspects of non-verbal communication, proxemics, kinesics and paralanguage: Proxemics (personal comfort zone): This refers to the physical distance separating individuals when we communicate with each other. In English speaking North American society why tend to be comfortable communicating with someone who is between 1.5 to 4 feet away from us. If this personal space is violated, a range of reactions can occur, from moving away, to anger and frustration. Different cultures have different distances of

personal space. Latin Americans, Africans, Indonesians, Arabs, South Americans and the French have much closer personal communication spaces than English speaking North Americans. A Latin American person may find an English speaking person who moves away to open up more space, snobby or impersonal. On the other hand, an English speaking person may find the Latin American closeness as uncomfortable or too personal.

Research has shown that how we set up our furniture in our offices can affect crosscultural communication. A Latin American person may find having a desk between himself/herself and the person they are talking to, uncomfortable or impolite. It is always important to consider the proxemics when communicating with someone from a different culture. This can be done by being aware of your own style and that of others. Also, if possible, making your office environment flexible to cross-cultural communication (i.e. different areas, chairs in front of desks and away from desks etc.).

Exercise Invite two people you know to your office to participate with you in this exercise. If possible, one should be of the opposite sex and also a person who speaks a different primary language or is partly or entirely from a different culture. Stand face to face about ten steps away from each other. Slowly move toward each other one step at a time. As you move closer say out loud how comfortable you are, when you get to a point where you first notice discomfort, stop moving. When you have stopped, note how far away from each other you are, if the other person is still comfortable allow them to keep moving towards you until they stop, once again note the distance. Return to Example 3 and re-examine the situation using what you know about proxemics.

Kinesics (Body language): This is the term used to describe how we move our bodies when we communicate. When we smile at someone we are using kinesics to help us communicate. In English speaking North American culture, smiling usually means happiness. However, some cultures (Japanese, Chinese) interpret smiling to also mean weakness or embarrassment. How you move your head can also have a different meaning. We shake our head side to side in North America to communicate no. In some areas of India, shaking your head side to side indicates happiness or pleasurable agreement. Shaking hands is also a method of communicating. In Latin American countries shaking hands firmly and for a long period of time is typical. In most cultures

you only shake hands with the right hand. Due to religious and cultural reasons, Muslims consider an offer of the left hand insulting. Eye contact is also often misinterpreted. In many cultures direct eye contact is disrespectful. In the North American culture indirect eye contact is considered to be a sign of weakness or untrustworthiness: “he would not look me in the eye”. Once again it can be seen that there are many opportunities to be misunderstood. Being aware that kinesics can play an important role in how you communicate is the first step. Don’t be afraid to ask questions about a persons kinesics.

This is often called gauging or calibrating a person’s communication style. This simply means you are trying to match a person’s kinesics to the meaning of what they are actually saying with their words.

Exercise If you have a family video of a wedding or a trip to another country, province, state, review the video with the sound off. Pay attention to the kinesics of the people in the video (i.e. postures, facial expressions, hand movements). Also, you can rent a foreign movie and turn the sound off watching for the kinesics. Choose certain people in the video to follow. When you are ready, turn the volume back on and try and calibrate the kinesics with the spoken words, to see if they match what you thought the kinesics meant.

Paralanguage (tone, loudness and pitch of our voice): This aspect of non-verbal communication refers to the “music” of a language; the tone, loudness, silence, pauses, rate or speed spoken, hesitations. Loudness of speech, for example, is quite variable across cultures. In many Asian countries people tend to speak softly compared to most in the United States.

When to speak is also culturally determined. Many cultures have very strict rules as when to enter a conversation and when not to. In North America, we tend to encourage open expression in our children. People from the British Isles tend to have more formalized rules about when to speak, or enter a conversation. A colleague working for the Foreign Service found it tiring and confusing when he tried to converse whilst living in a South American country. It was his opinion that people spoke over each other and no one seemed to take turns, everybody seemed to speak at once.!

How directly you speak seems to be culturally determined as well. This refers to how quickly you get to the point of what you are trying to say. In many Asian and Aboriginal cultures, stories or metaphors are used to make or add to a point. In English speaking,

North American cultures, where debate is valued, the point is usually made with as few words as possible.

Understanding paralanguage can greatly improve your understanding of how other cultures communicate. Once again, it seems complex, but the rules are simple, be aware, ask questions and calibrate.

Exercise With the permission of others, take a tape recorder and tape a conversation between yourself and several others, preferable of different genders and cultures. Play the recording back and pay particular attention to the paralanguage used. Another exercise to try is to close your eyes and listen to the conversation around you in the office. Once again try and note how paralanguage is used.

This very basic examination of cross-cultural communication demonstrates how complex a field it is. Try not to get overly analytical. For the most part, we tend to struggle through and communicate well enough to be understood. However, if you find you are constantly misunderstanding or being misunderstood, examine the non-verbals.

A Final Word Overall, we have covered some of the more important aspects of cultural diversity at work. This is particularly important because the world has become a Global Village and we can no longer avoid facing cultural diversity in our day to day lives.

Throughout my experiences in helping workplaces become culturally healthy, I have often noted how little importance is given this area of understanding. When a lack of cultural consideration occurs, a workplace loses much of its creativity and effectiveness.

A culturally insensitive workplace can be a lonely and isolating place. Creating a culturally sensitive workplace begins within yourself through self-awareness and self education. Through these two processes, you develop both flexibility and adaptability to differences amongst people and their cultures.

It is hoped that you have gained a greater awareness of what cultural diversity means and that you can apply some of this awareness to your workplace. It is an interesting and exciting area to explore. When done respectfully and with genuine interest, it can create a world of opportunity.

Chapter 11 Living Free From Addictions Dr. Iris Jackson It has often been said that humans have long sought altered states of consciousness, either for the thrill of the experience or as an escape from some emotional or physical pain in their daily life. As a child, you probably twirled around in circles making yourself dizzy and then collapsing on the ground in a gale of giggles. As a teenager, perhaps you enjoyed the rush a ride on the roller coaster gave you. Some adults use extreme sports to break free of everyday reality. However, a favourite way for many people is to become a bit buzzed on alcohol or another chemical. Alcohol and other drugs have been known to civilization since the dawn of time. Most people can use these chemicals periodically without any long term negative effects. Some people, however, get caught in the trap of addiction.

While the focus of the rest of this chapter will be on alcohol, much of what I will say can be applied to other chemicals. Although there are differences between chemicals that are depressants, such as alcohol, marijuana and the barbiturates, and those that are stimulants such as cocaine and amphetamines, the self-destructiveness and the damage to oneself and one’s lifestyle of abusing chemicals are similar. Some addictions just take longer to damage the person than others.

Some fictitious examples Please note: we respect the confidentiality of our clients, so our examples are not of real clients, but, rather, are fictions based on combinations of people we may have known in our personal or professional life.

Meg is a mother, wife and homemaker who is 32 years old. She has a little girl in school, 7 years old, and a little boy, 2 years old. Her son sleeps two hours in the afternoon. Her husband is a successful lawyer who works long hours and provides well for his family.

