Saturday, December 5, 2009

Recognizing Child Sexual Predators, Protecting Your Children

Child sexual abuse is a significant problem in our society. Many studies have estimated that an alarming 12 to 25% of girls and 8 to 10% of boys experience some form of sexual abuse prior to the age of 18 years. Other studies have suggested that these figures may even be an underestimate and that as many as 30 to 40% of women and 13% of men have been abused. Children may be abused by family members or non-family members, however, only 14% of children are abused by someone they do not know. Most of the time, they are abused by males, and approximately 20% of the perpetrators of child sexual abuse are adolescents.

The sequelae of child sexual abuse has been documented in numerous studies and observed in treatment by mental health practitioners. Although not always present, a wide range of psychological, emotional, physical, and social effects have been attributed to child sexual abuse, including anxiety, depression, obsession, compulsion, grief, post-traumatic stress disorder symptoms such as flashbacks, emotional numbing, pseudo-maturity symptoms, and other more general dysfunctions such as sexual dysfunction, social dysfunction, dysfunction of relationships, poor education and employment records, eating disorders, self-mutilation, and a range of physical symptoms common to some other forms of PTSD, such as sensual numbness, and loss of appetite (see Smith et al., 1995).

More recent studies have indicated that sexual abuse in children can lead to the overexcitation of an undeveloped limbic system. This could explain the problems sexual abuse victims have with regulation of mood and other limbic functions, especially as exhibited in borderline personality disorder. Other studies have also indicated that sexual abuse can lead to temporal lobe epilepsy, damage to the cerebellar vermis, along with reduced size of the corpus callosum. Changes in the hippocampus - the part of the brain that deals with short-term memory and possibly the encoding and retrieval of long-term memory - could, researchers suggest, be impacted by hormones flooding the brain during and after a stressful episode such as child sexual abuse.

There is little doubt, therefore, that child sexual abuse can be very harmful to children. Parents are, therefore, tasked with the responsibility of protecting their children from child sexual predators. But how is the parent to recognize the potential child sexual predator?

Child sexual predators often engage a technique called 'grooming' as part of their process of victimization. 'Grooming' refers to actions deliberately undertaken with the aim of befriending a child in order to lower the child's sexual inhibitions or establish an intimate friendship in preparation for the eventual introduction of sexual activities with the child. The act of grooming a child sexually may include activities that are both legal and illegal. At the outset, the groomer aims to lower the child’s inhibitions about non-sexual inappropriate behaviors by encouraging, permitting or covering up the breaking of rules. For example, the groomer may permit the child to secretly violate a rule set by a parent. In so doing, the groomer develops a “secret alliance” with the child, which then can be later exploited. Anna C. Salter, Ph.D., a well-respected expert psychologist in the study of sexual predators suggests, "The establishment (and eventual betrayal) of affection and trust occupies a central role in the child molester's interactions with children.... The grooming process often seems similar from offender to offender, largely because it takes little to discover that emotional seduction is the most effective way to manipulate children."

Grooming begins when the predator chooses a target area. The predator may visit places where children are likely to go: schools, shopping malls, playgrounds, and parks. They may work or volunteer at businesses or organizations that cater to children. Other predators strike up relationships with adults who have children in the home. For them, single parent families may make particularly good targets.

Victim selection and recruitment are next. Any child may be victimized, however, not surprisingly, predators often target children with obvious vulnerabilities. A child who feels unloved and unpopular will soak up adult attention like a sponge and predators often hone in on these children. Children with family problems, who spend time alone and unsupervised, who lack confidence and self-esteem, and who are isolated from their peers are all likely targets.

Predators may offer to play games, give rides, or buy treats and gifts as tokens of friendship. They may sometimes offer drugs or alcohol to older children or teenagers. And they also always offer a sympathetic, understanding ear.

The internet provides a large pool of potential victims for child pornographers and pedophiles. These "cyber-stalkers" may either lurk around or pretend to be children while learning details and earning the trust of their target victims. Their goals may include online sexual activity (in chat rooms) or meeting the child in person.

The first physical contact between predator and victim is often nonsexual touching designed to identify limits: an "accidental" touch, an arm around the shoulder, a brushing of hair. Nonsexual touching desensitizes the child. It breaks down inhibitions and leads to more overt sexual touching - the predator's ultimate goal.

Child grooming is neither benign nor temporary in its impact. Its intent is to shape and mold the underlying structure of the child, in order to convert them into “willing victims” of the predator by breaking down and ultimately violating their boundaries.

According to a NIMH study (1988), the typical child sexual predator molests an average of 117 children, most of whom do not report the offense.

So how can a parent protect their children from such predators? Here are some important things for parents to pay attention to:

1. Ensure that safety precautions are in place to protect your child at home, school, church, clubs or other activities, especially those involving special trips and overnight outings. Have the adults in these organizations undergone background checks? Are adults ever alone with a child? If yes, when and why? How can these activities be restructured to avoid isolation?

2. Stay involved in your child’s activities. Meet your child’s teachers, coaches, and activity leaders. Keep track of where, and with whom, your child is if she or he is not with you.

3. Be alert for adults or adolescents, particularly males, who display an unusual interest in children.

4. Do not allow anyone to have unsupervised access to children if he or she seems more interested in spending time with children than with his or her own peers, seems focused on children of a particular age or gender (especially if the person does not have children of that age), singles out a child for special attention, gifts, or favors, wants to take a child on special outings without others present, seems eager to spend alone-time with a child, invites children into his or her home unsupervised, allows or encourages children to do “grown up” things or things they are not allowed to do at home.

5. Recognize that most child sexual abuse is perpetrated by someone who is known to the child. Sexual abuse is more likely in families where (a) other abuse is tolerated (b) the family hides embarrassing secrets (c) the family is rigid and tightly controlled (d) there is a demand for blind, absolute loyalty (e) there are poor role definitions (f) there is disrespect for each others' privacy, rights, individuality (g) the parents are poorly differentiated in their families of origin, never became fully mature adults or able to function as competent parents (h) there is a conflictual marriage or troubled divorce (i) the children are expected to act like adults, play adult roles before they are ready (j) there has been lots of moving, change, traumatic stress (k) there is a low level of appropriate touch, where parents never hug, caress or cuddle their children, as normal families do and (l) there is sometimes a compensating veneer of religiosity in the family.

Due to fear, guilt or shame, children may often be reluctant to disclose sexual abuse, or may even retract earlier disclosures of sexual abuse. Parents must be alert to the fact that this disclosure pattern may exist and should not wait for a child's disclosure to confirm suspected sexual abuse, or be reassured solely by a child's denial of sexual abuse. By recognizing the behavior of child sexual predators, and by understanding the factors that leave children vulnerable to sexual abuse, parents can gain greater control in protecting their children from child sexual abuse.

Wednesday, December 2, 2009

After the Cheating: Top 10 Things to Consider

Recent revelations of superstar pro-golfer Tiger Woods' "transgressions" in his marriage have brought the topic of cheating front and center yet again. While most couples whose relationship suffer this injury do not have to deal with it in a public forum, they share with Tiger and his wife the challenging task of dealing with the aftermath of such a transgression on the relationship.

Once the cheating has been revealed, what's next? How does a couple go about managing the tremendous fallout from this disclosure?

Here is some advice I would give to Tiger, or others in his situation, as he contemplates working through this issue.

1. You must first decide whether you are seriously willing to invest in repairing your damaged relationship. If you have ambivalence about your relationship, or uncertainty about ending your liaison(s), you are not ready to work things through with your partner and should not do so half-heartedly. That will only ultimately cause more pain than you have already inflicted.

