Is it really all about me? The growing irrelevance of the clinical term narcissism

I’ve written several times about the debates in the therapeutic community concerning the relevence of adding certain types of mental disorders in the upcoming addition of the DSM: Parental Alienation Syndrome, new variations of eating disorders, and Seasonal Affective Disorder.  It seems that every other day there is an article in the newspaper or on popular blogs that questions how we define mental disorders.  If once named a mental disorder, is is always going to be classified that way?  The most recent sighting of therapuetic chatter was found in the New York Times Sunday edition, the author of said blog despaired over the “Malady of Me”.  His question: is Narcissistic Personality Disorder relevant for the DSM anymore, given how commonplace narcissistic behaviors are?  Where is the line between symptoms of narcissim and a truly pathologic mental condition?  Narcissism is clinically most commonly represented in Narcissistic Personality Disorder.  Someone diagnosed with this condition would be described as being “excessively preoccupied with issues of personal adequacy, power, prestige, and vanity.  It is closely linked with self-centeredness”.

The term “narcissism” has been used for decades – centuries, even.  It was coined originally by Freud who named the condition after Narcissus, a character in a Greek myth who fell in love with his own reflection in a pool.  While in this myth, Narcissus was forever content staring at himself, real-life narcissists need someone else to validate their self-centeredness.  This need for approval, grandiosity and ego stroking begs us to wonder about deeper levels of vulnerability and perhaps a defense against shame.  The editors of the upcoming edition of the DSM are considering removing personality disorders completely — Narcissistic Personality Disorder plus four others — and instead picking certain personality traits traits that describe a particular client.  This makes diagnoses like this less stigmatizing, but what will happen to the personality disorders — and are they even relevant anymore?

I found this topic fascinating because of the numorous ties that the focus on narcissism draws between medicine, psychology, and pop culture.  How do psychiatrists treat narcissism? Is there a medication that can help allieviate symptoms (having a sense of entitlement, preoccupation with having unlimited success, power, beauty, and other complicated criteria)?  Can we even treat it?  How would we know when it was getting better?  We are a culture that is becoming more and more narcissistic every day.  Everywhere we turn, there are celebrities, tv stars, and politicians in the public eye trying to get you to learn more about “me! me! me! and how wonderful I am!”.  A recent segment on NPR focuses on several examples and types of narcissism in our culture and ties them to psychological constructs.  The most blatent figure outlined in this segment is Nicole “Snooki” Polizzi, who told Barbara Walters recently that “I think I’m fascinating”.  The degree that Snooki and her Jersey Shore castmates could be diagnosed as narcissistic is questionable, as the lines between psychological symptoms worthy of a clinical diagnosis and plain old self centeredness in our culture today are getting quite blurry.

Clinicians would agree that a diagnosis of Narcissistic Personality Disorder would have to “come after the symptoms are totally pervasive in one’s life, affecting all areas of functioning”, states psychologist Keith Campbell.  Whereas vanity and being full of oneself could be off-putting to others and create an aura of disdain around the nacissistic individual, the commonality of these symptoms amongst certain types of individuals make these traits quite expected — almost accepted.  So maybe there is no use of Narcissistic Personality Disorder in the DSM anymore?  Having that type of diagnosis would almost justify the crazy antics of reality tv shows, wealthy celebrities, and cocky sports stars: “see? there is an explanation for me.  It is you all that are crazy, not me!”

I am drawn back again to the counseling professionals’ assertion that underneath the layers of fabulousness (which in reality may not be so fabulous and which may be quite thin) often lies terrifying fears of worthlessness, shame, and vulnerability.  What if the tan skin, the million dollar jewels, the bleached hair were taken away?  That security blanket often shields one’s true nature which, when exposed, is truly beautiful and worthy.  I fear that at the rate this society is going, we may find it more and more difficult to let the inner nature show and we may feel we “must” cover it up with obviously beautiful qualities such as botox and Porsches.  Every day with clients I encourage openness and acceptance for who they truly are, and I hold a non-judgmental space for them to explore that person.  It is amazing to me to watch as clients realize that the qualities about themselves that they might think are the most “undesirable” are actually the qualities that bring them the most authentic joy and inner peace.

