Monday, November 14, 2011

The Conspiracy of Silence: Penn State and Child Sexual Abuse

The recently revealed allegations of sexual abuse against former Penn State football coach, Jerry Sandusky, and the revelations that many were privy to this information but did nothing, has rocked the college football world and the entire country.

Concerns about Jerry Sandusky were apparently raised as far back as 1995 by the biological mother of a troubled teenage boy that Jerry Sandusky was fostering and would later adopt, although it is not clear whether the concerns at the time were sexual in nature.

Three years later, in 1998, however, a then 11-year-old boy reported to the police that Sandusky had showered naked with him. Another boy was apparently in the shower at the time. The police apparently set up a sting and they obtained what is described as a telephone 'confession' by Sandusky to the boy's mother. Despite this, the district attorney declined to prosecute and the Child Protection agency investigating the complaints at the time also felt they could not substantiate the claims.

Two years later, in 2000, a group of janitors allegedly observed Sandusky sexually abusing two other young boys separately. They testified to the grand jury that they apparently discussed between them how to report the incident at the time, although there appears to be no record of that report.

Two years later, in 2002, the then Graduate Assistant Coach, Mike McQueary alleged that he observed Sandusky sodomizing a boy who appeared to be around 10 years old. He allegedly reported the incident the next day to Penn State coach Joe Paterno, who then reported something to the Athletic Director and to the then university Vice President, who then apparently reported something to the then university President, Graham Spanier. What was reported from one level to the next remains in question, although it has been suggested that as reported allegations moved from one level to another, they became more and more minimized so as to ultimately allow the university to determine that the incident was insignificant. No action was taken. A police report was never filed and Sandusky was merely asked not to bring kids into the locker room. At the same time, the president of The Second Mile charity founded by Sandusky to aid troubled kids was also informed of the concern about Sandusky and they claim that they conducted an internal review and found no wrongdoing.

In late 2008, a high school freshman boy at a school where Sandusky was a volunteer coach eventually disclosed to his school principal and mother that Sandusky had been sexually abusing him. A grand jury convened in 2009 to investigate the charges. They have identified eight alleged victims to date, all of whom appear to have some connection to Sandusky's The Second Mile charity.
Since his arrest, Sandusky has been freed on $100,000 unsecured bail by a judge who had been a volunteer to his Second Mile charity.

When one lays out this sequence of events, they are shocking. How is it possible that, despite these numerous incidents, Sandusky has appeared unrestrained from engaging in this pattern of concerning behavior?

Sandusky's behavior is very typical of many child predators. 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. In establishing a career as a coach, centered around young children, and in particular young boys, Sandusky created a setting in which he could have ready access to potential victims.

Victim selection and recruitment are next. Although it is possible that any child may potentially be victimized, 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. In this case, Sandusky established an entire organization in which he could have a ready supply of vulnerable young people. His charity, The Second Mile, was specifically focused on the vulnerable and emotionally troubled young child who would be more likely longing for special attention, but who also might not be seen as credible should allegations surface.

It thus seems clear how Sandusky may have engaged in specific grooming behaviors and organized his life around obtaining victims to satisfy his disturbed desires. However, it should be equally clear that Sandusky would not have been able to continue these alleged abuses if those who came to know or suspect about them had done more.

How it is that those around Sandusky were able to witness all that they did and yet fail to act to stop him? How did so many ultimately engage in a conspiracy of silence?

To understand this, one must understand the powerful social psychological factors that impact behavioral outcomes. One such factor is cognitive dissonance. Cognitive dissonance is defined as the discomfort that is experienced when a person holds conflicting ideas or beliefs simultaneously. The theory proposes that people have a motivational drive to reduce tension, and thus to reduce cognitive dissonance. They achieve this by changing their attitudes, beliefs or actions in the face of experiences that challenge their strongly held belief or attitude. However, to do so, they may engage in behaviors such as justifying, blaming and denying.