2. If you are serious about working things through with your partner, stop all contact immediately with the person(s) with whom you have cheated.

3. Focus first and foremost on acknowledging the betrayal and hurt caused by the cheating, versus explaining the reasons for your cheating.

4. Contrary to the advice often given by other psychologists, do NOT provide an excessively detailed description of the affair(s) to your partner. Once that detailed information has been shared, it will become impossible for your partner to erase the hurtful imagery of the betrayal from their mind. Often, this will result in a painful preoccupation by your partner as the details are re-played over and over in their mind, which will undermine the rebuilding of trust later on. The focus of your disclosures should not be about assuaging your own guilt, but on protecting your partner from further pain. Do not lie about the details, or diminish the extent of the betrayal, but do not let the details become the focus of your conversations with your partner.

5. Recognize that the cheating resulted from some of your own personal failings that you will need to address. The biggest failings in cheating are the dishonesty and the betrayal of trust inherent in the cheating behavior. Whatever difficulties you may have had in the relationship, you will have to own your dishonesty and your betrayal of trust.

6. Recognize that an affair often reflects something wrong in the relationship that is not being addressed. Begin to identify the issue that you have not been addressing honestly in your own life or in your relationship.

7. If at all possible, do not share the occurrence of or the details of the cheating with your children. Children should not be put in the inappropriate position of worrying about the boundaries of the parents' relationship. This is for the grownups to take care of. Children are not, nor should they be, in a position to resolve their parents' relationship issues. Sharing this information with children is often done only to punish the other parent for cheating and alienate the children's affection from them, or to inappropriately seek emotional support from the children.

8. If the children do inadvertently become aware of the cheating, do not lie about the issue, but do not provide them with details of the cheating. Focus on addressing the feelings of confusion, hurt and betrayal and refocus the responsibility for repair of the relationship on the parents.

9. Apologize. Apologize. Apologize. But be aware that your partner cannot be expected to protect you from becoming aware of the hurt that you have inflicted on them. You must be able to tolerate witnessing the real pain that has been caused by your cheating and be prepared for the possibility that the damage that you have done to the relationship is irreparable.

10. Seek couple's therapy. If you are serious about repairing the relationship, you will need help as a couple in working through the pain from the cheating and the unresolved issues that preceded it.

Thursday, November 26, 2009

Obesity and Compulsive Overeating

You've read the headlines. You know the statistics. Obesity is epidemic in our culture. American children are the fattest on earth, and the Chinese are now not far behind. Explanations for this have primarily centered around the notion that our nation's longstanding economic success (and now China's emerging success) has resulted in a shift in our culture from frugality and hard work to overindulgence and sloth. In addition, this overindulgence and sloth has been coupled with the consumption of cheap, high fat foods that are addictive and have poor nutritional value. There is no doubt that these behavioral factors and food choices contribute significantly to this epidemic of obesity. However, these sociocultural and economic factors alone cannot explain this phenomenon.

The truth is that obesity often results from an eating disorder in the individual. Despite protestations to the contrary by some, it is virtually impossible to become morbidly obese without overconsumption. A person with compulsive overeating, or binge eating disorder, typically presents as preoccupied by food and frequently engages (sometimes secretly) in episodes of uncontrolled eating, or bingeing, during which she or he may feel frenzied or out of control. At these times, the person consumes food past the point of being comfortably full. These compulsive overeaters will even typically eat when they are not hungry. They often have feelings of guilt and shame after binge eating and they often binge eat alone.

In addition to binge eating, compulsive overeaters can also engage in 'grazing' behavior, during which they return to pick at food throughout the day. This results in a large overall number of calories consumed, even if the quantities eaten at any one time may be small.

Recent taxonomy has sought to distinguish between the diagnoses of compulsive overeating disorder and binge eating disorder. When a compulsive eater overeats primarily through bingeing, he or she is said to have a binge eating disorder. Where there is continuous overeating and grazing, but no bingeing, then the person is said to have a compulsive overeating disorder.

One patient who struggled with a binge eating disorder recently described her obsession with food and the excessive amounts of time and thought she devoted to food. Often, she would secretly plan or fantasize about eating alone where she would prepare what she described as a "feast." For her, eating was an opportunity to indulge in her deepest pleasure, to be a "baby queen" where every desire could be indulged without limit. She remarked, "I can go home and spend hours and hours preparing the most elaborate meal. It is grand. And then I spend several more hours eating it. I almost start to panic when I see that it is going to end. I just don't want it to end. I always want to feel that there is going to be more for me, like I'm never going to run out."

Of course, there may be genetic factors which contribute to a person's predisposition towards obesity. However, the above description reveals important psychological factors that can often contribute to these eating disorders. They include significant feelings of deprivation, significant feelings of envy and entitlement and the significant use of denial.

The significant feelings of deprivation emanate from early life. The child's enormous feelings of emptiness and longing, resulting from some emotional deprivation or trauma, become converted into an enormous appetite, needing to be filled up. There is often little consciousness of the true nature of the relationship between the person's compulsive overeating and any emotional struggle.

Significant feelings of envy and entitlement also emanate from this feeling of deprivation. The person longs for comfort and satisfaction and comes to feel that she or he deserves to indulge in order to feel good, to satisfy him or herself, to be rewarded. After all, should she not have what she wants? Why should he have to say no, or not have the desert he loves, or stop eating if it makes him feel good? Why should she have to be without? Entitlement may seem to be in contradiction to the low self-esteem often observed in the obese compulsive overeater, but it, in fact, consistent with it and results from unmet primary needs.

The significant use of denial is reflected in the failure often to acknowledge the amount of the overconsumption or the impact of it. In the moments of overindulgence, the person denies that she or he is taking more than they should. "I don't really eat that much", one 350lbs patient would frequently exclaim. Additionally, there is a denial of the limits and the boundaries of the consumption and of the body. There is also a denial of the absence of control that the person is exercising over their food.

Sometimes, of course, obesity and compulsive overeating are the sequelae of childhood abuse or neglect. In particular, emotional neglect and childhood sexual abuse have often been linked to these difficulties. Not everyone who is obese and compulsively overeats has been sexually abused, or not everyone who has been sexually abused will be obese and compulsively overeat. However, for those with the two co-exist, the obesity and overeating serve as an ineffective attempt to manage the emotional dysregulation caused by the abuse. Food is used to nurture, soothe and calm the chronic anxious feelings that ensue from childhood abuse or neglect. The obesity can sometimes serve as an unconscious attempt to create a sense of being held or a physical barrier between self and others; a soft envelope or a protective wall of fat, if you will.

There are many who treat obesity and compulsive overeating like an addiction, utilizing a medical model of disease. They see the compulsive overeater as being driven merely by her or his disturbed brain chemistry. This disturbed brain chemistry results in a dysregulation of the person's consumption. While there may be real clinical evidence of a biochemical component to the compulsivity seen in eating disorders, to ignore the psychological underpinnings of this illness is to suggest that the person is merely the victim of their bad chemistry, with little or no responsibility for or capacity to make choices about their behavior. "I'm an addict, I can't stop myself" one patient would often repeat, in explaining why she could not be responsible for having eaten nearly two dozen Krispy Kreme doughnuts.

Dieting is often unsuccessful for the compulsive overeater as feelings of deprivation are often activated by the restriction inherent in dieting. This then eventually fuels greater need for gratification, often leading to a binge episode. Appropriate treatment for obesity and compulsive overeating should include both attention to the biochemical components driving the compulsive behaviors, as well as attention to the psychological factors which contribute to the person's denial and feelings of deprivation, envy and entitlement.