Helping aging family members: the best care for them while caring for yourself

Often there is talk of life cycle phases and the emotional, physical and mental challenges that can come when coping with change.  I read articles and blogs about managing parental stress and learning communication skills in a new romantic partnership — but there is significantly less talk about helping an aging parent or loved one accept the physical and emotional changes of growing older while maintaining their integrity.  Often there are shifts in cognitive ability and functioning as the years go by and this can elicit feelings of fear, despair and misunderstanding — experienced by both the caretaker and the aging parent.  I am also interested in looking deeper at ways that children and younger caretakers can tend to their own emotional needs and hopes as they support the folks who have been their caretakers all their lives.

There are many factors that  should be considered as parents age: financial situations, physical capacity to take care of oneself, the responsibilities and expectations of each child in the caretaking roles, and emotional reactions as both parent and child realize that there is no way to stop the effects of aging.

A blog that I came across lays out in simple terms the things to look for when tending to the needs of aging parents: go visit them and see for yourself how effectively they are functioning, ask your parents’ permission to go through their checkbooks and statements to see if there are any finaicial red flags, remember that they can sell their house and move into a more cost-effective one (and one that may require less household maintenance), and help them get all of their important legal documents in order such as their wills and power of attorney.  These steps are very rarely as simple as they might appear — often times the house holds memories and feelings that parents do not want to give up (rightly so).  Sometimes the fact of a son or daughter trying to make decisions for the parent can bring up some insecurities about the parent’s mental functioning and ability to make sound decisions and can create discord in a family.  I can certainly understand the difficulty when considering that a parent might be better off moving out of the large family home that he or she has tended to and nourished for decades…and for many aging parents, this is not necessary.  But when it is, how do you have that conversation with your parent in a way that shows compassion and understanding, but also a bit of no-nonsense decision making?

Members of the “sandwich generation” might be raising children of their own — making decisions about curfew and piercings while also needing to make decisions about the best care for an aging parent or loved one.  This might mean needing to take a more active role in your parents’ lives …and nothing can prepare you for that sudden illness or accident that may put finances, caretaking, and functioning ability in a tailspin.  Going back to what I brought up before about self-care while managing this situation, it is important to note that there is no harm in letting parents go about their business and remove yourself from meddling if there appears to be no just cause to sound the alarm.  Why stress yourself out more when you don’t need to? Just keep a vigilant eye and note if there are more forgetful episodes or disorientation as time goes by.

What if one of your parents was verbally, sexually, or physically abusive? How will that type of past influence you today as you hold more power in the family?  Blogs differ on this topic, but I agree with several writers I have come across who argue that you do not need to get involved in something that you do not feel comfortable doing.  This is not to say that you should neglect your parent in ways that they might have neglected your needs…but you might hire an unbiased nurse or find a good assisted-living home for your parent(s) to move to so that you are not retraumatized by needing to get too emotionally close to the abusive parent again.

I ran across a very interesting concept in the New York Times – a blog talks about the “Caregiver Relief Fund”, which is a charity founded about a year ago that awards family caregivers one-time vouchers for professional at-home care, allowing them to re-energize and tend to their own physical and emotional needs.  This goes back to that self-care thing I keep bringing up.  This fund partners with organizations across the country to offer services to families in need.  It is headquartered in Chicago and over the next few months will spread to five more states – including Colorado!  The fund’s founder aims to give vouchers to over one million caregivers in the next decade.

While there are positive opportunities such as the caregiver fund, there are also millions of families who do not have such fortune to receive monetary assistance when caring for an aging parent.  Tending to the household needs, a potential move to an assisted-living facility, paying for medications and doctors visits, and other expenses pile up enormously and it is all too often that families have not been prepared for such demands.  Caring for an aging parent can also cause strong emotional swings and reactions as family members might feel that the parent they knew is changing and drifting, and the parent might feel that they do not know what to do with their lives anymore.

Trying to make decisions about longterm care for a parent can bring about conflict between children in a family and can trigger anxieties and wounds borne decades earlier.  How should the money and possessions be divided when the parent cannot manage their household by themselves anymore? Who will be the best person to talk to mom or dad about difficult topics? If your family is going through this phase or if it has already, did you notice certain members taking on certain roles? Is one person more of a caretaker? One more of an avoider? One more of a planner and navigator?