Meg keeps her home tidy and the children seem to be well cared for and loved. What is invisible to her neighbours and her husband is Meg’s pattern of having three to four

glasses of wine with lunch. She then goes to sleep with the baby for two hours and by the time her daughter comes home from school, Meg is usually fully alert, although a little headachy. By the time her husband gets home, around eight o’clock in the evening, she is ready to put her feet up and watch him eat his dinner. She usually has one or two glasses of wine with him as he winds down and they discuss their day. No one has ever seen Meg drunk. Meg has had this pattern of alcohol use for about six years, interrupting it only when she was pregnant or nursing her children. Is Meg an alcoholic?

Joe has worked construction for thirty-five years, since he was 18 years old. He has been a steady and reliable worker, although he has never risen in the ranks of his trade. A smart man with a marvelous sense of humour, he has always had a lot of good buddies.

For many years, he played baseball in the summer and hockey and bowling in the winter, in recreational leagues. From the beginning of his work life, he always drank a couple of beer after work, stopping at his favourite pub on the way home. Friday nights, he stays late with his buddies, often getting home at midnight after about 12 to 14 beer. When his wife complains, he points out that he has never missed a day of work in his life and she should count her blessings that they have all the things they enjoy. Recently, Joe has noticed that he thinks about the after-work beer all day long, and on Saturday mornings, he is not only hung over and irritable but he has the shakes and feels self-conscious about needing two hands to lift his coffee cup. Is Joe an alcoholic?

Mark, age 40, only drinks four times a year: New Years Eve, his birthday, the first day of spring and the first day of fall. He jokes about it, but he decided to do this when he was 25 years old and his father died of cirrhosis of the liver. He never wants to be a drunk like his old man. On those four occasions, however, he really cuts loose. He knows it is a binge, but he enjoys drinking for the complete abandon and freedom he feels. He figures that drinking only four times a year won’t trap him in alcoholism, because his dad drank everyday from noon until he went to bed. Mark would never do that. He is concerned however, that the last two times he binged, he lost three days. He does not remember what he did, and the last time, he did not even wake up at home. He was in a hotel in one of the suburbs of his town. Is Mark an alcoholic?

Jerry is 18 years old and has been drinking since he was 13. In fact, he clearly remembers getting drunk and very ill on the rye that he and a buddy stole from his father’s stash in the kitchen cupboard that first time. Now, even the smell of rye can turn

his stomach. As a result, he has decided not to drink hard liquor, and sticks to beer or wine. His friends used to be amazed at how much he could drink and not show it, but he has noticed that none of his friends drink every day like he does. He has had difficulty getting up in the morning to go to school and he has been in conflict with his parents all year because he has rejected all their household rules. Now, his dad is suggesting he find a job and his own room some where else, but, in his heart, Jerry worries that he can’t make it on his own. Who would get him up in the morning? What if he gave in to his craving to drink all the time? How could he afford to drink the way he does if he didn’t have access to his father’s wine cellar? Is Jerry an alcoholic?

Carol is a 38 year old business woman who has risen in the ranks of her corporation because of her vivacious sales skills and her excellent organizational abilities. She earns more money than she can spend, especially because she works long days and rarely takes holidays. She is single and has some good friends, both men and women, who are as career oriented as she is. She lives in a condo in a luxury high rise in the central part of town, but doesn’t see much of her place because of her long work days and frequent business trips. She learned to drink white wine when she started in sales, because she was told, and believed what she saw, that “you had to drink with the clients to make the sale”. Everyone did it. Now, she looks forward to the minibar in the hotel rooms, the free cocktails on business class air flights, and her well stocked bar at home when she is in town. In fact, Carol sometimes wonders if her preoccupation with the alcohol is preventing her from doing some of the things she used to enjoy. She recently turned down an evening out to the movies with an old friend because she would have to go two hours without a drink. She’d rather rent a movie at home and have a drink while watching it. Is Carol an alcoholic?

Conrad is 68 years old. He misses his management level job since he retired three years ago. Conrad doesn’t mind the summers too much, because he gets out to the golf club and sees his golf buddies, but the winters are hell. He hates the ice and snow and spends most of his time at home watching TV His wife would like him to make some things for his grandchildren in his wood working shop in the basement, but he just hasn’t had the motivation. Besides, he doesn’t know the kids well enough to figure out what they might want. He finds himself thinking about his working days and sitting around drinking.

Even in the summer, he and his golf chums spend a lot of time at the “nineteenth hole” drinking and rehashing the game. Conrad doesn’t say much but enjoys listening to the banter. His wife doesn’t like his drinking but he figures he is too old to be an alcoholic.

He knows, for sure, that he is too old to change his ways now. If only he could feel

interested and happy again. Is Conrad an alcoholic?

The short answer to the questions about Meg, Joe, Mark, Jerry, Carol and Conrad is: yes.

It is highly likely that all of them have developed a dependency on alcohol that would lead them to withdrawal symptoms, possibly to the point of seizures, if they stopped drinking. Many people think that alcoholics are skid row bums, and anyone with a good job or very young or very old cannot be an alcoholic. Wrong! Many fine people of all ages and all walks of life are alcoholic. People with all types of personalities have become addicted to alcohol. What then defines an alcoholic?

Alcoholics drink repetitively and compulsively in spite of negative consequences to their physical, mental, emotional and spiritual health and in spite of the problems their drinking causes their relationships at work and at home. They have lost the ability to control their intake, and so cannot stop at just one drink. Active alcoholics are typically in denial about the severity of the problem and the negative consequences. Alcoholics use too much alcohol too often, drinking for the drug effect. They cycle between intoxication and withdrawal symptoms, without much pause for a normal state of mind in between.

Initially, alcoholics develop a high tolerance for alcohol, and can drink a great deal without appearing to get drunk. Eventually, however, they loose their ability to metabolize (neutralize) alcohol quickly, their tolerance for alcohol drops markedly, and they appear to get very drunk very quickly. Alcoholics who continue to drink get worse with time until they develop medical problems with their kidneys, liver and brains, and until they lose everything they value; until they “bottom out.� Alcoholics are dependent on alcohol and experience withdrawal symptoms, such as shakiness, headache, and other symptoms associated with hangovers.

Studies of drinking patterns suggest that, in North America, between 5 and 10 percent of the adult population drink alcoholically. It usually takes men about twenty years and women about ten years to develop a dependency on alcohol. That is, it usually takes that time for alcoholics to develop enough social and physical problems that they or their loved ones know they have a problem.

Note: A drink is a drink is a drink. That is: 12 oz. Beer = 5 oz. Glass of wine = 1.5 oz. Spirits (hard liquor)

How Can You Tell If You Have A Drinking Problem?

1. Do you need to drink more and more to get the same effect of intoxication?

2. Conversely, do you get drunker much faster than ever before?

3. Do you get more hung over even when you have not drunk very much?

4. Do you find yourself drinking to get rid of the hangover?

5. Do you usually drink more than you planned, and that you cannot stop at just one drink?

6. Do you drink even when you promised yourself or someone else that you would not drink on this occasion?

7. Do you crave alcohol when you know it is not readily available?

8. Are you preoccupied about when and where you will have your next drink?

9. Have you wanted to cut down or stop drinking but have failed each time you tried?

10. Do you spend more and more time getting alcohol, using alcohol and recovering from the effects of the alcohol?

11. Have you given up or reduced important social, job related or leisure time activities because of your drinking or its effects?