Thursday, November 19, 2009

Women and Bad Relationship Choices

You all know who she is. Or maybe she is you. She drives 200 miles across state lines to meet the 'really great guy' she met on the internet. She always seems to find the man who is chronically unemployed or underemployed, who requires her support. Her boyfriends or partners often cheat on her. Or sometimes they are married or otherwise unavailable. Or they are so self-focused that they never plan anything or do anything with her that is not related to meeting their own needs. Sometimes they are emotionally absent or emotionally or physically abusive. Sometimes they are addicts. Sometimes it turns out that all they wanted was the sex that she too quickly offered.

Why do some women make these bad relationship choices, over and over again?

First, let's talk about self-concept. Her ideas about herself, her sense of her value and her conclusions about things to which she is entitled are formed early on in life. These earlier life experiences inform her about what she can expect from the world, and communicate to her about how others will value her. This woman, like all of us, is guided by her internalized model of relationships and the quality of attachment in her early life experiences (see previous postings for a discussion of attachment). Her self-concept is also impacted by her experiences in society at large. The woman who has had an earlier life in which she experienced excessive criticism, deprivation, devaluation and denigration, whether subtle or overt, whether in her family and/or in society at large, will come to view herself in a less than positive light. She may feel that there limits to what she can expect from the others, from the world and in relationships. Being treated as 'less than' in her relationship may, unfortunately, not be foreign for her. Therefore, to engage in a relationship in which she may not be sufficiently valued may be ego-syntonic and thus hardly noticed at all.

Denial is also a powerful psychological tool, aimed at helping her tolerate what would otherwise be felt to be intolerable. Is it not easier for her to believe that she is deeply cared for, rather than acknowledge that she is being exploited? Is it not less painful to believe that he is pining and longing and for her and will soon leave his non-understanding wife, than to believe that he is no more able to offer her a whole relationship than he is his wife? And besides, his drinking really isn't that bad. Powerful denial is required to protect the woman from the pain of these realities. She may have such a history of denying reality, or needing to deny a painful reality (or her reality being denied) that she can too easily convince herself of the most foolish things. When she is offered a crumb, she mistakes it for (or converts it into) a whole cake. She convinces herself that her belly is full and that she is truly being satisfied. Or she convinces herself that she really doesn't need very much. Yet, a crumb is still a crumb.

Are you a woman who keeps making bad relationship choices? Think about the messages you got about yourself and your value during your childhood. For example, were you seen as special, a burden, demanding, needy, greedy, bad, beautiful, invisible, stupid, intelligent? What role did you occupy in the relationships with your family? Do you feel any of those feelings in your life today? What do you think you should expect in a relationship? What do you think any woman should expect in a relationship? What boundaries do you feel are appropriate for you to set in a relationship? What are you really getting in the relationship that you have now?

Are you getting the whole cake, or are you settling for crumbs?

Saturday, November 14, 2009

Pornography and Sexual Addiction

I recently supervised a psychologist on a case in which I was introduced to a verb that was new to me - porning. This was a word that was used by the patient to describe his compulsive engagement in online pornography and masturbation. He revealed that he would spend hours and hours 'porning' at the expense of other activities and at the expense of engaging in real relationships.

Pornography has grown exponentially over the last decade, encouraged by cultural shifts around issues of sex and sexuality and by the expansion of technology and the internet. As a result, more and more patients are presenting with primary or secondary concerns around compulsive sexual behaviors, which sometimes includes the use of pornography.

Some of these compulsive sexual behaviors include compulsive masturbation, anonymous or near-anonymous sexual encounters, frequent and indiscriminate 'hooking up', frequent visitation to strip clubs and 'massage' parlors, voyeurism, exhibitionism, sadomasochism and the compulsive use of internet pornography.

According to recent statistics, 40 million people regularly visit pornography sites; 72% male and 28% female. Every second, approximately $3100 is spent on pornography. Asian countries, like China, South Korea and Japan, make a total revenue of $75 billion per year on internet pornography alone. The United States makes a total revenue of about $15 billion per year on internet pornography. According to some statistics, an astonishing 12% of all website are considered to be pornographic, and 20% of these are considered to be child pornography.

With such increasing access to sexual images, sexual addictions appear to have become more commonplace than ever before. In fact, in many ways, our culture has moved towards glorifying such compulsive behaviors, evidenced by the success of such television shows as 'Californication' and 'Sex and the City'. These shows have served to normalize compulsive sexual behavior in both men and women, allowing for a more open discussion of the issue.

Sexual addictions, like all addictions, arise from the combination of satisfying a physiological desire and a psychological need. Like other addictions, the pleasure centers of the brain (specifically, the nucleus accumbens), play a significant role. In addition to cocaine and amphetamine, almost every recreational drug has been shown to increase dopamine levels in the nucleus accumbens. Thus activating this part of the brain by engaging in these compulsive behaviors, results in dopamine release deep within the limbic system of the brain. This is the true physiologic addiction.

Of course, there are significant psychological factors that contribute to sexual addiction. Many psychologists understand that sexual addiction often emanates from an attempt on the part of the patient to self regulate and self soothe. While some patients become orally fixated and utilize alcohol or food to compulsively provide this soothing, a person's genital can sometimes become a substitute to compulsively gratify these early needs. Sometimes this genital/sexual preoccupation results from neglect, where the child has been left with only his or her sexual pleasure for comfort. At other times, this genital/sexual preoccupation occurs as a result of trauma. While experiences such as childhood sexual abuse or traumatic sexualization serve to compound the possibility of sexual addiction, sexual addiction is not a necessary sequelae of sexual abuse. However, for those with such a history of trauma and resulting sexual compulsivity, their compulsive sexual behavior can be described as 'abuse reactive'. That is, their compulsive sexual behavior remains some way of perpetually re-enacting and/or attempting to re-work their earlier traumatic experiences.

One patient described her compulsive masturbation which resulted in her spending entire weekends locked in her apartment, masturbating and binge eating. For this patient, her feelings of extreme deprivation and need for gratification were enormous and were reflected in her insatiable appetites. This, behavior of course, was followed by tremendous feelings of guilt, shame and self-loathing, which ultimately resulted in a greater need for self-soothing. Psychotropic medication to address the patient's impulsivity and powerful need for dopamine in her brain's pleasure centers, coupled with three times a week psychotherapy, led to a significant decrease in this patient's compulsive masturbation and binge eating.

Another patient presented in couples therapy to address the impact of his chronic cheating behaviors. The patient, who had justified his frequent cheating as part of his culture and his 'natural' large sexual appetite, was having to face the destructive relationship consequences of his sexual escapades. Further work revealed a history of premature (and ultimately traumatic) sexualization, which resulted in cementing the patient's identity around his sexual prowess.

Treatment for sexual addictions has become more commonplace, with the increase in the number of treatment facilities aimed specifically at sexual addictions. 12-Step self-help groups like SAA (Sex Addicts Anonymous) and SLA (Sex and Love Addicts Anonymous) have also grown in membership as people are less ashamed to acknowledge their addictions. A string of high profile people forced to acknowledge sexual addiction (e.g. former NY Governor Eliot Spitzer, TV actor David Duchovny) and former President Bill Clinton's documented struggle around sexual behavior have served to highlight the pervasiveness of this problem.

