Category Archives: Private Practice

The Warrior in All of Us

Oh, the warriors within us!  Longfellow said it eloquently:  “If we could read the secret history of our enemies, we should find in each man’s  suffering enough to disarm all hostility.” Indeed.  And yet, we do find many things to argue about.  Usually it’s not so much about the subject as it is about someone being on your turf.

As parents we spend a certain amount of energy interacting with our warrior children — hopefully this is only a small part of your relationship, but sometimes it can go on for too long, and it might be worth further exploring your internal warrior — the part of you that engages quickly in conflict, the part that escalates even as you know it isn’t good, not right or healthy or even sane.

Same holds true for marriages.  Hopefully you are not spending the majority of your time interacting with your partner’s warrior, but we’ve all been there, and when it gets really ugly, it’s no fun.  John Gottman talks about the four horsemen of the relationship apocalypse and one of them is “contempt.”  When the conflict gets to the point that you genuinely begin to feel contempt for your partner, it’s time to get help.

I enjoy helping clients explore the parts of them that get in the way of harmonious relationships, the parts that bring more conflict into their lives than they need or want. Sometimes what lies beneath the fightin’ mad part of us is a very interesting part — a creator or a fool or an innocent — who wants to enjoy life or work at something more important.  But with the warrior always being in conflict, these other archetypes don’t get the time and attention that they deserve.

(cross-posted from my private practice site.)

 

Ehrenreich Argues for Better Thinking, Not Positive Thinking

I will definitely need to read Barbara Ehrenreich’s newest book. Not only is she one of my favorite political writers, but now she is delving into cultural criticism related to the mental health field’s relentless pursuit of “positive thinking.”

Newsweek’s Julia Baird provides a short review:

[...] In her new book, Bright-Sided: How Relentless Promotion of Positive Thinking Has Undermined America, Barbara Ehrenreich calls positive thinking a “mass delusion.” She argues that an unrelenting drive to train our brains to overlook problems and blame ourselves for failures has blinded us to inequality, incompetence, and stupidity.

The philosophy of positive thinking, she argues, developed both as a reaction to the negativity of Calvinism and a salve for the sick and anxious, but has, over time, been turned into a kind of blind optimism. At the heart of positive thinking is a belief that you can will anything you like into happening: recovering from cancer, getting a promotion, becoming a millionaire. Often, the worse things are, the more vehemently people are encouraged to be sunny. The more companies downsized and restructured in the ’80s and ’90s, the more popular affirmation-chanting, team-building consultants became. And all the while, as the country’s wealth shot up, the gap between rich and poor ballooned.

Myths About Marriage and The Need to Talk

This headline in MSN jumped out at me — “How To Improve Your Marriage Without Talking About it” — because I recently talked with a couple about needing to talk to each other less. That’s right — to make their relationship work better, talk less. The corollary for their situation was: do more. Talk less, do more. Show your love in other ways — by being on time, by following through on promised projects, by nourishing each other with good food.

It looks like Patricia Love and Steven Stosny, the co-authors who wrote the new self-help marriage shocker, How to Improve Your Marriage Without Talking About It, have some compelling research to present about how men and women differ in communication patterns. From MSN:

[...] According to Stosny’s analysis of several hundred human and animal studies, male and female responses to stress are distinct from birth. “When a baby girl hears a loud noise or gets anxious, she wants to make eye contact with someone, but a baby boy will react to the same sound by looking around, in a fight-or-flight response,” he says. What’s more, while newborn girls are much more easily frightened, boys have five times as many “startle” reactions, which are emotionally neutral but pump up adrenaline. Boys need to intermittently withdraw into themselves to keep from becoming overstimulated. These differences hold true for most social animals and correlate with our biological roles: The female’s fear response is an early warning system that serves to detect threats and alert the males of the pack to danger.