12. Do you continue to drink in spite of recognizing the effects your use of alcohol is having on your body (for example, ulcers), your mood (for example, depression), your relationships (for example, fights with your spouse or boss), your budget (spending too much on the chemical) or your job (loss of productivity)?

13. Has anyone ever told you that they thought you have a drinking problem or that they wanted you to stop drinking?

14. Have you ever been arrested for driving while impaired by alcohol or for disorderly conduct?

Low Risk Drinking Guidelines: Healthy people who drink can minimize the risk of injuries, disease, social problems and alcohol dependence by following these guidelines: • Drink no more than 2 standard drinks on any day. • Limit your weekly intake to 14 or fewer drinks for men and 9 or fewer drinks for women. • Drink slowly, waiting an hour between drinks; take alcohol with food and

nonalcoholic beverages.

• If you abstain, don’t start drinking for its protective effect against heart disease; there are less risky alternatives such as exercise, better nutrition and quitting smoking.

• If you choose to drink, the protective effects of alcohol can be achieved with as little as 1 drink every other day.

• If you seek help for a drinking problem, seriously follow the advice of your counselor.

(These guidelines are adopted from The Ontario Addiction Foundation’s 1998 low risk drinking guidelines with some additions from my own knowledge and professional experience.)

Who Should Not Drink?

• people with certain health problems, such as liver disease, pancreatic disease (such as diabetes), psychiatric illnesses, chronic fatigue and some neurological diseases; • people taking certain medications, such as sedatives, tranquilizers, antidepressants, antibiotics, anti-inflamatories and some pain medications; • people with a personal or family history of serious drinking problems; • women who are pregnant, trying to get pregnant or breast feeding; • people operating any kind of vehicle, heavy machinery or dangerous equipment; • people responsible for the public order (such as police or fire fighters), or while working in a position of trust (such as counselors or clergy);.

• people responsible for the safety of others, such as those in charge or children or the elderly; • people under legal restriction from drinking, such as those on probation or parole, when not drinking is a condition of release; • people engaged in a challenging physical activity during which being alert is important for safety, such as any type of extreme sport; and, • people wanting to loose weight.

So I think I have a Problem: What Do I do First?

When people realize that they have a problem, most immediately try to stop drinking for a while. This may not be the best strategy. If you have been drinking heavily for a long

time, stopping suddenly could lead to you having seizure. Also, just because you can stop drinking for a week or a month or even three months, does not mean that you don’t have a drinking problem. An alcoholic who stops for a while and then starts drinking again, frequently returns to the same rate of consumption, or more, very quickly.

Some people can drink in a controlled way and not return to over doing it. However, such people are few and far between. Because scientists have not yet found a way to determine which alcoholics can safely control their drinking without having it get destructive, most counselors recommend abstinence.

The first thing to do is to go to your family physician and be honest about your drinking rate. Ask your physician to do a complete physical examination, including testing your blood, so that you can learn what damage may have been done by the alcohol and also if it is safe for you to stop drinking abruptly. If the physician determines that it is not likely to be safe for you to stop drinking abruptly, he or she may prescribe some medication to ease your way to sobriety, or you may try to taper off the alcohol by slowing your rate of consumption by some percentage each day.

Although it sounds difficult, the easiest thing to do if you think you have a drinking problem is to set a date for stopping and then stop. Many people require some support to do this, such as Alcoholics Anonymous, an addictions counselor and/or a wise mentor (not a family member). Family members are usually too caught up in their own subjective reactions to the alcoholic’s drinking to be of much help in the sobriety process.

Some people stop for a while (months through to years) and then start drinking again to see if they can drink without abusing the alcohol again. It seems that the longer some people stay sober the less they believe that they have a problem. Very frequently, people who start drinking after a prolonged period of sobriety get right back into heavy drinking very quickly, and find that they must stop again. People who have cycled through this a few times become very cautious and wary of alcohol, stating that they “haven’t got another recovery in [them]”.

The reason that stopping completely is easier than trying to control your drinking is that it is simple, and it is black and white. There are no further decisions to make about drinking if you decide to abstain. However, if you decide to try to cut back on your drinking, you can do that in a number of ways. One way is to cut back by a certain percentage a week. For example, if you typically drink 21 drinks in a week, you could

try cutting back by 15 percent a week. The first week, you would drink 18 drinks, the second week you would drink 15 drinks, the third week you would drink 13 drinks, the fourth week, 11 drinks and so on until you have stopped drinking. Another way to stop drinking is the 3, 3, 1 rule. That is, you could try drinking only three days in any week, only three drinks on those days and only one drink an hour. Of course, if you do the 3, 3, 1 rule, you will not get drunk, and for many drinkers this defeats the purpose of drinking.

If you find that to be true for you, then abstinence is your best bet, because you are clearly drinking for drug effect and you are not likely able to (or interested in) becoming a social drinker.

I Tried But I Can’t Stop: What to Do Next Some people stop drinking without professional help or self-help groups. However, many people do need support to quit. The next step is to go to an Addictions Assessment Center (most mid- to large towns have them) for an assessment of your drinking and a referral for treatment. Addictions treatment programs are either “outpatient” or “residential” in nature. “Outpatient” programs have you live at home, but come into the facility for counseling groups and individual sessions for some part of the day. These programs are less disruptive of people’s lives and jobs. However, it is challenging to remain sober while in the same environment you were in when you were drinking. These programs help you make plans to change your lifestyle so that you can develop friends and resources that are not part of your past drinking world.

Residential programs require that you go into the facility (often a converted hospital or lodge) to live while you go through the program. The usual length of stay is 28 days, although some people with very serious problems with alcohol sometimes go to residential treatment facilities where they stay for six months. While these programs clearly disrupt your usual life, they also permit alcoholics to focus on learning to get better in a safe and protected environment with 24 hour help. Research and experience has taught that people need to have at least two years of follow-up help after discharge from a residential treatment program in order to prevent relapsing back to drinking.

Attending follow-up groups, Alcoholics Anonymous meetings, or finding a counselor or psychotherapist in your community is critically important to staying sober.

Some people use Alcoholics Anonymous (AA) groups as their sole source of help to enter recovery from alcohol addiction. If you decide to try just using AA, it is a good idea to get involved as much as possible, as fast as possible. Some people believe the

best way for a beginner to do that is to attend “90 meetings in 90 days”. While this sounds intense, it is an excellent way to become familiar with what types of meetings there are and what types of people go to the different meetings. Each meeting has its own “flavor”. Ninety meetings in ninety days helps people learn about the program, become familiar with the twelve steps and twelve traditions, get to know people so they can choose a sponsor or mentor, and find “home group” to which they make a commitment to attend. Going frequently to AA meetings also siphons off some of the anxiety that stopping drinking and being new to the groups can create.

The family members affected by the alcoholic should also do some work to recover from the experience of living with the alcoholic. A great deal of their life experience has been distorted by living with an addict, and few people come through the experience unscathed. Adults affected by alcoholics can attend Al-Anon while teenagers can attend Ala-teen. Ala-teen is not for teenage alcoholics but, rather, it is for teenagers affected by someone else’s drinking. Family members can also go to agencies and counselors knowledgeable in addictions. Reading books on recovery from addictions is also a useful way to learn more. However, implementing the ideas found in books is difficult and often requires some real, live help in the form of a sponsor, mentor or counselor.