Untreated sexual addiction, like any other addiction, ultimately results in numerous personal consequences for the addict, but also results in significant social problems for any society. As sexual boundaries become more diffuse, and as sexual addiction more pervasive, all of us (and our children) become increasingly at risk for being exploited to meet the addict's needs. Parents should, therefore, pay special attention to their children's online use and openly address internet pornography use as well as their children's developing sexuality. Parents should not assume that this issue does not affect their child. Statistics indicate that the average age at which a child is likely to first encounter online pornography is 11 years. Children are able to become addicted to pornography in the same ways that they are able to become addicted to drugs, and parents should, therefore, give importance to this growing problem. They, too, might be out there, porning.

Thursday, October 22, 2009


Most of you have probably known someone who can be described as a hoarder. There are different levels of hoarding, from the avid baseball card collector to the person who cannot get out of his house because it is covered from floor to ceiling with a variety of items.

Hoarding behavior can be seen in both animals and humans. Squirrels and hamsters, for example, often collect large amounts of food and store it in a single place. This natural behavior serves to protect the animals from going hungry during expected periods of food scarcity, and thus allows for species survival. The hoarded food, in this case, is eventually consumed.

Hoarding behavior in humans can also have the similar function of species survival, at times where there is a real fear of imminent society-wide danger or food shortage. Wars and natural disasters may lead people to collect essentials that they believe will be in short supply. In these cases, the hoarded items are also eventually consumed.

Compulsive hoarding (or pathological hoarding) is something quite different from this. It refers to the acquisition of and failure to use or discard such a large number of seemingly useless possessions that it causes significant clutter and impairment to basic living activities. A person who engages in such compulsive hoarding is often called a "pack rat."

This kind of hoarding results from underlying feelings of anxiety. The hoarder often struggles with an Obsessive Compulsive disorder that leaves him or her plagued with anxiety about the idea of letting go. But what is it exactly that they are so fearful of letting go of? Certainly, it is not the old clock radio that no longer works, the three hundred volumes of the New York Times or the scores of empty Perrier bottles, is it? No, it is not the objects, per se, but what the objects represent that evokes the fear of letting go.

For the hoarder, the objects have become invested with such significant meaning that the loss of them appears to represent the loss of something significant. Thus, the hoarder likely is a person with much unresolved issues in his or her early life. There is a both powerful underlying anxiety and an equally powerful need for soothing. Like the hamster and the chipmunk who are driven to hoard because of fears around species survival, the hoarder, in this case, is driven to hoard because of fears around emotional survival.

Typically, in early life, if all goes well, childhood anxieties are met by the presence of a soothing (often maternal) figure who helps to emotionally regulate the infant and who provides a sense of security and safety. (I will use the term 'mommy' throughout this article to represent any primary caregiver - mother, father, grandmother, etc.)

If all goes well enough, and this mommy figure is consistent and available enough, the infant can eventually internalize this soothing, calming mommy who is available to be 'conjured' up when the child needs her. This allows the infant to tolerate separation without too much distress, reassured by the feeling of this mommy, now felt to be inside her, to calm and soothe her.

Before the infant gets to this point of being able to 'conjure' up the mental representation of the soothing mommy in the face of anxiety, there is a transitional period where there is sometimes a need for an actual transitional object. During this period, the child invests in a special, comforting object all of the features of the comforting mommy that it knows. As a result, during periods of separation and anxiety, the child is able to tolerate the evoked feelings because of the presence of this transitional object which represents mommy. These transitional objects are often the special stuffed animals and the must-always-be-with-me baby blankies that young children sometimes carry with them. This transitional period represents a period of normal psychological immaturity, where the child is not yet able to fully mentally represent the mommy in her absence, and thus relies on the concrete object, imbued with 'mommyness', in the transition. In periods of uncertainty, adults can sometimes find that they too rely on the magical solutions used during this early period. The use of 'lucky charms' in normal adults is an example of such an attempt at a magical solution in adulthood - that is, the use of a special object that is invested with magical qualities to provide security and soothing in the face of uncertainty or anxiety.

The compulsive hoarder's relationship with objects is considerably more complex than the normal adult's use of a lucky charm, however, and reflects both significant anxiety and significant psychological immaturity. The hoarder is a highly anxious person, even if he is not aware of the level of his anxiety. In fact, it is his hoarding behavior that often keeps the anxiety from his consciousness.

At the heart of the hoarder's dilemma is anxiety and fear of deprivation and of loss of security. The hoarder, filled with an unnameable anxiety resulting from feared (or sometimes actual) loss and deprivation, unconsciously projects onto various objects the soothing and containing mommy that she needs. Her psychological immaturity, due to an insufficient personality structure, does not allow for a mental representation of mommy to be sufficient to provide comfort. Instead, she relies on the excessive collection of physical objects (or, sometimes, excessive collection of food or small animals) to provide the comfort and reassurance that she needs. However, this anxiety is only momentarily abated, until the fear of loss and deprivation arises again. This eventually results in the compulsion to have yet another object to quell the anxiety.

The hoarder fears giving up or losing the hoarded objects, as much as he fears giving up or losing the secure, soothing mommy that he has unconsciously invested in the objects, leaving him alone with his anxiety and feelings of insecurity and emptiness. One object is never enough, for as soon as the anxiety or fear is assuaged by hoarding one object, the underlying anxiety and fear of loss and deprivation emerges again, necessitating further soothing and thus further objects.

The hoarder will often find it hard to articulate why the hoarded objects feel to be so necessary to hold on to, but does have some sense of discomfort if forced to give up the loved objects or if he is prevented from hoarding. There is no consciousness of what has been invested in the hoarded objects that make them feel like necessary objects - the hoarder only knows that he is compelled to have them.

Cleaning out the hoarder's dwelling is not a sufficient solution to this complex problem. The best treatment for hoarding is a combination of medication that impacts serotonin in the brain and is implicated in obsessive/compulsive behaviors (such as a SSRI antidepressant) and intensive psychotherapy. Family members of hoarders should understand the complexity of this disorder in order to provide appropriate support and guidance towards treatment.

Saturday, October 17, 2009

The Narcissistic Parent and the Trophy Child

Who is the narcissistic parent?

She is the parent who demands certain behaviors from her child because she sees her child as an extension of herself. He is the parent who needs the child to represent him in the world in ways that meet his emotional needs. She is the parent who expects the child to realize her unfulfilled dreams, wishes, and fantasies. For these narcissistic parents, the child is groomed to be a trophy, a symbol of the parent's success and specialness, to be admired and envied in the way that the parent would wish for him or herself. The child, in this way, serves as a source of narcissistic supply for the parent.

The child learns from the very beginning what is necessary to capture the interest and maintain the positive regard of the narcissistic parent. She quickly learns to stifle her own desires, her authentic self, and to become the shiny, attractive trophy child that will make her parent feel good. He quickly adopts a false self, an accommodation of himself that leads him to define himself and his value by his ability to gratify his narcissistic parent. His true self, his authentic self, is left far behind.

So what becomes of this trophy child?

She is the child who devotes her life to the sport that her father loves, sensing that her success as a player makes her father feel like a winner, thus winning his praises and special affection. He is the child who never expresses any feelings of upset to his mother, ensuring that her needs are taken care of and that she is never unhappy with her 'special boy'. She is the girl who becomes her mother's confident, setting aside her own need to be mothered to become the mother to a mother whose needs are made to be greater than her own. He is the boy who must show his loyalty to his father by appearing to hate his mother just as much as his father hates her.