As girls grow, they go beyond needing eye contact and refine a coping strategy identified by UCLA psychologists as “tend and befriend.” If there’s a conflict, girls and women want to talk about it. Boys and men, however, need to pull away. A man’s greatest suffering, Stosny says, comes from the shame he feels when he doesn’t measure up—which is why discussing relationship problems (i.e., what he’s doing wrong) offers about as much comfort as sleeping on a bed of nails.

Similar to Stosny and Love’s approach is the idea of the diversity of ways to express love described in The Five Love Languages. For many couples, there is a much greater need for showing their partner that they care about the relationship by attending to the children, or doing chores, or being on top of finances — by what Gary Chapman calls “Acts of Service.” For others, gifts and quality time are more important, and still others are primarily concerned with physical touch. Finding out which of the love languages is primary for you and your partner can help you reflect and build a better relationship. And sometimes what you might learn is that you want to talk less.

Cross-posted at my private practice site, kierstenmarek.com

Some Advice on Marriage, with Comparisons to Scandinavia

I’ve been doing a lot of thinking and reading about marriage and family lately, due to my practicing more couples therapy and wanting to beef up my knowledge and technique, as well as just general curiosity about what makes a marriage or a family into something enriching and rewarding. I set out googling and goodsearching to answer two basic questions: what makes a family work and what makes a marriage work?

These do not seem to be burning questions in the minds of many other people. In America today, we seem to be too busy trying to exclude people from marriage (i.e. same-sex couples, although this is changing, slowly, state by state, with NH signing it into law yesterday and RI destined to be dead last in following suit) to notice that our institution is in serious disrepair, with 50% of US marriages ending in divorce, and a rate for children growing up in single-parent households that continues to steadily rise.

In my quest for information on what makes marriage work, I discovered some fascinating research called State of Our Union by Barbara Dafoe Whitehead and David Popenoe, who work out of the National Marriage Project at Rutgers University. The Project at Rutgers has studied marriage from several different angles including a comparative study with Scandinavian families and their divorce rates. Here is how they describe the ideal family environment for raising young children:

[...] I have suggested that the ideal family environment for raising young children has the following traits: an enduring two-biological parent family that engages regularly in activities together, has developed its own routines, traditions and stories, and provides a great deal of contact time between adults and children. Surrounded by a community that is child friendly and supportive of parents, the family is able to develop a vibrant family subculture that provides a rich legacy of meaning and values for children throughout their lives.(9) Scandinavians certainly fall short on the enduring two-biological parent part of this ideal (yet even there they are currently ahead of the United States), but on the key ingredients of structured and consistent contact time between parents and their children in a family friendly environment, they are well ahead of us.

The authors go on to describe how difficult it is in America to achieve this ideal environment:

In America today the achievement of this ideal family environment requires what many parents are coming to consider a Herculean countercultural effort, one that involves trying to work fewer hours and adopting the mantra of “voluntary simplicity” for those who can afford it; turning off the TV set and avoiding popular culture; seeking employment in firms that have family-friendly policies such as flexible working hours; and residing in areas that are better designed for children and where the cost of living is lower. Families in Scandinavia need not be so countercultural to achieve these goals because the traits of the ideal child-rearing environment are to a larger degree already built into their societies.

If you want to keep going with learning about marriage, Poponoe and Whitehead publish a yearly version of “State of Our Unions.” In the most recent version I could find online, Poponoe talks about ways to recommit to marriage, and suggests we’d need a cultural awakening to pull it off. Here is a link to the 2007 essay.

With regard to the question of what the key ingredients are of stable long-term relationships, here are some very telling statistic from Poponoe and Whitehead:

By now almost everyone has heard that the national divorce rate is close to 50% of all marriages. This is true, but the rate must be interpreted with caution and several important caveats. For many people, the actual chances of divorce are far below 50/50.