It is important to be a wise consumer in seeking a counselor if you decide that you want to be seen for individual help. Not all physicians, psychologists or social workers have addictions training. Not all addictions counselors have prior credentials in nursing, psychology, or medicine that provide a sound basis for recognizing the range of problems that people bring to their counseling sessions. About 34% of people with addictions problems also have other, diagnosable, problems, such as depression, anxiety, or phobias that require treatment. Such people are often referred to as “dual diagnosis” or “concurrent disorder” clients, because they need help with both the addiction and the other mental health problem. Check the credentials and experience of the counselors you see. Ask questions about their accountability and who governs their work if they should make a mistake with you. Through your life experience, you have a great deal of first hand expertise about addictions. If the counselor’s beliefs or approach to helping you rings false, find another counselor. A good way to find a counselor who will be useful to you is to ask someone whose sobriety you respect, if they know someone.

You can also find a counselor by calling the state/provincial associations for the profession you would like to see or by talking with your family physician to get a referral. Some people work for companies that have an Employee Assistance Program

and can see a counselor for assessment and referral. The EAP counselor has a wide knowledge of community resources and of other professionals who are knowledgeable in addictions and can provide the longer term follow-up so necessary to prevent relapse.

There is more than one right way to get sober. Recovery from addiction is a process not an end point. Keep trying, get help and good luck!

Chapter 12

Consulting a Mental Health Professional - Counselling, Psychotherapy and Medication Dr. Doreen Gough Recently I asked a new client[1] what brought her to therapy. She answered, “Because my friends and relatives said I should get counselling.� Her response suggested to me, among other things, that the general public views psychotherapy and counselling as having a purpose in peoples lives. Furthermore, she responded with an ease that indicated she was comfortable speaking with me and that she accepted the idea of seeking professional help for her problems.

This client was experiencing difficulties in her marriage and had a parent recently diagnosed with a terminal illness. She worried about the effect of these problems on her teenage children, who were beginning to show troubling changes in their behaviour. She had a high school education and grew up in a rural community. She now lives in a small town and commutes to the city where she works in an office. My initial assessment of her was that there was no significant family dysfunction. Until recently, she viewed her life as relatively normal.

After my initial meeting with this client, I recalled a conversation 15 years ago with a

highly educated, city-raised friend of mine. My friend disclosed that she and her husband, who was also educated and from the city, were experiencing a particular sexual problem, one that therapists usually remedy with less than six months of weekly therapy. While they both thought that going to a psychotherapist should be a decision made just as easily as that of going to their family physician or dentist, they resisted therapy and lived with the problem.

So what was it that accounted for the difference between my new client who sought therapy and the couple who resisted therapy? Was there a change over time in the image and acceptance of psychotherapy? Or did personality, education, where they had grown up or what their family had taught them cause the difference between my client and the couple? Did the couple resist therapy because they were ashamed, because they worried about confidentiality, or did they believe that quiet suffering made an individual morally strong? Had they reached a level of resignation described by the American philosopher Henry Thoreau[2] who said: “The mass of men lead lives of quiet desperation.”?

Some people advise distressed individuals to just get on with things and to “forget about yourself and your problems” through work, spirituality, sports, or helping others. This advice sounds like Nancy Reagan’s simplistic slogan of the 1980’s that to combat substance abuse you “Just Say No." It is true that a person becomes more involved in areas of love and work when they become independent from addictive substances, compulsive activity, crippling self-consciousness and irrational thinking. However, the achievement of such goals is not easy or automatic. It does not involve just shutting down and ignoring the challenges in life. Counselling and psychotherapy can help you gain independence from the forces in your life that are unhealthy and to establish healthy ways of thinking and relating to people and activities.

The second question I usually ask new clients is what they expect from psychotherapy.

This new client was not too clear about what she expected. I realized that the couple who was unwilling to seek help probably did not know what to expect from a psychologist either, despite their apparent sophistication. The intent of this chapter is to help you decide when you should turn to a mental health professional and what help you can expect to get. It will also explain what happens in psychotherapy.

Talking to a trained, knowledgeable, objective professional can help you to: • think about and understand yourself;

• recognize your deep needs and conflicts; • increase your ability to think rationally; and • decide when or if you need medication.

People turn to mental health professionals for assistance with their experiences - both past and present - which require examination, discussion, evaluation, and resolution in a safe and caring environment. They want to gain (or regain) a sense of calm, control and direction, as well as to increase self-acceptance and self-confidence. They receive an objective, knowledgeable and non-judgmental source of understanding, direction and validation. A special relationship develops between client and therapist. As the client, you should expect your therapist to become increasingly attuned to you. This means that you will hear your therapist at times speaking about and naming your inner experiences even before you have spoken about them. Occasionally your therapist may even act as an advocate on your behalf.

The previous chapters in this book may have helped you begin to make sense of your problems. Through your reading you may have begun to form ideas and words that describe the source of your suffering. There is a sense of relief when you see words on a page that describe your experiences, explore possible causes for your suffering, and suggest possible treatments. Perhaps a helpful analogy to this might be when your family doctor tells you that you are ill from an upper respiratory infection. It is caused by bacteria and the treatment is taking antibiotics for 10 days. Your relief starts even before the cure is complete.

You may decide that it is sufficient to read about how to help yourself to deal with your psychological and relationship problems. You decide not to pursue psychological treatment. You prefer dealing with things on your own, or by talking with friends. Had you declined the physician’s medicine, your immune system may have defeated the bacteria eventually on its own or with home remedies. Without antibiotics, people do survive some infections. However, ignoring the treatment usually leads to prolonged and more intense suffering. Most individuals do not want to suffer in mind or body if there is medical, dental, or psychological treatment that can alleviate this suffering.

In the following sections I will describe psychological interventions for mental suffering.

These include: 1. when to consult a mental health professional; 2. why talking to a professional is more beneficial than talking to a friend; 3. who qualifies as a mental

health professional; 4. what services are provided; and 5. how treatment cures.

When to Talk to a Professional Some people think that you need to be “crazy” to need therapy. Actually, the people who see mental health professionals are very ordinary people. They may be seeking relief from pain and suffering caused by losses such as marriage breakdown, death, or unemployment, loss of self-esteem or self-confidence, conflict or trauma. They wish to explore and resolve relationship and sexuality problems. They may feel that any hope for a significant relationship with others is futile. People have become more attuned to their emotions, and links between their own internal world and the outside world, between their mind and body, and between their past and present. In a recent Academy Awards ceremony, four of the five movies competing for best picture examined the theme of human relationships, both the damaging and beneficial effects in relationships.

It is quite normal and healthy to feel upset at certain times in one’s life - it is unhealthy to deny or suppress emotions. However, we cannot tolerate for long the feeling of being overwhelmed or flooded by emotions - anger, fear, rage, sexual tension, sadness, and despair. We look for ways to reduce or manage them. For example, babies turn their heads to get away from an upsetting adult. They cry if such evasive techniques fail.

People look for ways to cope with or reduce tension. These may be relatively healthy, such as the use of humour, or they may be more destructive, as in the use of substances.