Social psychologist Leon Festinger first introduced the idea of cognitive dissonance in his 1956 book "When Prophecy Fails." In this book, he chronicled the followers of a UFO cult who, when faced with the reality that their predicted end of the world date had come and gone, found ways to justify and strengthen their beliefs, rather than experience the discomfort of questioning and abandoning them. In this way, those around Sandusky similarly engaged in reducing cognitive dissonance. They had a view of Sandusky, of those in his position, or of those who are revered in football to be of a particular moral character. When faced with suggestions or evidence to the contrary, they must have experienced significant cognitive dissonance. After all, how could a founder of children's charity, a respected football coach, assistant to such a revered coach of a revered college, in such a revered sport, be a pedophile? And so, they engaged in the processes to eliminate this dissonance, such as minimization, justifying and denial. They preserved their view of Sandusky, of Paterno, of Penn State and of football, by eliminating any cognitive dissonance the new knowledge would have brought. This cognitive dissonance was experienced on a wide scale resulting in many people on many levels engaging in the process to remove it. This is the beginning of the conspiracy of silence.

The other factor at work here, on a broader scale relates to how, as a society, we understand and treat weakness and power. In his celebrated 1947 book "If This Is A Man", author and Holocaust survivor Primo Levi wisely invited us to consider that "a country is considered the more civilized the more the wisdom and efficiency of its laws hinder a weak man from becoming too weak and a powerful one too powerful." He, of course, was reflecting on a system that had allowed the rise of the powerful to such a degree that it resulted in the ultimate incivility, the Holocaust. Levi rightly describes the problem as a systemic problem, one that results from how we, as a collective, choose to enact restraints within our systems and our societies. He reminded us that monsters do exist, "but they are too few in numbers to be truly dangerous. More dangerous are…the functionaries ready to believe and act without asking questions."

Sandusky derived special power by his alignment with a powerful college football system, a powerful coach, and a powerful profession, and our collective deference to these powers. We created and accepted a society in which these powerful forces were allowed to be too powerful. On the other hand, the children, the janitors, and perhaps even the graduate assistant coach, McQueary, may have felt themselves to be too weak to challenge the powerful system. They, perhaps, understood the position of powerlessness that they occupied. This combination of a powerful one that is too powerful, and a weak one that is too weak became a recipe for a kind of unthinkable incivility. Penn State football, and all those who were seen to contribute to its power, was too powerful, and it was the existence of this outsized power that resulted, in part, in these most egregious acts.

Sandusky may be a monster but, as suggested by Levi, what made his predatory behavior truly dangerous was the willingness with which those around him were ready to believe and act on his behalf without asking the proper questions. They were willing to do so to reduce their own cognitive dissonance. No one was willing to rock the boat, to challenge or restrain the powerful. And to the extent that Sandusky was aligned with the power system of football, he was not sufficiently challenged or restrained.

Tragically, all of these forces conspired to create a deafening silence about Sandusky's behavior, to protect individual feelings of dissonance, and to defer to the powerful at the expense of the weak.

Children were made victim and gravely harmed. We must all understand our responsibility in this.

Saturday, February 26, 2011

He loves me, he loves me not, she loves me, she loves me not...

Do you remember the feeling of trying to figure if the person about whom you are excited might be excited about you?  This dilemma and the ensuing feelings date back to that very first crush when we first try to decode the mysteries of love.  Can we not all relate to trying to find the answer to this burning question?  As we all come to understand, of course, this is not solely a dilemma of early life, but one which continues to plague us well into adulthood.  I recently received the following inquiry from a young girl which exemplified this struggle.  She wrote:

I'm 13 years old and turning 14 on march and I have this huge crush on this friend of mine who is 12 and turning 13 in september... But the other day he was outside playing soccer with his friend and I was outside with my friend too and they didn't even said hi.. So when they left I started to cry and my friend texted his friend and told him that I was crying and my crush found out so later he texted me that he was sorry because he was nervous and that it wasn't his intention to make me cry..

Now I don't know if I should start a conversation with him via bbm..
Can u please help me.. I don't know what to do... But I'm starting to like him just as a friend.