The narcissistic parent has a hard time tolerating the separateness of thoughts and feelings that exists between the parent and the child and feels that his or her views are the child's views. This parent has a hard time recognizing that the child may have different and separate feelings than she does. He is oblivious to the child's needs that do not comport with his own. In order to survive such a relationship, and so as not to cause injury to this narcissistic parent and experience the resulting abandonment and rejection, the child quickly accommodates to the parent's desires. She quickly discovers that her authentic self has to be set aside. This true self holds little value when compared to the parent-pleasing self she takes on. His identity becomes constructed around maintaining the admiration and positive regard of the other - a false self. At times, it is constructed around merely avoiding disappointing by making choices of his own.

As a result, the child may fail to develop confidence in her own feelings and may need constant reassurance that she is pleasing, lest she may face parental abandonment by way of disapproval. She becomes the person who needs to let others know at all times that she is pleasing and will set aside her own needs to make sure that the other person remains happy. She will find herself in a relationship with someone who needs someone who is willing to set aside their own needs for him, likely a narcissist.

At other times, he identifies with the parent's confirmation of his special trophy status and becomes attached to the idea of his uniqueness, specialness and entitlement for special attention and praise. He learns that there should be no space between what he thinks and needs and what others think and need and therefore becomes intolerant (and sometimes rageful) when others fail to be in line with his desires. He is the one who will likely find himself in a relationship with the girl described above.

The narcissist rarely recognizes his narcissism and its impact. Christopher, a product of a narcissist parent himself, would often brag about his son's accomplishments, about how bright his son was, and about his son's expected future. He would swell up with pride to feel that his son reflected the specialness that he felt to be a part of himself. He enjoyed seeing the admiration that his son would capture as it felt like an admiration of him. He could not psychologically separate himself from his child. As a result, Christopher's son was tasked with the responsibility with ensuring the ongoing admiration that the father had come to depend on. When Christopher's son announced that he wanted to go to film school instead of law school, Christopher felt betrayed. It hadn't mattered to him that his son had no interest in the law. In fact, he had never even noticed that. And he was not even fully conscious of his worry that his own father would be disappointed that he had not been able to produce a son worthy of his own father's admiration.

Janine had spent much of her life aware of the special relationship she had with her mother. Throughout her life, her mother would often remind her of how similar they were. When her parents divorced, Janine, as was expected, supported her mother. She refused to talk with or visit her father. Her mother had demanded absolute loyalty. Janine and her mother would often talk about how Janine's father had betrayed them both by leaving Janine's mother. Once Janine became a teenager, she and her mother began to dress more and more alike. Although this was increasingly troublesome to Janine, she grew weary of the fighting between herself and her mother when she would try to establish a more separate life. Janine was embarrassed when her mother would flirt with her high school boyfriends and yet her mother appeared so unaware of how Janine might feel about this. It was not until Janine's mother emptied their joint bank account to make an extravagant purchase that Janine came to understand that her mother had always been incapable of thinking about her needs.

But for all the trophy children who try to please their narcissistic parents, there are those who conclude that they can't, or won't. There are those children who become convinced very early on of their inherent defects because of their inability to please their parent. These children easily give up in their own pursuits or don't even begin to try. There are those who refuse to succumb to the parent's impossible need for mirroring and gratification and, therefore, rebel. They live their lives in anger and opposition, refusing to meet parental (or societal) expectations. And for all the narcissistic parents that appear to be so preoccupied by their children, there are those that are so excessively focused on themselves that their children barely register on their radar, except for the moments when the child gratifies them. These children continue to struggle, to varying degrees throughout their lives, to establish their authentic selves.

To understand more about this dynamic in parent-child relationships, the following books are recommended:

- The Drama of the Gifted Child by Alice Miller
- Trapped in the Mirror: Adult Children of Narcissists in Their Struggle for Self by Elan Golomb
- Why is it always about you?: The Seven Deadly Sins of Narcissism by Sandra Hotchkiss

Saturday, September 12, 2009

The Fear of Intimacy: Cat and Mouse Games in Relationships

Tom and Jerry. Sylvester and Tweety. Elmer Fudd and Bugs Bunny. These famous unlikely couples exemplify the tortured relationship prototype of pursuit and flight. Despite the frustration on the part of both the pursuer who can never be gratified, or the pursued who is constantly made anxious and must be on guard, the individuals in the couple are seemingly unable to exist without the other. Their pursuit of and escape from each other is what ultimately defines their relationship. They are engaged in a 'cat and mouse game.'

The term 'cat and mouse game' is an English-language idiom dating back to 1675 that means "a contrived action involving constant pursuit, near captures, and repeated escapes." So many couples seem to construct their relationship around this very dynamic of pursuit, near capture, and flight. One client recently remarked to me, "I really like the beginning. Trying to get him interested in me. But the moment he becomes too interested and starts to pursue me, it's over. Yuck. I'm just not interested anymore. But then if he wants to break up, I start to feel a little panicked and I start being really nice to him." Another noted, "I always seem to find the most difficult women. I guess I must just like women who are hard to get. But when I get them..." A third revealed, "Every time my husband and I are getting along for a little while, one of us always seems to pick a fight for no reason. It's like we can't get along well for too long, without one of us opting out. It's almost like we're not comfortable unless we're fighting."

The truth is that these relationships reflect an unarticulated struggle that exists within the participants. They are both fearful of intimacy and their cat and mouse game allows them to engage in this unspoken dance, where each of them participates in maintaining a certain distance in the relationship. The truth is, unconsciously, the cat is interested in the mouse because it flees, and the mouse is interested in the cat because it chases. As long as one is fleeing and the other chasing, they can each be reassured of a connection between them, but also that a certain distance will be maintained.

Relationships like these may often reflect an underlying ambivalent attachment of childhood. Children who are ambivalently attached tend to be extremely suspicious of strangers. These children display considerable distress when separated from a parent or caregiver, but do not seem reassured or comforted by the return of the parent. In some cases, the child might passively reject the parent by refusing comfort, or may openly display direct aggression toward the parent. This is also consistent with the rapprochement phase of separation-individuation as described by psychoanalyst Margaret Mahler. During this developmental phase, the child's pursuit of independence is tempered by its feelings of separation anxiety, which then serves to regulate the space between the mother and the infant.

As adults, those with this ambivalent attachment style often feel reluctant about becoming close to others and worry that their partner does not reciprocate their feelings. This leads to frequent breakups, often because the relationship feels cold and distant or too engulfing. However, these individuals feel especially distraught after the end of a relationship. As a result, the relationship that is often maintained is like the one of Tom and Jerry, a cat and mouse game in which the partners often switch off between who will be the cat and who will be the mouse. The underlying fear for the couple is as follows. The cat fears that she/he will be abandoned by the mouse, and therefore must maintain a certain proximity in order to feel secure, but sufficient space in order to survive the inevitable abandonment. The mouse fears that she/he will be overwhelmed or consumed by the cat and therefore must maintain a certain distance in order to maintain connection yet preserve the self. The truth is that neither one of the couple really knows how to be intimate without fear of abandonment or fear of merger or consumption. They, therefore, manage their fears by unconsciously regulating the space between them.

Cat and mouse games in relationships are exhausting and do little to deepen the connection between the parties. They are simply a way of the fearful couple playing at a relationship, without really having to risk true intimacy. In addition, each party might be unconsciously more gratified by other aspects of their role of cat or mouse. The cat feels powerful with the possibility of being able to catch the unattainable, that there is something about his or her talent that is able to convert the unwilling into the willing. The mouse delights in being the object of such intense interest, that he or she has the capacity to motivate this drive to pursue in the other.

Yet, Tom never really ever gets Jerry, and Jerry is never really gotten. They never really get close enough to each other for true satisfaction and therefore never really have a truly intimate relationship, even if they marry. The work for each in the couple is to address their underlying fears of abandonment or merger/enmeshment that likely have their roots in their early lives. It is with this examination and working through that they could become ready to truly participate in an intimate relationship.