Another way is to look for causes of the predicament - blaming the environment, family or friends, or themselves. Exclusive reliance on one or two ways of coping usually indicates that a person is in need of help.

The two main reasons a person goes to a physician or dentist are preventative maintenance (annual checkup) or relief from pain or fever. Similarly, some people go to a mental health professional to get a better understanding of themselves. They realize this will free them from troubling thoughts or behaviours and leave them more vitalized and clear-headed. The majority of clients unfortunately wait until they are in great distress with crippling loneliness, anxiety or depression. They may feel overwhelmed or threatened and unable to muster emotional resources to reduce the threat. This gives them the motivation to seek help from a professional, where they will find a compassionate, trained, non-judgmental person who will help them understand and then resolve their problem.

Why Talk to a Professional Rather Than to a Friend Some clients I see may be grieving the loss of a child, feel distressed after a miscarriage, or feel frustrated with infertility. They report to me some of the things well meaning friends or relatives have said to them that have increased their distress and suffering.

Such comments might include “you can always have another baby” or “maybe it is for the better." These statements have caused my clients to feel misunderstood and painfully alone, wondering if there is something wrong with the way they feel. The impact their statements have had would probably shock these friends or relatives. I believe many well meaning people may be trying to avoid their own feelings of sorrow or embarrassment and thus keep in control of themselves. They try to resist being affected by the grief of the survivor. They may also wish to take away the pain from the sufferer.

There are events in life that have no cure, such as terminal illness, death, job loss, sometimes infertility. People learn to live with trauma, aided by the healing effects of the grieving process and time. Seeking help from a mental health professional can speed up the healing process, through understanding and guidance. In a parallel to physical medicine, some people who go to their family doctor with an upper respiratory illness will have an infection caused by a virus rather than by bacteria. Medical science has not yet found a cure for viral infections, so antibiotics will not help. It is up to the immune system to provide the cure over time. Some times a secondary bacterial infection occurs while the immune system is working to defeat the virus. Antibiotics can treat these secondary infections. Life events may also lead to secondary conditions that psychotherapy can treat. Such events include prolonged grieving, or loss of communication between a couple when one faces a terminal illness.

Professional therapists accept and empathize with other’s feelings and assist the suffering person to put their deep feelings into words. Through their training they evaluate the effect their words or actions have on others. The genuine suffering and despair of others also touches therapists. They realize however that comfort comes to the client through understanding. Their goal is to help the client express what they are feeling rather than shut them down.

For many there is comfort in sharing feelings and innermost thoughts, intimate experiences and fantasies or fears. Yet some may experience this sharing as extremely painful or embarrassing. Sometimes there are things that are too difficult to say to a friend or relative. The therapist’s calm, non-judgmental attitude, maturity and freedom

from being overcome by the client’s revelations can help alleviate these feelings of anxiety, hopelessness, helplessness, embarrassment, pain or fear.

Table 16.1 summarizes the differences between telling your problems to a trained therapist and to a friend. Mental health professionals look for important things that the client does not say, and links seemingly disconnected events, thoughts, feelings, behaviour, attitudes and emotions. They find patterns among the chaos and then choose words that will help the client clarify why they think, feel, and act the way they do. The therapist says things that would be difficult or inappropriate for an acquaintance or friend to express. It is a skill, acquired through education and experience, to say things in tactful and illuminating ways, like a poet, author, or journalist, all specialists in communicating ideas and experiences.

Table 16.1 Differences of Qualifications Between a Professional and a Friend Therapeutic Activities Listening Understanding Assessing Evaluating Intervening Interpreting Re-Framing Providing a more rational perspective.

Mental Health Professional Genuine and impartial interest.

Discreet and confidential.

Unwavering attention.

Fee for service.

Responsible, ethical, nonjudgmental.

Effective listening: - keep from intruding - keep focus completely on client - avoid judgment or disdain - hearing painful material - hear what is said with minimal distortion - hear what is not said.

Have sufficient awareness and resolution of own conflicts.

Avoid reacting in a way that interferes with the client’s free

Friend / Relative / Acquaintance Lack of training, experience, and knowledge.

Unfair to expect them to take responsibility.

Unfair to ask them to work in therapeutic capacity regularly for little or no reward.

Wants to limit emotional involvement.

May have vested interest and therefore, not impartial.

May have insufficient awareness of their own issues resulting in undue reaction, bias or influence.

Offers opinion.

Possible lack of tactfulness.

May not keep what you have revealed to them in confidence.

expression of thoughts and feelings.

Resists undue influence.

Perception influenced by scientific study and collected wisdom, clinical experience, and regular discourse with colleagues.

Tactful.

Careful matching of the client’s need with the appropriate supply.

The therapist is not there to cheer you up or stop you from feeling bad. However effective therapy occurs only when you perceive the therapist, most of the time, as warm, caring, respectful, non-judgmental and empathic. However, disruptions do occur. Clients may sometimes feel misunderstood or hurt by something the therapist does or does not say or do. Therapy may not progress in the way they would like. There may be differences in personality and disagreements over how quickly the therapist returns telephone calls, applies cancellation and payment policies, and adheres to start and stop times. These occurrences are normal in the therapeutic relationship. Between any two people who like and respect each other there are occasional clashes or differences in opinion or agenda. One benefit of therapy is that you can openly discuss and address disruptions.

Therapists take training to find tactful and respectful ways of explaining themselves to minimize resistance or distress in the client. Therapists confront the client in a calm and comforting way. The client then learns to contain feelings well enough to discuss with the therapist experiences they have with each other. As a human being, the therapist may have feelings about the kind of issues just discussed. Clients make progress when they see how the therapist contains his or her own feelings without making them part of the problem. For example, the therapist does not react angrily to the client’s anger. The therapist also tries to protect the client and the results of the therapy from the client’s intense feelings. This is similar to how a parent holds the child who is having a temper tantrum so that his aggression does not harm either himself or the parent.

In summary, mental health professionals have schooling, training and experience in helping people with problems. They can give you information obtained through both

scientific research and clinical experience. Provincial and state governments create specific governing bodies to hold licensed professionals to high ethical standards. They have ready access to professional colleagues for their own guidance and support. They are paid so you don’t have to socialize with them, see them outside therapy, or pay them through indirect means. You don’t have to worry about mutual give and take, as you would with a friend. Furthermore it is highly likely the therapist is in the profession because of a genuine desire to help others. The therapist enjoys the respect received from being entrusted with a client’s most precious and vulnerable life stories, thoughts, fears, and fantasies.

Who Are Mental Health Professionals Within the mental health field there are large variations in the type and degree of education and training a therapist has acquired, as well as expertise and minimal training standards, ethical requirements, and licensing regulations. The caveat of “buyer beware” applies to this field as much as to any other profession. However professional organizations licensed by state and provincial governments regulate many mental health practitioners who have post-graduate degrees from recognized universities. These regulatory organizations maintain high standards of professional ethics and competence. These four groups (psychiatrists, psychologists, social workers and psychoanalysts) take training and have graduated from medical schools, schools of psychology, schools of social work, and have taken highly specialized and advanced postgraduate training.