Heartbreaking, isn't it, but I am sure that all of you can remember a similar heartbreak and confusion.  I responded as follows:

I hope I can provide you with some help with your problem.  The situation that you describe is a very common one.  Often, part of the fun of having a huge crush is being able to fantasize about who the person is and how wonderful they will be with you.  And you want to believe that the other person is thinking about you in the same way.  Because of this, you sometimes are looking for evidence of their interest (or of their rejection) in every little thing that they do - all without that person ever knowing that what they say or do is having so much meaning for you.  Looks that that is what happened with this boy who had no idea that his saying hi (or not saying hi) to you was having so much meaning. What you later  found out that he was having his own anxieties going on in his head that he had to push past in order to talk to you - but he did.  He wanted to let you know that his not saying hi had nothing to do with you (it had to do with his own anxiety).  Don't take it personally.  In situations like this, there is more than just your feelings involved.  Now that he has contacted you, you think that you just want to be friends.  Think about how scary it may have been for him to contact you.  Are you thinking about just being friends now because this guy is now becoming more real to you, not the fantasy that was in your head before?  Or are you afraid of the reality of what having a real romance will mean?  Or was he was more interesting to you when he was harder to get?

The bottom line is that this is the normal course of crushes.  You are likely to have many, many more crushes.  First, don't make assumptions about what is going on in the other person's mind, either positive or negative.  Second, remember, the other person has feelings too.  And finally, before you really give your heart over to someone, try and get to know them first so that the connection is actually based on something real, rather than the fantasy in your head.  That way, it will be a feeling that will not be fleeting.

 Hope this helps.

The same goes for grownups too. 

Thursday, October 7, 2010

Death by candid camera: Voyeurism, Exhibitionism and the suicide of Tyler Clementi

Tyler Clementi was a freshman at Rutgers University whose sexual encounter with another young man was deliberately videostreamed over the internet without his knowledge, by his roommate and another freshman.  On discovering that this had occurred, Tyler apparently became distraught and tragically took his own life by jumping off the George Washington bridge.

Many serious issues are rightfully raised by these events, including the prevalence of bullying and suicide in gay youth, the scope of the definition of hate crimes and the role of the internet and social media in our culture.  The horrifying statistics are that almost 85% of all lesbian, gay and bisexual teens report are bullied in high school because of their sexual orientation and lesbian, gay and bisexual youth are four times more likely to attempt suicide than their heterosexual peers.  The internet and social media outlets have also all rightfully come under increased scrutiny for their perceived contribution to exposing Tyler's private life.  Dharun Ravi and Molly Wei, the two freshman students who have been accused of invading and exposing Tyler's private life have also rightfully been called to account.  However, did the behavior of Dharun and Molly behavior not merely reflect a disturbing and longstanding development in our culture coming to its most dangerous conclusion?  Could it be that this disturbing use of the internet and social media was merely a natural consequence of our culture's increasing compulsion towards voyeurism and exhibitionism, encouraged by a brand of television that began in the 1940s? 

Beginning around the late 1940s, the television show Candid Camera first aired, unofficially marking the birth of a new genre of television - reality TV.  This 'hidden camera' show aimed to capture the reaction of unsuspecting people who were made the victims of a prank.  The audience was to be intrigued and delighted by being allowed to spy on what was assumed to be a private experience of emotional expression and vulnerability, by knowing that they were "in" on something that the victim was unaware of.  There was the supremacy that the audience could feel in knowing something that the victim did not, and a delight in seeing the victim display their gullibility for all to see and laugh at.

This genre of television soon evolved, eventually with the camera no longer needing to the hidden, and with the subjects no longer unsuspecting, but volunteering to exhibit their private experiences for public consumption.  While 'hidden camera' shows were still preserved (with shows such as Punk'd and The Jamie Kennedy Experiment) shows such as the Real World, Big Brother, The Bachelor and Real Housewives marked the beginning of this newer genre of reality television.   No longer was there the need to construct a prank for the delight of the audience, the audience could now be delighted by witnessing 'real' events unfold that they would not ordinarily have access to.  In this new genre, there was now an agreement - the 'victims' agree to be the exhibitionist, providing entertainment and delight to the voyeuristic audience.  The audience (the voyeur) could satisfy itself by being able to witness the cast members' (the exhibitors) perceived humiliating behavior or their enviable lives.  Reality TV had become humiliation TV.