All families go through transitions – and there is never a cookie-cutter way of planning out how to navigate these changes.  Shifts in roles and responsibilities can bring up insecurities but can also bring families closer together.  In every new chapter, there is the possibility of hope and healing!

What is Parental Alienation Syndrome (PAS) and should it be included in the next DSM?

Families go through numerous transitions and life cycles as the years progress.  Reality brings happiness and hardship.  Unfortunately, numerous families break up due to parental conflict and disconnection.  This type of distress often brings uncertainty and change for children involved in a family break-up, and children cope in any way they know how to try to make sense of their parents’ split.  In the early 1980s, Richard A. Gardner coined the term Parental Alienation Syndrome (PAS) to describe a disorder in which a child, on an ongoing basis, belittles and insults one parent without apparent justification.  This can be due to a combination of factors, including encouragement from one parent (almost always in the process of a child custody conflict), and the child’s own effort to criticize the targeted parent.  PAS is up for review to be included in the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), due to come out in 2012.

The Denver Post ran an editorial yesterday describing the personal effects of PAS on a family system and wondering about its justification for being included in the DSM.  The editorial focuses on a 46-year-old father of two adolescent girls who “desperately wants a relationship with his two girls” but “feels that their mother has brainwashed them against him”.  In court, the girls told the judge that they had been sexually abused by their father and their fabricated testimony appeared “rehearsed and prepared”.  The evident devastation of the father (who states that his ex is “executing a campaign of denigration” against him) is almost as upsetting as the fact that the girls appeared to be “genuinely terrified” of their father and he did not know why.

This man is not alone.  There are men and women in broken families who experience the effects of PAS every day — and, as the article describes, there are also millions of children who experience the strain of two warring parents.  In the family spotlighted in this editorial, the writer states that the mother purposely did not take the children to their father even though he was awarded joint custody and turned them against him so that the girls refused to see him when they had the chance.

Think about the emotional effects on each member of the family in this situation.  You may know a family that has gone through or is going through similar issues.  As a child in a family that is splitting up, so much is already tragic, already horrific, that to have a parent feel that he or she needs to demonize the other parent and turn the children against them exemplifies the emotional harm tremendously.  This might put the children in the middle and force them to choose — who loves them more? who is the better parent? who would it be better to live with?  These are questions that may have no clear answer …and are definitely not questions that children should have to consider at this tumultuous time.  Putting the serious emotional consequences on the children aside, I have to look at the emotions that each parent might be feeling.  What the editorial did not spend much time on was the way this affected each parent individually.  PAS may be defined as a syndrome that a child experiences in a broken family, but I also believe that the syndrome throws the targeted parent into a role of defending him or herself against their own children while they are experiencing the destruction of the family system they have built.  The personal feelings this role might scramble include guilt, shame, anger, fear, sadness, loneliness, and despair.

And what of the parent who drives the targeting?  Behind the defenses, behind the army-building, there must be a terrified parent who fears losing his or her children as well.  For some reason, instead of stating this or exploring why he or she is creating a sense that there is a “bad parent” in the family, the automatic response is to turn the children against the other parent.  I wonder if there is evidence as to if certain types of family breakup scenarios encourages PAS more than others?  Is it more likely to occur when one partner has strayed?  If one partner has taken more of an involved role in the upbringing of the children?  If one type of parenting style is more likely to lead to PAS than another if the family breaks up?

There is much controversy about including PAS in the upcoming DSM V.  Some argue that it will help get more insurance coverage for families experiencing this issue and that it will bring more attention to the severity of it in court.  Others have difficulty even understanding what PAS is and why it is considered a “syndrome”.  I tend to agree with the author of the editorial:  “the key is education.”  Educate the courts, educate parents, educate professionals about the effects of Parental Alienation Syndrome and perhaps it will be eradicated before it even has a chance to be included in an official manual.  Tell me: what do you think?

Violence in schools: no boundaries, few answers, no end in sight?