Psychiatrists are medical doctors, specializing in the diagnosis, treatment, and prevention of mental disorders. Following graduation from medical school where they acquired knowledge and experience in general medicine they undertake a four-year residency program where they minister to those suffering from mental disorders. They are all schooled in the management and pharmacological treatment of clients. In fact, they are the only mental health professionals licensed to prescribe medication. The quality and intensity of training in psychotherapy, however, vary among training programs and among individual psychiatrists. A psychiatrist is more likely to prescribe drugs than practice psychotherapy. Some psychiatrists believe that mental illness is primarily organic, caused by some as yet unknown disorder of the brain's chemistry. Regrettably, they may not accept the link between psychotherapy and medicine, and between mind and body. Therefore they prescribe physical or pharmacological remedies only.

Fortunately many psychiatrists acknowledge the psychological realm in the formation

and treatment of mental distress and a growing minority of them are skillful practitioners of psychotherapy. Upon initial consultation with a psychiatrist, it would be prudent to inquire about his or her view on the comparative utility of psychotherapy and medication.

Psychologists have obtained post-graduate degrees from university schools of psychology and have completed at least two years of supervised training with clients. In most provinces and states, only those who hold a Ph.D. or D.Psy (Doctor of Psychology) from an accredited school of psychology may call themselves a Psychologist. Those with a Master's degree call themselves some other variation of that (ex., Psychological Associate, Psychometrist). In the remaining minority of provinces and states, a Master's degree is the minimal requirement to use the title Psychologist. Only graduates of the Ph.D. or D.Psy program may refer to themselves as Doctor. Psychologists have followed a program of study that includes courses in normal and abnormal psychology and research methods. These programs require them to conduct a large and publishable piece of research that makes a contribution to the field. Their training bases itself on assessment and psychotherapy of mental disorders, with a strong emphasis on the rational for scientific inquiry and understanding of mental processes. Psychologists take extensive training in assessment, diagnosis, and treatment of mental disorders, especially with psychotherapy. While not presently licensed to prescribe medication for mental disorders, the majority of psychologists have been education in psychotropic medication and stay abreast of developments. Psychologists consult with medical doctors, usually the client's general practitioner, when therapy indicates drug treatment.

Social workers have graduated from schools of social work, usually with a Master's degree, following which they also take extra training and supervision under a registered social worker before certification. The majority of social workers who specialize in treatment of psychiatric / psychological problems work in institutions. They are valuable members of multi-disciplinary teams composed of psychiatrist, psychologist, social worker, psychiatric nurses and recreational and occupational therapists. They may conduct psychotherapy, often in groups, and are charged with the integration and advocacy of clients within the client's social milieu. Some social workers are selfemployed in private practice where they treat individuals and families, sometimes following highly prescribed behavioural therapy, such as for sexual dysfunctions.

Psychoanalysts are graduates from various doctoral programs (M.D., Ph.D., or D.Psy) who have undergone at least four years of further training and specialization in the psychoanalytic techniques of diagnosis and therapy. During that time they attend weekly

lectures and obtain further supervision from senior psychoanalysts. They also take a minimum of four years of personal analysis in order to complete the licensing process.

Psychoanalysts typically enjoin their clients to attend sessions four or five times a week and to recline on a couch during sessions. However they occasionally conduct therapy with less frequent sessions and in the face to face sitting position.

What Does a Mental Health Professional Do There are three activities carried out by mental health professionals: assessment, diagnosis, and treatment. In the first two or three sessions the professional asks questions to assess current difficulties, degree of well-being and specific needs, conflicts and personality of the client. In this initial assessment, therapists also ask clients their symptoms and behaviour and how they and those around them are affected by their problems. The professional will want to explore, in detail, the events that precipitated their decision to seek to help. It is also important for clients to provide an accurate account (with specific examples) of their personal history. This includes their problems and their development, through infancy and childhood, and where appropriate through adolescence and adulthood. Also assessed are educational and occupational history, social history, sexual and marital history, medical history, and family history. Through the evaluation, clients need to express all their thoughts and feelings without censoring any of them. What they will get in return is an accurate and professional evaluation and subsequent diagnosis that is critical to their welfare and treatment.

The professional uses the assessment to diagnose, or to distinguish between psychological categories of mental health disorders (i.e. Generalized Anxiety Disorder, Depression, Post Traumatic Stress Disorder, Phobia, Panic Disorder, Marital Discord).

The diagnosis includes a clear understanding of the present symptoms and emotional conflicts as well as the contributions from genetics and life experiences. Usually the most important part of the evaluation is to arrive at a conclusion about treatment for the disorder. Treatment may involve counselling, therapy, medication, or a combination of these. In some cases, the treatment of choice may be counselling alone. The professional advises the majority of clients to undertake psychotherapy or drug treatment, or a combination of counselling, psychotherapy and medication.

The words ‘counselling’ and ‘therapy’ are often used interchangeably but there is a difference between them. Counselling involves the exchange of advice, opinions, consultation, and guidance. While this activity may be therapeutic, it is not the primary

intent. During counselling, professionals give information and direction to a client. It has a more “here and now” orientation, and current circumstances form the basis of counselling. The focus is on identifying and reinforcing the client’s healthier coping abilities, and on increasing a healthy adaptation to life and situations. Individual life circumstances and society make stressful demands on people and impose constraints on the way we deal with these demands. Counsellors also help people learn the complex rules of interaction with the natural environment and with social relationships. They assess the client’s current resources and propose ways in which the client might gain the most benefit from available support.

Therapy is an activity intended to remedy or alleviate a disorder or undesirable condition. It has a healing or curative quality. In contrast to counselling, psychotherapy works on a deeper level, helping clients change their inner thoughts, subconscious needs, conflicts and character structure. I will take further liberty with the previous medical example to illustrate the difference between counselling and therapy. Regardless of the source of the respiratory infection, and thus regardless of whether your doctor can effect a cure, he or she will probably counsel some treatment. You must drink large quantities of fluid, get plenty of rest and possibly take an analgesic such as Tylenol to reduce the pain and fever. While not producing cure, such measures provide guidance and comfort and enhance the therapeutic action of the immune system or antibiotics.

While this book and many others provide counsel, it also has a less obvious third intent to be therapeutic. Again I quote from Henry Thoreau[3], “How many a man has dated a new era in his life from the reading of a book!” Seeing your experiences described in books or articles may give you the words you need to say how you feel and think, to yourself and to others. Finding the words to describe, define and communicate an experience, thought or feeling also has the effect of changing a person’s character and personality. Just as the measuring and observing of something cause it to change, so the activity of reading this book and then reflecting on yourself may change you. You may feel better understood, less embarrassed, more hopeful, less depressed, or less frightened. If so, it has had a therapeutic effect on you. In fact you could say that by reading this book you received “bibliotherapy."

The primary intents of the previous chapters in this book are to provide information that you may use for self-assessment and to counsel you by giving advice, guidance and recommendations. As the rest of this book addresses counselling, I focus on the other two forms of treatment. I will provide a more detailed description of how psychotherapy

cures. Some directions then follow on the use of medication.

How Does Treatment Work?

Psychotherapy Talking about things enhances the pleasurable effect of those events that are desirable, or neutralizes the distressing effect of those events that are undesirable. For example, speaking certain words during love-making may enhance the mood of the event. Alternately, the opportunity for a child to communicate to a trusted adult will diminish the effects of traumatic childhood experiences. Children and adults need to tell or show others what has happened to them and how they feel. Together the client and the mental health professional embark on a creative endeavour to talk about the client’s experiences and personal history. Eventually this changes both the client’s sense of self and perception of the environment. They will also attempt to bring order to the client’s chaos.