Tuesday, September 1, 2009

When Women Abuse: Nancy Garrido, Female Perpetrator in the Jaycee Dugard Case

We have all been rightfully outraged by Phillip Garrido, the registered sex offender who abducted and sexually abused the 11 year Jaycee Dugard, holding her for 18 long years. However, little has been said about his wife, Nancy Garrido, who was married to him at the time of the abduction, and who lived with him during the 18 years that he held Jaycee, sexually abused her, and fathered her two children.

Who is she, and what kind of woman would participate in such a thing?

Nancy Garrido apparently met her husband while she was visiting a relative in prison. At the time, Phillip Garrido was serving a 50-years-to-life sentence for the brutal kidnapping and rape of a 25-year-old Reno casino worker. Their relationship resulted in marriage even before Phillip Garrido was released on parole. Nancy Garrido knew all about her husband's crimes before she married him and she was allegedly with her husband on the day that Jaycee was abducted. Carl Probyn, Jaycee Dugard's stepfather who witnessed the abduction, apparently described a woman who closely resembled Nancy Garrido.

Women who seek out inmates, or knowingly build relationships with disturbed men like Phillip Garrido, often suffer from a variety of psychological problems. Many of these women are often depressed and have extremely poor self-esteem. They are often described as highly dependent and are often subservient or deferential in their relationships. Yet, the question arises as to how they could know about the horrific aspects of these men, and yet maintain a relationship with them. The answer is that these women may excessively rely on the psychological defense mechanism known as splitting.

Splitting is a term central to the object relations theory introduced by psychoanalyst, Melanie Klein. It emerged from the observations that infants can only keep one of its strong contradictory feelings or thoughts in its immature awareness at a time. To maintain its fragile personality structure, the infant uses splitting to keep apart the conflicting inner feelings that the good (loving, gratifying) and bad (frustrating, depriving) aspects of the mother arouses. It is not until later development, if all goes well and there is not excessive trauma, that the infant achieves integration and comes to understand that the 'good' mother and the 'bad' mother are one and the same. The infant realizes that the mother that it loves and the mother that it hates, are the same person.

However, if a person fails to accomplish this developmental task of integration, borderline pathology can develop. The borderline personality is not able to integrate the good and bad images of both self and others and therefore relies excessively on splitting. Black and white thinking becomes the central way of organizing information. Trauma in early life often results in an overreliance on splitting, in order to manage incompatible or intolerable feelings. These conflicting feelings can be split off and projected, locating them outside of the self. The person survives by either freeing herself of all bad feelings and just being left with good, or she can preserve the outside world as good while holding all the bad feelings.

An example of this is the case in which the criminal partner is idealized while the jailhouse wife devalues herself. The result may be a woman with a self-identity rooted in powerlessness and devaluation, having 'split off' and projected into her partner all feelings of power and idealization. She may believe that by joining with him and supporting him, she can be protected by his power and be close to his good and idealized parts. This can explain how women like Nancy Garrido can know about their husbands' abusive ways, yet appear to idealize them or desperately want to be with them. The truth is, for her and others like her, the pedophile and the idealized husband are psychologically separate and distinct beings to her. She is, therefore, invested in protecting her idealized husband, even at the same time as she may be the victim of his abuse.

Some researchers, e.g. Faller (1987), have confirmed that many female sex offenders have had significant difficulties in psychological and social functioning. About half have mental problems, both retardation and psychotic illness. More than half have chemical dependency problems, and close to three-fourths have maltreated their victims in other ways in addition to the sexual abuse. Only 7.5% of the women have been classified as psychotic at the time of the sexual abuse.

Other researchers, e.g. Mathews, Matthews, and Speltz (1987) and Patton (1987), have found that just about all female sex offenders were themselves victims of childhood sexual abuse and many were also victims of physical abuse. They tended to have strong and consistent patterns of childhood social isolation, alienation, and a lack of development of interpersonal skills and competence. The researchers have identified three categories of female sex offenders: Teacher/Lover, Predisposed (intergenerational), and Male-Coerced.

The Teacher/Lover offender is generally involved with prepubescent and adolescent males with whom she relates as a peer. Her motive is, ostensibly, to teach her young victims about sexuality and often sees herself, on some level, as an adolescent girl.

The Predisposed offender is usually a victim of severe sexual abuse that was initiated at a very young age and persisted over a long period of time. She has typically initiated the sexual abuse herself and the victims are usually her own children. Her motives are nonthreatening emotional intimacy.

The Male-Coerced offender usually acts initially in conjunction with a male who has previously abused children. She exhibits a pattern of extreme dependency and nonassertive behavior, and she may eventually initiate sexual abuse herself. Her victims are children both within and outside of the family.

Reports of Nancy Garrido suggest that she had a highly dependent and deferential relationship with Phillip Garrido. She has been described as "strange" and "robotic." There is no evidence to date that suggests that she has engaged in previous sexual abuse of children. Given this, she can most likely be categorized as a male-coerced offender. However, there appears to have been a period of about four months during Jaycee's detention where Phillip Garrido was incarcerated on a parole violation. Nancy Garrido continued to hold Jaycee during this time, and it was shortly after this release from jail that Phillip Garrido impregnated then 14 year old Jaycee for the first time. It may be that Nancy Garrido was so excessively psychologically dependent on her husband that, even in his absence, she continued to behave in ways to meet his needs and maintain his world in order to maintain her connection to the idealized aspects of him. A thorough evaluation of Nancy Garrido's history and previous behavior could determine whether she was truly a male-coerced offender and/or if she may also have been a predisposed offender.

Certainly, most women are especially protective of children. In fact, if it were not for the keen attention of two women police officers, sensitively attuned to non-verbal communication signals of children, this case would have never been solved. Yet we need to understand the factors that contribute to the destruction of such a protective instinct that could lead to a woman like Nancy Garrido and a case like Jaycee Dugard's.

The truth is that Nancy Garrido's behavior likely reflects the sequelae of horrific childhood sexual abuse, undiscovered and untreated.

Sunday, August 30, 2009

The Impact of Long-term Abduction and Sexual Abuse: The Jaycee Dugard Story

I was recently interviewed by a reporter who was interested in my assessment of the case of the recently found Jaycee Dugard, the 29 year old woman who had been the victim of a kidnapping at 11 years old, and who was held for 18 years in captivity by her abductor, a registered sex offender.   The abductor's chronic sexual abuse of Jaycee, which began shortly after her abduction, eventually led to the birth of two daughters, now aged 15 and 11 years old. (Click here to read the newspaper article.)

This case is one of immense tragedy and trauma.  Not only did this young girl have to survive the terror of abduction and the immediate loss of family and anything that was previously familiar to her, but also with the trauma that was to follow in the form of chronic sexual violence.

Tragically, the 11 year old Jaycee, who was held in the minds of her loved ones for those 18 long years, is long gone.  In her place is a now 29 year old woman who, for most of her life, suffered unspeakable sexual abuse and exploitation, and lived in unusual social isolation which robbed her of any reference of what was normal.  In the place of normal social and family experiences was the experience of being raised by a severely psychologically disturbed parent couple with a bizarre world view which included a distorted view of physical, emotional and sexual boundaries, justified through a bizarre religious belief system into which she was indoctrinated.

By instinct, Jaycee would have, no doubt, immediately become aware of the significantly vulnerable position she was in and that her life and survival depended on these two highly disturbed people.  As would be expected in a situation like this, she would have tried to find any modicum of safety she could locate, even if it meant that such safety would be located in her perpetrators.  This combination of extreme terror and dependence are necessary ingredients for the development of the Stockholm Syndrome.