At the same time, this cosy, yet sometimes destructive relationship between the voyeur and exhibitionist was also being cultivated in the celebrity community with the explosion of the paparazzi.  Photos and sex tapes of celebrities were hunted and exposed, supposedly providing benefit for both.  The voyeur/exhibitionist relationship in this dynamic centered both on humiliation and titillation.

Facebook and YouTube further crystallized the exhibitionistic and voyeuristic impulses where the user agreed implicitly to be both exhibitionist and voyeur.  Privacy norms were eroded and information that was once private was now accessible for all to see who cared to see it.  With one click, everyone could see someone's child having a meltdown, see a teenager being beaten, see a kitten playing the piano or someone abusing a dog, or hear a politician say something offensive they thought no one had heard.  The voyeur/exhibitionist dynamic was now permanently sealed into our culture, providing both humiliation and titillation.

To be very clear, this is not to suggest in any way at all that Tyler Clementi willingly participated in this interplay between exhibitionism and voyeurism, that he wished to be exhibited or that he bore any responsibility for his exposure.  What is being suggested here, however, is that Tyler Clementi became an unwilling victim of what is ultimately a current compulsion in our culture: the compulsion to look at things which titillate us and our desire to convert the unsuspecting into subjects for humiliation for this purpose.  As such, Tyler Clementi was forced into the role of exhibitor by voyeurs Dharun and Molly, who no doubt must have relished the feeling of supremacy they felt in knowing that they could witness Tyler's secret behavior without him even knowing.  Indeed, Tyler Clementi was forced into the role of exhibitor by a culture that is compelled towards voyeurism and that has believed (long before Andy Warhol's declaration) that everyone secretly wishes to be seen, that everything should be seen, and that to witness the humiliation of another is the best titillation of all.  Smile, you're on...

Rest in peace, Tyler Clementi.

Monday, February 15, 2010

Coping with Seasonal Affective Disorder (SAD)

Seasonal Affective Disorder (SAD) was first described in the 6th century as a winter depression to describe a common slump in the mood of some inhabitants of most of the Nordic countries.

Seasonal Affective Disorder is a Major Depressive Disorder experienced by people who have normal mental health throughout most of the year, but experience depressive symptoms in the winter or, less frequently, in the summer, spring or autumn, repeatedly, year after year. Usually, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. Some people have the opposite pattern and become depressed with the onset of spring or summer. In either case, problems may start out mild and become more severe as the season progresses.

Just as sunlight is known to affect the seasonal activities of animals (i.e., reproductive cycles and hibernation), SAD is believed to be an effect of seasonal light variation in humans.  As the seasons change, it is suggested that there is a shift in the “biological internal clocks” or circadian rhythm, due partly to these changes in sunlight patterns.  It is this shift that is believed to cause the biological clocks to be out of “step” with the daily schedule, resulting is Seasonal Affective Disorder.

Symptoms for SAD are similar to those for atypical depressive illness such as hypersomnia (increased sleep), increased appetite with carbohydrate cravings, weight gain and profound fatigue.  Younger individuals, particularly women, appear to be at higher risk for SAD.

Researchers have long sought to locate the biochemical sources of this disorder.  It has been discovered that the pineal gland, located in the middle of the brain, responds to darkness by secreting melatonin, which re-sets the brain's central clock and helps the light/dark cycle re-set the sleep/wake cycle and other daily rhythms.  To further evaluate this, researchers (Lewy et al, 2006) tracked sleep, activity levels, melatonin rhythms and depression symptoms of 68 SAD patients who took either low doses of melatonin or a placebo in the morning or afternoon for a winter month when they were most symptomatic. They had previously determined from healthy subjects that a person's rhythms are synchronized when the interval between the time the pineal gland begins secreting melatonin and the middle of sleep is about 6 hours.  They found that seventy-one (71) percent of the SAD patients had intervals shorter than 6 hours, indicating that their rhythms were delayed due to the later winter dawn. Taking melatonin capsules in the afternoon lengthened their intervals, bringing their rhythms back toward normal. The closer their intervals approached the ideal 6 hours, the more their mood improved on depression rating scales, supporting the hypothesized link between out-of-sync rhythms and SAD.