The background characteristics of people entering a marriage have major implications for their risk of divorce. Here are some percentage point decreases in the risk of divorce or separation during the first ten years of marriage, according to various personal and social factors:

Percent Decrease in Risk of Divorce:

Annual income over $50,000 (vs. under $25,000) — -30%
Having a baby seven months or more after marriage (vs. before marriage) — -24%
Marrying over 25 years of age (vs. under 18) — -24%
Own family of origin intact (vs. divorced parents) — -14%
Religious affiliation (vs. none) — -14%
Some college (vs. high-school dropout) — -13%

So, you want to reduce your risk of divorce? Have a household income of more than 50 K. That’s right, all those people who try to tell you money doesn’t count in love, well guess what? It does. If you have a household income of less than 50 K and you are still married, you are beating some pretty stiff odds. You should probably find some cheap way to celebrate your amazing luck and good fortune in relationships.

You want to do something else to reduce your risk of divorce? Be at least 25 before you tie the knot. Go to college and think about what kind of person you want to spend the rest of your life with.

Want to reduce your risk even more? Join a church. Get around a good group of people who share your core values.

Oh, and one more thing. Use birth control (and hope that it doesn’t fail) until you are married. It helps.

And finally, if you are having trouble in your marriage, you might want to consider going to a professional (not that I’m biased!). The biggest problem I see with couples is that by the time they get to making an appointment to see a therapist, they are often feeling extremely burned out about the relationship. They are sick and tired of fighting and want things to be better, but their ability to feel hopeful about the other person or the relationship is quite damaged.

Couples therapy does not need to be a long, involved process. Many times the process of a therapist suggesting some reflection and communication exercises is enough to get the ball rolling. You can also read up on your own and try being your own therapist. I recommend John Gottman and the Gottman Institute, particularly the book 10 Lessons to Transform Your Marriage. For a more spiritually-centered approach, I also recommend Gary Chapman and The Five Love Languages.

Reactive Attachment and Closeness with Children

Over the years I have treated many children with reactive attachment issues and, while sometimes heartbreaking, there is also a great deal of joy in the work. Reactive Attachment Disorder (RAD) is a cluster of behavioral and emotional issues that are believed to relate to a child’s lack of appropriate early bonding with a primary caregiver. RAD is often what is going on when a child asks if I can be his mommy during the first session, or when a child makes little or no eye contact and behaves as if he doesn’t want to interact with me. Usually with RAD, there are clear markers in the child’s history — sometimes in utero, sometimes after birth in the first three years — when there was no stable primary caregiver.

It happens a lot with foster children, naturally, if they have been moved around a lot, or if their reunification plans with bio family keeps falling through. I also think there is an argument to be made that reactive attachment can start off in utero, when a child is exposed to high levels of stress hormones. Mark Brady, PhD, has a great post in which he describes the developmental problems resulting from neglect and early stress. He quotes Dr. Bruce Perry, author of The Boy Who Was Raised by a Dog, talking about how the human brain responds to childhood neglect:

“As you grow, the brain is essentially like a sponge. It’s absorbing all kinds of experiences. So if a child is not held, touched, talked to, interacted with, loved, literally neurons do not make those connections, and many of them actually will die.”

“Big, big ventricular spaces (show up in stressed out kids), which will impact sleep, regulation of anxiety, regulation of mood, whether or not you’re very happy or sad.”

“Simple things like eye contact, touch, rocking and humming can make all the difference to a baby. It makes neurons grow, it makes them make connections. Then, it makes the brain more functional.”

One of the most impactful experiences I have had working with a RAD client was working with a little boy who had been raised for his first three years in an extremely neglectful environment — to the point where when he was moved to foster care, he did not know how to play other than to lay on his belly on the floor and put his fingers in front of his face and move them around. There were very few toys in his early home, and even less of a primary person paying attention to his needs and giving him the closeness he would need to understand the world emotionally. He had come a long way by the time I was seeing him, could play and interact with others, had probably quadrupled his vocabulary in the year he had been in a stable home, but he was still a very skinny kid with rotted teeth that had to be capped and lots of ear infections and other illnesses constantly weighing him down.