The Stockholm Syndrome term emerged after a 1973 bank robbery incident in Stockholm, in which  bank robbers held bank employees hostage for about 6 days.  In this case, the victims were observed to become emotionally attached to their captors, and even defended them after they were freed from their ordeal.  The term Stockholm Syndrome has come to refer to the particular psychological response, sometimes seen in abduction cases such as Jaycee's, in which the victim forms an attachment to their perpetrators.  The victim, needing to find security and safety in a terrifying situation, projects into and identifies in the perpetrator the safety and protection she desperately needs to feel exists in the outside world.  By so doing, the victim comes to feel that she has some external safety as she connects to the perceived protective parts of the perpetrator, even while at the same time as she might be the victim at the hands of the same perpetrator.  The victim ultimately develops a complete psychological dependence on her perpetrator.  Abuse becomes fused with care. Such appeared to be Jaycee's experience.

Jaycee's identity has been shaped by and she is now permanently linked to this sick man.  She has borne two children by him who, no doubt, bear the scars of the sick life he imposed on them and their mother.  They are, however, likely to be deeply attached to the only life that they have ever known, a life that includes their father and all of his ideology.

One of the consequences of this kind of attachment in these kinds of circumstances, is that one is likely to see what appears to be contradictory behavior by the victims towards their abuser.  For example, it is possible that Jaycee may have felt positive feelings towards the perpetrator, negative feelings towards authorities or others who may have seemed likely to rescue or support her, or may have displayed support for the perpetrator's disturbed reasoning and behaviors.  It is possible that she engaged in supportive behaviors towards the perpetrator, at times helping him, and may have found herself unable to engage in behaviors that would have assisted her release or disengagement from him.

Now on release, she is likely to have overwhelming feelings of confusion and may continue to display these contradictory feelings and behaviors.  She may also experience significant feelings of guilt for having depended on her abuser and for her attachment to him.  Yet, the attachment that she developed must be understood as a normal part of a helpless victim's attempt to survive. 

So what now?  Now that Jaycee has been found and reunited with her family, how does she begin to mend her life?  The answer is, 'Very slowly and very carefully.'  Jaycee is likely to demonstrate symptoms of Post-Traumatic Stress Disorder.  Both she and her children are likely to demonstrate symptoms consistent with significant social isolation and extreme psychological dependence, as one often sees in those who have been long term members of a cult.  They will all need intensive, long term treatment and the family will need to be prepared for a long and complicated journey.  The joy of reunification will soon be followed by a range of emotions, not all of them pleasant.  The family would do best to protect these fragile, broken young people from the public's eye, so that they can commence their long road to healing. 

Thursday, August 27, 2009

When Bad Things Happen to Good People

Senator Teddy Kennedy was, by most accounts, a good man.  Yet, he had a life that was riddled with tragedies.  By the time he was 32 years old, he had lost all three of his brothers to violence and had lost the essence of a sister to a lobotomy.  He would later survive two near death experiences, one resulting in the death of another.  Two of his three children would battle cancer, one eventually losing a leg to it at the age of 12.

Bad things can happen to good people.  I say this to say that sometimes the things that happen to us may not reflect our innate goodness or our innate badness, they just happen.

From the moment that we recognize that when we cry as babies that we can make our magical mommy appear with breasts full of milk, we are encouraged into the idea of our omnipotence.  Yes, our earliest experiences rightfully encourage us to believe in our own power.  This experience, while vital in the development of  self-esteem, may also leads us to incorrectly conclude that we can control more than we actually do.  It is a sad state of affairs when the child has to come to terms with the reality that he or she may not have the wished-for power. The child comes to realize, for example, that she cannot make her annoying brother disappear, he cannot convince mother that he must have that special toy, or she cannot stop daddy from having another drink.  It is a developmental achievement for the child to continue to believe in his or her own power, even in the face of such disappointing and painful realities, but come to recognize the limits of it.

The child who survives infancy and childhood into adulthood psychologically intact does so by surviving these experiences and by accepting that which is the most difficult to accept - that we are often powerless over these events.  At the same time, the child must also accept that these life experiences are not a reflection of the child's innate badness or goodness.  Great things don't happen to the child because she or he is inherently good.  Bad things don't happen to the child because she or he is inherently bad.  Most importantly, the child must  believe in being inherently good and believe that she or he maintains her or his goodness, even when bad things happen.

To be sure, there are those who spend a lifetime trying to control bad things from happening, by trying to find ways that they can control the outcome of each event.  The fantasy is that they can keep bad things from happening by their own actions.   The woman who believes that she can be relieved of horrible feelings of dread should she wash her hands 17 times.  The man who must have his directions in all aspects in his life followed to the letter so as to make sure no unforeseen events occur and that the possibility of a bad thing occurring is controlled.  When they are not able to ultimately stop a bad thing from happening, they become excessively vulnerable to depression because they are unable to separate out the bad event from their definition of themselves.

Now, I am not arguing that we have absolutely no control over our lives.  There are choices that we can clearly make every day that diminish the possibility of a bad outcome.  Not drinking and driving is one of them.  Getting a check up with the doctor when one becomes ill is another.  What I am suggesting is that when bad things do happen, we could fall victim to depression should we entertain the idea that something about our being is  responsible for such a bad thing.  Belief in being 'cursed' or 'unlucky' reflects such an identification with external events that may reflect a belief in being inherently bad.

Healthy psychological adaptation means being aware of one's powerlessness in the grand scheme of things, while at the same time believing in one's own power.  Having belief in one's own power requires a belief in one's inherent goodness and sense of omnipotence borne from good enough early childhood experiences.  That is,  even when bad things do happen, we believe that we are made up of good stuff and that that good stuff can survive.

I suspect that that is how Teddy did it.

"The work begins anew.  The hope rises again,  And the dream lives on."  Edward Moore Kennedy (1932-2009)

Monday, August 24, 2009


Life can sometimes be likened to being on a train. Most of the time, it is going along quite well, getting to the appropriate destinations on time and without incident. Sometimes, it is a bumpy ride or there is some need for a diversion. On a few rare occasions, however, there can be a derailment that leads to disaster.

We are the train drivers of our lives. As long as we are in the driver's seat, we can have a clear view of what is in front of us. We can have clarity about where we've been, and can anticipate what stop is coming up next. We can be satisfied that we can have some reasonable control of the train, yet recognize that there might be some things that might occur, from time to time, that are outside of our control.

Sometimes, however, for some people, the ride is not always  a smooth one. In fact, for some, it is downright out of control. For children who have been the product of a chaotic early life, life can be described as the equivalent of being on a roller coaster train. A chaotic early life can result from the presence of parental alcohol or drug abuse, parental conflict, chronic parental disorganization or significant psychological difficulties in a parent. Unexpected childhood traumas, such as a life-threatening illness or the loss of a parent or sibling, could also contribute to an emotional upheaval. These experiences may leave a child with the fear that they are on a train that is going or has gone off the tracks, out of control. That is, the chaotic external life becomes the child's chaotic internal life. Sometimes, children raised in these situations become helpless, succumbing to a life of chaos and out of control behaviors. Others employ Herculean efforts in an attempt to bring some order to their otherwise chaotic experience.

They try to exercise CONTROL.

Think of the following examples. The young boy of the alcoholic parent who spent much of his young life making sure his mother was put to bed at night after an alcohol binge, or who would have suffer her rages throughout the day as she cursed him and everyone else in the world. The young girl who experienced abuse in early life and did not feel protected or supported by her family. Both of these children may have had the experience of feeling like they were on a train that was going off the tracks. While children like them may later live in an adult life that reflects derailment, others may work in an excessively disciplined way to correct the course and get their train back on track.