Apart from melatonin supplements, treatment for SAD also includes bright light treatment. For this treatment, the person is required to sit in front of a "light box" for half an hour or longer, usually in the morning.  Another useful treatment is called dawn simulation. For this treatment, a dim light goes on in the morning while the person sleeps, and it gets brighter over time, like a sunrise.  Treatment for SAD can also include antidepressants which have been shown to be effective in the treatment of SAD.  Finally, psychotherapy, in conjunction with the above, has resulted in improved overall coping for sufferers of SAD.

Those believed to be suffering from SAD should seek professional consultation to obtain an accurate diagnosis and to rule out other causes for the depressive symptoms.

Saturday, January 16, 2010

ADHD in Adulthood

Attention Deficit/Hyperactivity Disorder (often referred to as ADHD, AD/HD or ADD) is a chronic neuro-behavioral disorder, usually first diagnosed in childhood.  The DSM-IV has described ADHD as having three subtypes: predominantly hyperactive-impulsive, predominantly inattentive and combined hyperactive-impulsive and inattentive.

For the predominantly hyperactive-impulsive subtype, most of the symptoms (six or more) are in the hyperactivity-impulsivity categories.  Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.  Symptoms of hyperactivity in children may include:
  • Fidget and squirm in their seats
  • Talk nonstop
  • Dash around, touching or playing with anything and everything in sight
  • Have trouble sitting still during dinner, school, and story time
  • Be constantly in motion
  • Have difficulty doing quiet tasks or activities.
and symptoms of impulsivity in children may include:
  • Be very impatient
  • Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
  • Have difficulty waiting for things they want or waiting their turns in games
For the predominantly inattentive subtype, the majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.  Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing.   Symptoms of inattention in children may include:
  • Be easily distracted, miss details, forget things, and frequently switch from one activity to another
  • Have difficulty focusing on one thing
  • Become bored with a task after only a few minutes, unless they are doing something enjoyable
  • Have difficulty focusing attention on organizing and completing a task or learning something new
  • Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
  • Not seem to listen when spoken to
  • Daydream, become easily confused, and move slowly
  • Have difficulty processing information as quickly and accurately as others
  • Struggle to follow instructions
For the combined hyperactive-impulsive and inattentive subtype, six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.  Most children with ADHD have the combined type.

Estimates of ADHD have varied, but it is believed that it affects between 3% and 5% of children.  Although it has previously been thought of as a disorder of childhood, it is now understood that ADHD often continues well into adulthood.  In fact, it is believed that as many as 30% to 70% of children with ADHD may continue to experience symptoms as an adult.  Like ADHD in children, adult ADHD is not indicative of the person's creative capacity or intellectual abilities.  In fact, people with all levels of talent and IQ may struggle with ADHD.

There are many adults who have never been identified as having ADHD in childhood, yet they present with difficulties and behaviors in adulthood that are suggestive of an undiagnosed and untreated ADHD.   These difficulties and behaviors are often difficult to identify as ADHD because they are often mistaken for other things, such as stress and coping problems, substance abuse or other psychological problems. ADHD is not often recognized in these adults until they seek help with one of these conditions.  In fact, many adults may first realize they have ADHD only when their own children or another family member are diagnosed with the condition.