Part of my message to RAD kids is the constant reminder to them (and to their brains!) that they are growing, expanding, developing, changing, become whole, becoming strong. I say these things not only because they are true but also because they are the mantra of our shared hope — that their growth will now take place, that they will be able to make up for lost time and accelerate fast enough to get the ABC’s and color identification and some decent social skills in before kindergarten starts. And most of all, because I want them to know that I see them. I see them. They are here.

The importance of this knocked my socks off one day in session with this little guy, who I’ll call James. I was giving him the message that he was growing, asking him how old he would be turning on his next birthday, reinforcing that he would soon be in kindergarten, when suddenly James said, “When I was a baby, I was invisible. Now that I’m older, I have skin and bones.”

“Indeed,” I said, to draw out the moment. “And you have your whole body. And you’re growing bigger all the time.” When I had James create himself on “Mi” on the Wii (I did the controls as he was behind most kids on video game skills) he created a person who was as tall and big-boned as possible, with a big head of black hair. He wanted to be big. And compared to how small he had been made to feel in his birth home, he was indeed a big guy now.

We all need closeness in order to know we exist. If no one knows who you are, knows you internally, knows your needs and how to fill them, you grow up feeling invisible. Anyone who has ever been in a situation where everyone around them was deliberately ignoring them knows how awful it is to feel invisible. Imagine this being the world you are born into. Imagine how devastating that would be.

The good news is that most of us are not born into such cruel environments. Even in families where there is physical and emotional abuse, there is often still a sense of attachment for the child — that their needs are still very high on the list of things that get taken care of. It was enlightening, but also frightening, working with James — realizing just how powerfully he was experiencing the arrival of his identity, and how much catching up there was to do.

Don’t Make Decisions on a Tired Brain

(cross-posted from my private practice site.)

This article from Scientific American describes new research that suggests that if you wear your brain out with executive function activities, you might not want to make any big decisions right away. Even using your executive function for mundane self-control such as avoiding eating foods that are not good for you or following directions that tell you to ignore something that is mildly interesting, may have the effect of making you more susceptible to errors in judgment in subsequent decision-making.

This is news, but it also contains a message as old as human consciousness itself: when you are tired, rest. Forcing yourself to stay awake and perform tasks is a good way to end up making serious mistakes. Of course, taking a rest is often easier said than done. But bear in mind the option of putting off decision-making or major confrontations or attempts to solve seemingly-entrenched problems until you can come at them with a brain fully loaded with fresh executive function capability.

There’s also a wise old message for parents hidden in this research: put your children to bed. Help them settle down when they are tired. Do not try to discipline them or force them to use their executive function skills if it is the end of the day and they are unraveling. Better to let them get a good night’s sleep and start something challenging the next day, even if it means getting up earlier in the morning to make sure something is done for school.

Olson and Kutner Research Video Games and Violence

(This is cross-posted from the blog on my private practice site.)

In 2004, Lawrence Kutner, PhD, and Cheryl K. Olson, ScD, cofounders and directors of the Harvard Medical School Center for Mental Health and Media, started doing research on the effects of video games. With $1.5 million in federal funding from The US Department of Justice, Kutner and Olson set off on an mission to review all of the literature on the subject and then to conduct independent research in order to discover whether there is any real scientific evidence to back up the claim that violence in video games causes real life violence. Their book, Grand Theft Childhood: The Surprising Truth About Violent Video Games and What Parents Can Do was just released on April 15th. An excerpt of the book is available here from Simon and Schuster.

I have not read this book, but it looks like a good one for parents, educators, and helping professionals concerned about violence in video games and violence in society. Olson and Kutner also share about their personal experiences with video games in the first chapter of the book:

Our Journey as Parents

The prolific scientist and author Isaac Asimov famously stated, “The most exciting phrase to hear in science, the one that heralds new discoveries, is not ‘Eureka!’, but ‘That’s funny…’ ” So it shouldn’t be surprising that our first step into what would become several years of full-time research was our casual observations of our son, who liked to play video games.