Instead of giving advice or opinions as in counselling, the psychotherapist aims to free up the client’s vitality. This includes a sense of liveliness and excitement, together with an interest in things. Rather than listening to others, an individual should let feelings and level of excitement guide his or her actions. The therapist vitalizes the client by encouraging and assisting him or her to put feelings or experiences into words, stories, or ideas. Through the therapist’s non-judgmental attitude, helpful curiosity, and caring interest in the client, the client gradually overcomes feelings of shame, anger, depression and anxiety. The client learns how to actualize or mobilize excitement and to act upon it through mature and positive outlets.

There are variations among psychotherapists in their assumptions about how problems happen. Differences include ways to describe the structure of the mind, style of conversation and techniques, as well as the how they view of the relationship between client and therapist. Yet, all they believe that each individual has a unique way of understanding and relating to the world and to those in it. All therapists emphasize the importance of examining thoughts, assumptions, expectations, and beliefs in connection with clients’ moods, behaviours, physical sensations and events. Clients are helped to identify and regulate their feelings, emotions, and thoughts.

Scientists and philosophers have shown us that the perception or personal meaning of an

event or experience has a powerful effect on our responses to it. It is our personal history, and what we have learned, that has an enormous effect on our perception. We react and relate to a person or event on the basis of how we consciously experience that person or event in reality. Simultaneously we react on the basis of previous learning and automatic assumptions. These are stored in the “unconscious” part of the mind. We place the current person or event in the context of previous events or experiences with people.

Always there is a propensity to displace feelings and attitudes from the past onto the present, especially if the current person or event has features similar to those of the past.

Naturally these displacements give rise to distortions and conflicts.

Perhaps a computer analogy will help to clarify the relationship between the conscious and unconscious parts of the mind. There are two kinds of computer languages: the userfriendly language most of us are aware of (ex. Windows, WordPerfect), and the machine or operating language (ex. Java) of which most of us are not aware. Likewise we are familiar with the conscious or “user-friendly” part of our mind. We know what we think and we think about what we know. Yet there are deeply embedded constructions, assumptions, meanings, ideas, images and memories in our mind that we are not aware of. The unconscious part of our mind is like a computer operating language. It helps us to give attention to and process the infinite amount of stimulation and experiences that we take in about the world. Without being aware of it, the operating language enables us to focus, perceive, comprehend, classify and respond to incoming data. Our memory may be able to hold large quantities of data but this operating language gives us the clues as to what is going on around us. Through maturation, genetic makeup (or temperament) and the individual's unique environment, we acquire our operating language.

Individual characteristics play themselves out during the therapy. The client and the therapist become drafted or cast into specific roles by the client's unconscious mind or automatic thinking. The script for this “enactment” is written in the client’s mind and is a compilation of learned behaviours and memories of previous experiences. Individual temperament, conflicts, needs and beliefs also have an influence. Thus the client may at times experience the therapist just as he or she has experienced important people in the past - mother, father, siblings, lovers. The client has the same automatic reaction to the therapist as to these people. For example, one client may think a quiet therapist is also one who is cold and aloof because that was the way the client’s father was. Another client with the same therapist may feel heard and understood. A warmly responsive therapist may be thought of by one client as receptive and supportive. Possibly that client is vaguely reminded of his or her grandparents who provided safety and encouragement

in childhood. Yet another client may experience the therapist’s intent as phony and unwarranted. That client will not feel safe because of expectations of a more neutral response from the therapist.

Sometimes, clients may find themselves treating the therapist in the same way as others have treated the client. The therapist is in the role in which the client usually finds him or herself. For example, the client acts or sounds like his or her parent talking to the therapist as if the therapist is the child. We also see the effects of past experiences on the current situation when clients have specific reactions to their therapist’s regular activities. For example, some therapists take notes during therapy. One client may feel unworthy during times when the therapist does not write. Other clients may feel slighted while the therapist is writing or may worry whether the notes are confidential.

Some therapists believe that an individual learns to understand themselves through these experiences. Change comes about when that person identifies and discusses the behaviour and the roots of it. Eventually, the client learns how to make a more rational assessment of what has been happening between themselves and others. They also become more aware of what others are actually feeling or thinking. Other therapists do not address such role “enactments” but focus more on concrete thoughts and behaviours. Their objectives are to: 1. observe and challenge automatic thoughts; 2. undo depressive thoughts that generate more depression; 3. train clients how to be more assertive, and 4. gradually decrease the client’s irrational fears.

It is the work of the psychotherapist to address the unconscious part of the mind.

Borrowing from psychiatrist Arnold Goldberg[4], it can be said there are three tasks in therapy: 1. unearthing the unconscious; 2. reshaping or re-framing automatic thoughts; and 3. making new constructions - i.e. rewriting the “operating language”.

The aim of “unearthing” is to get a relatively accurate rendition of the client’s vision of things and of those events and experiences that his or her mind has recorded. Like a good quality CD player or phonograph player the professional therapist encourages the fixed record of the client's past to emerge with clarity and minimal distortion or undue influence. The therapist listens to both what clients say and what they do not say, to what is obvious and what is inferred. The therapist is similar to an experienced music lover who listens to an orchestra and hears things that a less seasoned patron cannot. Then, the therapist will ask questions that will aid the client’s discovery - for example, "What was

going through your mind just before you started to feel this way".

The second task of therapy involves finding evidence that either supports or refutes the client’s automatic thoughts or assumptions, or finds alternative thoughts or causes. The client comes to realize the extent to which early childhood experiences or previous learning influences the present. Clients are encouraged to take off their rose colored or dark shaded glasses to see things differently. The therapist assists this achievement by describing what he or she sees from his or her different vantage point. The client begins to imagine more and more of what the world looks like without tinted glasses. This new vision alters the meaning of something that at first glance seemed certain and unambiguous. We witness this process in the writing and rewriting of history or in the reinterpretations of the Bible.

In the third therapeutic task the therapist and client establish new ways for the client to think and understand ideas, in order to accommodate the new way of seeing things.

Through trial and error, the client attempts to adjust or conform to new conditions. As a result of this “working through”, the client reconciles much of the past and settles many inner conflicts. At this stage of therapy, clients find themselves exploring new interests or forming new relationships. These healthier choices more frequently fulfill their personal needs. The major accomplishment of therapy is to upgrade a less mature way of seeing things to a view that is more vital, powerful and sophisticated.

Sylvia was a person I saw for two years who felt more fulfilled after therapy. Initially she did not feel a sense of rapport or “chemistry” with me as she had with a previous therapist. She experienced me "like a doctor", whereas her previous therapist seemed more friendly and encouraged Sylvia to call the therapist by her first name. The friendly overtures included numerous self-revelations and offers of “therapeutic camping trips”.

Such interventions usually have little value and may potentially cause severe repercussions to the client if they lead to a greater breakdown of professional boundaries.

Despite my not meeting Sylvia’s initial expectations, she remained in weekly therapy where we did an extensive investigation and re-shaping of her life. She came to realize that my questions, my focused interest in her, and my understanding of how her mind operated led to a healthier understanding of herself, her activities and her relationships.