Thomas E. Brown, Ph.D., an expert in the area of ADHD, and author of the highly recommended book, Attention Deficit Disorder: The Unfocused Mind in Children and Adults, suggests that ADHD reflects a developmental impairment of executive function.  He noted that ADHD adults typically present with a variety of complaints, including concentration problems, disorganization or distraction, and difficulty initiating tasks, working consistently, and attending to detail.  As a consequence, Dr. Brown identified six symptom clusters that were consistently reported by those with ADHD.  These included problems in:
  1. Activation: organizing tasks and materials, estimating time, prioritizing tasks, and getting started on work tasks. Patients with ADHD describe chronic difficulty with excessive procrastination. Often they will put off getting started on a task, even a task they recognize as very important to them, until the very last minute. It is as though they cannot get themselves started until the point where they perceive the task as an acute emergency.
  2. Focus: focusing, sustaining focus, and shifting focus to tasks. Some describe their difficulty in sustaining focus as similar to trying to listen to the car radio when you drive too far away from the station and the signal begins fading in and out: you get some of it and lose some of it. They say they are distracted easily not only by things that are going on around them, but also by thoughts in their own minds. In addition, focus on reading poses difficulties for many. Words are generally understood as they are read, but often have to be read over and over again in order for the meaning to be fully grasped and remembered.
  3. Effort: regulating alertness, sustaining effort, and processing speed. Many with ADHD report they can perform short-term projects well, but have much more difficulty with sustained effort over longer periods of time. They also find it difficult to complete tasks on time, especially when required to do expository writing. Many also experience chronic difficulty regulating sleep and alertness. Often they stay up too late because they can't shut their head off. Once asleep, they often sleep like dead people and have a big problem getting up in the morning.
  4. Emotion: managing frustration and modulating emotions. Although DSM-IV does not recognize any symptoms related to the management of emotion as an aspect of ADHD, many with this disorder describe chronic difficulties managing frustration, anger, worry, disappointment, desire, and other emotions. They speak as though these emotions, when experienced, take over their thinking as a computer virus invades a computer, making it impossible for them give attention to anything else. They find it very difficult to get the emotion into perspective, to put it to the back of their mind, and to get on with what they need to do.
  5. Memory: utilizing working memory and accessing recall. Very often, people with ADHD will report that they have adequate or exceptional memory for things that happened long ago, but great difficulty in being able to remember where they just put something, what someone just said to them, or what they were about to say. They may describe difficulty holding one or several things "on line" while attending to other tasks. In addition, persons with ADHD often complain that they cannot pull out of memory information they have learned when they need it.
  6. Action: monitoring and regulating self-action. Many persons with ADHD, even those without problems of hyperactive behavior, report chronic problems in regulating their actions. They often are too impulsive in what they say or do, and in the way they think, jumping too quickly to inaccurate conclusions. Persons with ADHD also report problems in monitoring the context in which they are interacting. They fail to notice when other people are puzzled, or hurt or annoyed by what they have just said or done and thus fail to modify their behavior in response to specific circumstances. Often they also report chronic difficulty in regulating the pace of their actions, in slowing self and/or speeding up as needed for specific tasks.
These problems often result in difficulties in many areas of the person's life.  Adults with ADHD may demonstrate chronic problems which impact their career development, their relationships and their general functioning.  Research has found that the most common behaviors in the ADHD adult that have a negative impact on relations are:
  • doesn’t remember being told things
  • saying things without thinking (sometimes resulting in social inappropriateness)
  • “zoning out” in conversations
  • problems dealing with frustration
  • trouble getting started on a task (procrastination)
  • underestimating time needed to complete a task (poor planning, time management)
  • leaving a mess and being disorganized (can include a messy or disorganized home, office)
  • forgetting special dates, meetings or always being late
  • not finishing a project
As a consequence of all of the above, the ADHD adult can be experienced as unmotivated, lazy or immature.  They may be experienced as requiring constant encouragement or supervision in order to remain focused or complete role appropriate tasks.  They may be experienced as unreliable or insensitive.  Their verbal impulsivity can make other people feel uncomfortable. People with ADHD may often enjoy vigorous conversation as a source of stimulation, however may struggle to recognize that others may not share this enjoyment,  As a result, while others in similar situations may know to tone down the argument and move onto another topic, the ADHD adult may persist in the conversation, leading to social unpleasantness.