One of us (Cheryl) is a public health researcher specializing in media influences on health-related behaviors. The other (Larry) is a clinical psychologist and journalist specializing in child development and parent-child communication. We’re old enough to have been teenagers at a time when the few video games available had titles like Pong and Space Invaders. But we’re young enough to feel very comfortable working and playing with computers and other technology.

Neither of us were “gamers” a few years ago; one of us is today. (The other can take it or leave it — a sure sign of a generation gap.) Our teenage son, Michael, had first played simple computer games in childcare when he was about three years old. Those games had crude graphics and agonizingly repetitive (to an adult) music. They involved completing simple tasks, such as lining up an animated fire truck with a mark on the screen so that the cartoon firefighters could rescue a cat in distress. [full text]

Going into Private Practice

After 12 years of practicing as a licensed clinical social worker in a variety of settings including hospitals, social service agencies, schools, and homes, I am very excited to announce that I have gone into private practice. Currently I am a provider for Blue Cross Blue Shield of Rhode Island, and I hope to be a provider for United Health and Neighborhood Health Plan of Rhode Island in the near future. My office is out of South County Child and Family Consultants, which is a group of practitioners headed by Ira Randy Kulman, PhD. Dr. Kulman has been practicing and leading a group of clinicians in South County for over 20 years and has extensive experience with providing psychological services for children and families.

Dr. Kulman has spent the last several years researching and developing clinical applications for technology in psychotherapy with children, under a new organization he has founded called Learningworksforkids.com. The development of the Learningworksforkids site is still in Beta, which means some parts of it are not yet complete. But as you look around the site, I think you will find there is a great deal of compelling information, and the promise of much more to come. Plus it’s partially about video games (the good ones, not the violent or inappropriate ones) so remember to have fun when you’re there.

I will be working with Dr. Kulman to develop clinical strategies for using digital technologies in psychotherapy. As our knowledge base on using digital technology in therapy grows, we will be providing education through the website, consulting, and public presentations. Our goal is to help both professionals and parents learn how to use digital technology to help children behaviorally and emotionally.

Here is a brief description of the therapy services I am offering for adults and children over age 3:

Cognitive and Psychodynamic Approaches I am well-versed in cognitive-behavioral techniques for improving mood and behavior, but I also like to help clients look a little deeper into themselves, to explore motivation and meaning. I have studied Carol S. Pearson’s work and have employed Pearson’s ideas and language to guide clients toward balance and empowerment in their lives.

Grief, Loss and Trauma Therapy for Children and Adults My work in trauma response for Rhode Island Hospital and Hasbro Children’s Hospital means I have seen the full range of grief reactions to severe and sudden losses. I have also done psychotherapy with people struggling to recover from more subtle forms of grief, such as recurrent sadness over a failed marriage or emotional distress in dealing with illness or disability. In addition, I have a background in working with foster and adoptive children who have suffered severe neglect and trauma.

Digital Play Therapy and Executive Function Training There is a growing body of literature that suggests that some video games may be able to help children emotionally and behaviorally. In consultation with Dr. Kulman, I will be offering families therapeutic interventions which involve the use of digital technology when appropriate. For more on this, visit the Learningworksforkids.com website, particularly the section on executive functions.

Sexual Abuse Evaluation/Treatment Working as a Diagnostic Assessment Clinician for the Rhode Island courts gave me a basic background in sexual abuse evaluation. As a clinician for Bradley Hospital and Day One (formerly the Sexual Assault and Trauma Resource Center), I gained further experience in sexual abuse evaluation and treatment.

Referrals can be made by calling (401) 789-1553 during regular business hours. Currently, I have available appointment times on Wednesdays from 9 to 5 and and Thursdays from 3 to 9.

Follow

Get every new post delivered to your Inbox.

Join 971 other followers