She was eventually able to relate to men and to friends and family in a way that allowed her to both assert her needs and balance these needs with those of others.

In summary, therapy helps clients to resolve their problems, distressing symptoms and

unhealthy behaviours by addressing the underlying conflicts, distortions and assumptions. The therapist and client talk and together try to understand the client’s unique way of seeing things. The results of therapy include: 1. vitalizing the client so that he or she feels more active and efficient; 2. developing within the client greater self acceptance so that he or she feels peaceful and calm; 3. enhancing the client’s capacity to keep control of mounting excitement, anger, shame, or rage; 4. promoting within the client a sense of feeling loved and cared for in order to resist dissolving into shame, rage, craziness, despair, or mania; 5. establishing for the client ways to gain both a sense of equilibrium and of feeling grounded; and 6. helping the client restore and mend broken resolutions, feelings, or relationships, if and when emotions and feelings do cause one to feel overwhelmed.

Medications For the majority of people experiencing mental distress there will come a time when the professional considers drugs for the management of psychiatric or psychological symptoms. Estimates suggest that about 10 percent of the population use psychotropic prescription medication. For the most severely disturbed clients the use of medication over the last fifty years has been tremendously effective. For less severely disturbed clients, the individual and his or her mental health professional will collaborate to resolve the issue of medication.

Basically there are three classes of medications that alter feelings, thinking and behaviour. Doctors prescribe them for psychotic disorders (called anti-psychotics), depression (anti-depressants) and anxiety (anti-anxiety or anxiolytics). Doctors use antipsychotic drugs to manage psychotic symptoms, particularly in schizophrenia and mania.

There have been striking improvements in the management of clients with psychotic mental illnesses. The combination of drugs and administrative changes in institutions, including group therapy and rehabilitation have been important. Mental health professionals have interrupted or shortened many acute episodes of psychosis with these modern therapies.

The use of anti-depressants has suggested a link between depression and a lack of certain brain chemicals. However it is not known whether depression causes the imbalance in the brain, or vice versa. The efficiency of anti-depressants is most impressive in more severe forms of depression where their use can help severely depressed people function more normally, i.e., getting up in the morning, going to work. They also show some

favourable results with some other disorders, namely phobias and post traumatic stress disorder. For milder forms of depression, anti-depressants may be less effective than psychotherapy. These drugs do not help people confront strong emotions and trace their feelings back to the source. Clients who received anti-depressants may never deal with their feelings. Many psychotherapists prefer their clients to manage without such drugs (unless the depressive symptoms are very strong). The initial relief from depression brought on by medication may lead clients to believe the medication performed a cure and dissuade them from following the more labor-intensive course of psychotherapy.

These drugs do not cure people, and symptoms return when they discontinue using the drugs, unless they also have had psychotherapy. When clients confront their pain, understand their problems, and resolve their issues, they cure their depression.

Some clients feel so depressed and discouraged that the psychotherapy cannot be effective until the depression becomes less intense. The relief felt by some clients when the correct anti-depressant takes effect can dissolve crippling feelings of helplessness and hopelessness. When this treatment restores hope and lessens intensive symptoms of depression, the client experiences an attitudinal change that allows him or her to focus on the help offered by the therapist. Together drugs and therapy can bring about faster results.

Treatment of depressed individuals starts with moderate doses of an anti-depressant selected according to the characteristics and intensity of presenting symptoms. The doctor usually increases the dose gradually until he or she achieves a balance between benefits and side effects. A careful assessment of physical functioning must be made prior to medication. There are a number of side effects that can occur with the use of these drugs, such as dietary restrictions. It is also necessary to ensure that there are no adverse effects of the medicine, such as sleep disturbance, agitation or suicide risk.

Furthermore, the safety of their use during pregnancy or breast-feeding is not clear. An important feature of all anti-depressive agents is that it takes between one and three weeks to get the beneficial effects. If there is no improvement in two or three weeks, the doctor will need to try another group of anti-depressants.

Despite reports to the contrary, anti-depressants are not magic. They cannot make you happier and more healthy. Although the newest class of anti-depressants that includes Prozac and Zoloft holds more promise, be cautious of exaggerated promises. There is no such thing as a wonder drug. Thirty years ago the favoured drugs were Valium, sleeping pills and diet pills. Over-prescription of these drugs adversely affected many people (i.e.

Valley of the Dolls). Medication can be addictive, does not work for everyone, and drugs can cause adverse effects.

Until recently, the anti-anxiety drugs were the most widely prescribed drug in the western world. They were hailed as a cure for depression, anxiety, insomnia, and bereavement.

These drugs do not cure the symptoms for which the doctors prescribed them. They simply depress the nervous activity in the brain. All tranquilizers have a tendency to produce psychological dependence and addiction. Over time the client requires increasingly larger doses to reach the desired effect. They may also dis-inhibit emotions, making mood swings more volatile and increasing unwanted impulsive behaviour.

This class of drugs has a sedative effect: producing muscle relaxation, inducing sleep, reducing agitation and anxiety, and sometimes, improving mood. They are popular because they are quickly effective (within a few hours) and because there is a high frequency of anxiety and insomnia among individuals in society. The benefit of antianxiety medication is the short-term treatment of relatively transitory forms of anxiety, insomnia, fear and tension. Doctors also use them widely as sedatives before surgery and in the management of short-lived painful syndromes and other illnesses with unexplained physical symptoms. Most health professionals believe that psychotherapy is more effective than medication in the treatment of prolonged anxiety disorders and mild depression. They limit the anti-anxiety medications to brief use in some mental disorders where there is a quick onset of symptoms.

Psychotherapists do not particularly incline themselves to rely on anti-anxiety drugs.

Furthermore people who are good candidates for psychotherapy usually dislike the sedative and addictive effects of these drugs. Clients may experience themselves as less productive while taking them. The sedative effects of these drugs may cause a lethargic or passive attitude as well as a decline in memory. Clients become less motivated and less attentive to the issues and problems that they need to address and resolve in therapy.

Alternatively, clients who do not favor psychotherapy, who are unable to speak about their problems, or who are not psychologically inclined, tend to get the best response from this class of drugs. Interestingly, if the physician presents them to the client in an enthusiastic and charismatic way, the outcome from taking these drugs is more favourable.

In this section I provided information on when to consider medication, as well as some of the pros and cons of using them. It is not within the scope of this chapter to provide clear guidelines on what is the most beneficial treatment for a given disorder. Neither do I list

these drugs, nor name their side effects or contra-indications. If you are on medication or considering medication, ask your physician, pharmacist or health care provider to provide you with such information.

[1] . In order to protect client confidentiality, I have not written about an actual client of mine. When I refer to a client’s story, it is a fictional composite of details from many lives. The problems I have referred to in these stories are fairly representative of the problems I help people with, and the fictional clients I create are within the range of people I treat.

[2] Henry Thoreau, Walden, (Koneman , 1998), Chapter 2, [3] ibid., Chapter 3 [4] Arnold Goldberg, ‘Three Forms of Meaning and Their Psychoanalytic Significance’, Journal of the American Psychoanalytic Association, 45, p.491-504, 1996