Many times, adults with ADHD might unconsciously seek relationships with those who act as organizers for them - disciplined, controlled people who 'loan' their organizing functions to the ADHD adult from time to time.  While this may often result in a cooperative and supportive relationship, frustrations in the relationship may exist as the ADHD adult may be experienced as needing a lot of management, and as being demanding and immature.  The partner may find that they are constantly nagging the ADHD adult to get up, to tidy up, to get organized, and to take care of business. The ADHD adult may be constantly misplacing their keys or forgetting to do important tasks.  In addition, the partner may sometimes feel hurt that their ADHD adult loved one doesn’t seem to listen to them, blurts out hurtful things, and leaves them with the bulk of the responsibility for organizing and planning.

The ADHD adult may struggle in making career decisions, in being disciplined in ways that allow for the successful development of a career, or may demonstrate impulsivity resulting in frequent career changes.  At work, they may be disorganized, may procrastinate or may be verbally impulsive which may negatively impact relationships at work. They may demonstrate difficulty concentrating, completing tasks, listening, and relating to others which can also lead to trouble at work. They may make frequent errors in writing and spelling which they do not notice soon enough.  In their personal lives, managing finances may be a concern. The ADHD adult may find him or herself struggling to pay bills, losing paperwork, missing deadlines, or be in debt due to impulsive spending.  Their inattention and impulsivity may lead to frequent clumsiness or an increased risk for car accidents or traffic tickets.

Impulsivity and trouble with organization in the ADHD adult can also lead to problems with health, such as compulsive eating or reaching for unhealthy foods, a reinforcing cycle of alcohol and drug abuse, or trouble making appointments or forgetting medication for a chronic condition.  Many ADHD adults may self medicate with chronic marijuana use (or other substances) in their unconscious attempts to increase their focus or regulate their affect.

Structure and organization can significantly improve the life of the ADHD adult.  Personal aids such as PDAs and other organizers can be invaluable in keeping the ADHD adult on track and on task.  Developing consistent schedules for everything, including eating and sleeping can also be important in regulating affect and behavior.  However, medication intervention, coupled with the above changes, has often been the most effective treatment for the ADHD adult.  Adults who might suspect a diagnosis of ADHD are encouraged to obtain a proper assessment such as psychodiagnostic testing by a skilled psychologist, to properly confirm the diagnosis of ADHD.

    Sunday, January 10, 2010


    'Tweenager' is a deliberately created word.  Marketing professionals recognized something important about the psychology of children (girls, in particular)  in the stage between youth and teenager.  They understood that these children, although a unique group, had a striving to be like their older counterparts, but also had a certain naivete that could be exploited.  Thus, the creation of the word 'tweenager' provided for the pre-teen an identity that acknowledged their relative youth status, but connected them to the older girls/guys they were aspiring to be.  The 'tweenage' stage, between the age of 10 years and 14 years, is an important period of cognitive, social, moral and sexual development that can present some challenges for both the child and the parents.

    In terms of cognitive development, during the tweenage period, the child moves from the Concrete Operations stage to the Formal Operations stage, as described by renown developmental psychologist, Jean Piaget.  During the Concrete Operations stage which occurs between the ages of 7 and 12 years, the tweenager begins thinking logically about concrete events, but may still have difficulty understanding abstract or hypothetical concepts.  As she/he moves into later tweenagehood and into Formal Operations, skills such as logical thought, deductive reasoning, and systematic planning begin to emerge.  Therefore, even though the tweenager may have the appearance, at times, of being an emerging adolescent, he/she may not have the cognitive sophistication to take on the complex decisions of adolescence.

    Changes in social development are also evident as the child moves through tweenagehood.  Renown developmental psychologist Erik Erikson described the social developmental process in eight stages.  Each stage is regarded by Erikson as a "psychosocial crisis," which arises and demands resolution before the next stage can be satisfactorily negotiated.  Erikson believed that the fourth psychosocial crisis was handled during what can now effectively be called the 'tweenage' period.  During this fourth stage, the issue of competence is central.  The tweenager, therefore,  is learning to master the more formal skills of life such as relating with peers according to rules, progressing from free play to play that may be elaborately structured by rules and may demand formal teamwork, and mastering important academics and increasing self-discipline in homework.  If all has gone relatively well for the child to this point, she/he will emerge feeling  competent and will be trusting, autonomous, and full of initiative and will learn easily enough to be industrious. However, this is also the period during which self-doubt, and feelings of shame, guilt and inferiority may be expressed when the child does not achieve this feeling of competence.