That person might become the adult who emerges from these situations paying very close attention to keeping things under control. Behaviors such as restrictive eating, excessive stinginess, perfectionism, obsessive cleaning, rigidity of personality or other ritualistic behaviors might reflect an attempt to bring order to what would otherwise feel like a chaotic world.

The fear for the now adult is that the train could go out of control, go off the tracks, but for the vigilance and CONTROL of the driver. The driver must apply the brakes, swerve hard, and avoid disaster.

Sometimes however, being chronically fearful of the possibility of the train going off the track, (or one's life going off track in some way) or being finely attuned to any slight bumpiness, the driver spends a lifetime with his or her foot on the brakes, and swerving from left to right. This 'over-correction', a response to the feared out-of-control train, ultimately leads to a train that is at risk of actually going off the tracks. That is, paradoxically, the attempts to control the feared out-of-control train, may itself lead to an out-of-control train or a train wreck. A person, fearful of becoming or feeling out of control, may ultimately engage in damaging out-of-control over-controlling behaviors.

For example, Gabrielle, a survivor of a chaotic early life, struggled with chronic anxiety and fears of her life becoming out of control. She has spent a lifetime over-controlling her food intake with the unconscious fantasy that, by so doing, she could free herself from the feeling of being out of control. Paradoxically, her attempts to control her out of control feelings resulted in an out-of-control eating disorder.

When thinking about your own controlling tendencies, pay close attention to what might be behind the need for such control. Remember that controlling behaviors emanate from fears of being out of control. Think about what is really out of control that might require inflexibility in relationships, spotless cleaning, or rigid rule bound behaviors. Do your attempts to correct your course ultimately lead to something else out of control? Is your train really out of control or do you just fear that it might be? Are your attempts at correction appropriate to the actual deviation of your train, or do you risk derailing your train by overreacting and overcontrolling?

Friday, August 21, 2009

Monitoring Behaviors in Romantic Relationships

I recently overhead a conversation between two young women. "Oh my God. This guy that I have been going out with is totally commenting on my Facebook every five minutes and, like, asking questions about everyone of my friends." Without skipping a beat, her friend proclaimed, "Stalkerrrrr!"

Monitoring behaviors in romantic relationships are not new. They involve a pattern of behaviors of closely monitoring the proximity of the person of interest. This can include a monitoring of not just the physical proximity of the person, but also a monitoring of the mental and emotional proximity.

"Where are you?" "Who are you with?" "Are you thinking of me?" These are all questions that may have the aim of ensuring an ongoing link with the person of interest. This relationship style represents not only the insecurity in the current adult relationship, but research indicates that it might reflect the person's early childhood attachment relationship. Specifically, monitoring behaviors in romantic relationships may reflect an anxious attachment of early childhood.

John Bowlby, a British psychoanalyst, originally developed the theory of attachment based on his observation that infants go to extraordinary lengths to either prevent separation or reestablish proximity with a parent. He argued that these were adaptive responses to separation from someone who provides support, protection and care.

Securely attached infants tend to be the most well adjusted. These infants have had the experience of relatively consistent and reliable parenting with few significant stressors or traumas in their early life. They tend to be resilient, well liked and get along well with peers. On separation from their primary attachment figures, they do become upset, but when the parent returns, the child actively seeks the parent and is easily comforted by him or her. In adulthood, these people tend to be more satisfied in their relationships and their relationships are characterized by greater longevity, trust, commitment, and interdependence. They easily turn to look to their relationship for comfort in times of distress.

In contrast, when trauma, inconsistency, abandonment or other significant stressors are a part of the infant's early experience, a different kind of attachment relationship can emerge.

Avoidantly attached infants tend to avoid expression of distress upon separation from their parent, although they are seen to be experiencing physiological distress. Upon reunion, these infants actively avoid seeking contact with their parent, sometimes turning their attention to other objects instead. In adulthood, these people may appear not to care too much about close relationships, and may prefer not to be too dependent upon other people or to have others be too dependent upon them.

Anxiously attached infants tend to become ill-at-ease on the initial separation from the parent, and then become extremely distressed. When reunited with their parents, these children have a very difficult time being soothed, often exhibiting conflicting behaviors that suggest that they want to be comforted, but also that they want to "punish" the parent for leaving. In adulthood, these people may tend to worry that others may not love them completely, and be easily frustrated, anxious or angered when their needs for connection go unmet. This is the attachment style that can lead to excessive monitoring behavior in adult romantic relationships.

Do you know your attachment style?

Secure Attachment Style
I find it relatively easy to get close to others and am comfortable depending on them and having them depend on me. I don't worry about being abandoned or about someone getting too close to me.

Avoidant Attachment Style
I am somewhat uncomfortable being close to others; I find it difficult to trust them completely, difficult to allow myself to depend on them. I am nervous when anyone gets too close, and often, others want me to be more intimate than I feel comfortable being.

Anxious Attachment Style
I find that others are reluctant to get as close as I would like. I often worry that my partner doesn't really love me or won't want to stay with me. I want to get very close to my partner, and this sometimes scares people away.

Thursday, August 20, 2009

On Becoming a Couple

Some people just struggle in relationships. They just do. There are a few that can't quite seem to manage to begin them, and there are those who just can't seem to manage to sustain them. If you are one of the folks for whom this is true, here are a few things to think about.

Our very first relationship experiences form the template for our future relating. Beginning from birth, our relationship with our primary caregivers is critical to our concept formation about relationships. These early life experiences of disappointment or satisfaction mould our image of what a relationships should or could be.

As a psychologist who often works with couples in psychotherapy, I find that helping individuals become aware of what they bring to a potential couple relationship is critical in helping them work through of the couple's difficulty.

For example, who could compete with Fiona's vision of the 'perfect' father she imagined her father to be and who would ever measure up to the critical analysis of her mother?

Dane could never let anyone get too close to him, but he would find that he often felt desperate and needy in relationships. His father had left the family when he was two years old, and his mother vacillated between being depressed and angry.

Neither Fiona nor Dane was conscious of being impacted by their relationship with their parents, but neither one could sustain a relationship. It was not until they began to understand how they would consistently re-enact the templates from their early life relationships in every relationship, could they begin to make different choices which led to more sustained relationships.

If you are struggling in forming or sustaining current relationships, it would be important for you to understand the impact of your early life relationships and the messages about yourself and others that resulted from that experience.

Here are five tips to help guide you through the relationship process.

1. Get to know yourself, including what your fears and hopes are in relationships.
2. Make a map of your family, and identify the quality of the relationships between the family members.
3. Ask yourself the following question: Do the feelings in my relationship remind me of anything in my early life?
4. Remember that communication is key. This may be hard for those who were raised in families that didn't communicate well and this may require extra effort.
5. Don't be afraid to seek couples therapy to address concerns in your relationship.

Wednesday, August 19, 2009

Have you heard about Executive Function Disorder?

The concept of ADHD, Inattentive Type, is changing! The understanding of inattention is shifting from the inability to stay on task to a broader concept called Executive Function Disorder (EFD). This acknowledges that the inattention often seen in children with this diagnosis can sometimes reflect a broader set of executive functioning difficulties. Keep posted for more information about this potentially new diagnostic category.

Remember, the best way to get your child properly diagnosed is with psychoeducational testing. Please feel free to contact my office to schedule your child for testing. You can go to my website at for more information.