    The tweenager period ends when the child emerges out of this psychosocial crisis where struggles around competence is central and enters into the fifth psychosocial crisis (adolescence, from about 13 or 14 to about 20). Now an emerging adolescent, the tweenager begins to learn how to answer the question  "Who am I?"  During this period,  some role identity diffusion occurs and many may experiment with minor delinquency and rebellion.  However, it is also a critical period when this late tweenager may experiment with different - usually constructive - roles rather than adopting a "negative identity" (such as delinquency).  However, tweens sometime consolidate their identities through the formation of cliques.  Tween girls, in particular, as seen to be highly susceptible to forming cliques which, although can be a source of support and identity, can sometimes result in the phenomenon where tween girls may cruelly exclude their peers.  Both tween boys and girls also sometimes engaging in problematic bullying.

    Changes in moral development are also evident in the tweenager.  According to psychologist Kohlberg's theory of moral development, a change from a pre-conventional morality to a conventional morality typically begins during the tweenager stage.  The pre-conventional level consists of the first and second stages of moral development, and is solely concerned with the self in an egocentric manner. A child with pre-conventional morality has not yet adopted or internalized society's conventions regarding what is right or wrong, but instead focuses largely on external consequences that certain actions may bring.  As a result, if there are no negative consequences to their behavior, or if some positive comes of it, the tweenager may struggle to fully appreciate the inappropriate of his or her behavior. 

    As the tweenager develops, a shift towards a conventional level of moral reasoning is seen in the later tweenager stage.  This level of moral reasoning is typical of adolescents and adults. Those who reason in a conventional way judge the morality of actions by comparing them to society's views and expectations. The conventional level consists of the third and fourth stages of moral development. Conventional morality is characterized by an acceptance of society's conventions concerning right and wrong. At this level an individual obeys rules and follows society's norms even when there are no consequences for obedience or disobedience. Adherence to rules and conventions is somewhat rigid, however, and a rule's appropriateness or fairness is seldom questioned.

    For more and more, tweenagehood marks the onset of puberty and sexual development.  Girls usually experience the changes associated with puberty between the ages of 10-12 and it tends to happen a bit later for boys (between 12-15 years of age). Like any developmental milestone, there is a wide range of "normal."  Typically, however, these changes in sexual development are likely occurring in the context of changes in concrete cognitive operations, struggles around competence and pre-conventional morality, all of which may not optimally be in sync.

    Parents may notice changes in their tweenager as the changes in their cognitive, social, moral and sexual development converge.  For example, tweenagers may demonstrate new concerns or fears.  They may increasingly have a fear of kidnappings, rapes, and scary media events, as opposed to fantasy things such as witches, monsters, ghosts.  They may also have a more developed sense of looking into the future and seeing effects of their actions (as opposed to early childhood where children often do not worry about their future).  Parents may also notice that their tweenagers may begin to view human relationships differently.  They may notice the flawed, human side of authority figures, including their parents, whom they previously may have wholly embraced without question.  They may start caring about what they look like and what they are wearing.  In fact, alarmed parents may see their tween dressing like a teenager but still be unable to make the more sophisticated cognitive, social and moral decisions, which could leave the tweenager very vulnerable.  While they are trying out at being teenager by engaging in teenager behaviors, they may not have the emotional capacity to deal with the consequences of these choices.  Sometimes this includes the beginning of sexual experimentation.

    Parents must be prepared for the major shifts that are occurring in their children and be prepared to help them navigate through the changes in their cognitive, social, moral and sexual development.  Ultimately, like all periods of development, there is an eventual movement on to the next stage.  If sufficient support and understanding exists for the tweenage period, successful navigation into teenagehood will bring new and exciting challenges for all.

    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?