As I was doing research for my blog post today, I came across numerous articles and blogs that all sung the same tune:  violence in schools is deadly and tragic, and we need to focus our efforts on understanding possible causes and enforcing prevention of this serious issue.  The articles also rang clear: how do we predict, prevent, and eliminate the prevalence of students and other distressed individuals coming into schools and erupting in violent means?  I was moved to write about this topic today because of the hostage situation and suicide in a Wisconsin high school on November 29th.  Although school shootings and violence are quite rare, it struck a chord with me as I pondered how school violence appears to be getting more tragic and more frequent.  In this particular situation, the gunman, a 15 year old high school student, held his English class hostage for five hours before fatally shooting himself.  Quotes from his classmates state that he had no demands — he barely even spoke at all during the situation — and that he gave no evidence why he brought several guns and several magazines of bullets to class that day.  His teachers and fellow students state that he had not appeared distressed before that day and they were not aware of any bullying.  So now, tragically, a young teenager is dead, dozens of others are emotionally traumatized, and there are NO answers.

Installing metal detectors in schools is one of the first responses of many school officials in the wake of a school tragedy or violent incident.  This may help to detect when a weapon is entering the school — and prevent violence ensuing — however, it does not prevent (or explore) the feelings and motivations felt by these children (CHILDREN) that causes them to feel they need to react in violent ways.  School counselors are on hand for the emotional needs of students, however oftentimes the counselors are overwhelmed with the amount of students and tasks on their caseload and are unable to provide the type of counseling that emotionally distressed students may desperately need.

There is no set profile for a student who may engage in school violence.  There are the stereotypes, of course: he is usually a “goth” or wears “trenchcoats”; he was being bullied or had no friends; and, most basically, that it is typically a “he”.  Going through evidence of school shooting scenes over the past decade, researchers find less and less of a solid profile of this population.  A helpful article explains the top ten myths about school violence.  The impulse to think that “he just snapped” is one of these myths.  Oftentimes, students who react in violent means have tried to get help for emotional disturbances but have not felt like they were helped or did not have resources for further treatment.  An example of this is the Virginia Tech massacre of 2007, where Seung-Hui Cho killed 32 people, wounded many others, and then committed suicide — after several years of receiving therapy and special education courses.   Seung-Hui was South Korean, debunking another assumption and myth that most school shootings are by White, American men.  He had been given a previous diagnosis that would have helped Virginia Tech counselors understand predisposed issues he was working on, but due to federal privacy laws this diagnosis was not disclosed as he entered the university.  This makes me ponder how lack of communication and legal issues can also create gaps in the school system that may affect the mental health care of students.

For those parents who have students in schools, I do not intend to increase your worry.  I simply am hoping that we as a community can take more care to listen to our children and to notice when they might be going through some difficult times.  Adolescence and teenagehood is certainly stressful for parents and children both.  Some signs that your child might be distressed can be if he or she talks about being bullied or put down at school, if he or she feels lonely and displaced in the social environment, if he or she has severe appetite or sleep shifts (eating/sleeping too much or too little), if he or she has extreme mood swings and hesitates to open up about what is going on.  I encourage you to find someone for your child to talk to: a trusted adult, the school counselor, an outside counselor, a priest or clergyman, or another family member.  While it may be like pulling teeth to get your child to talk to someone, I believe strongly that the sooner that we can intervene in emotional distress, the better our children will feel and the safer we all will be.

Adjusting to seasonal changes and illuminating the mechanics of Seasonal Affective Disorder

It is almost a visceral reaction: our bodies sense that the days are getting shorter and the nights are getting longer, and we react in the way that feels most natural to us.  The earth’s turning, the seasons changing, and the holidays’ impending arrival can mean excitement and joy for many of us, and it can also bring increased feelings of depression and anxiety.  Therapists and doctors have coined a term for the emotional shifts that occur around the same time every year: Seasonal Affective Disorder (SAD).  This is a relatively new term, and was not defined until 1985.  Most often the symptoms for SAD begin in the fall, continue through the winter months, and then begin to alleviate in the spring as the earth warms up and daylight hours lengthen.  Studies show that SAD has a stronger presence in populations that live further from the equator (when nights may be particularly long), and that it is present in (or reported by?) four times more women than men.  It is also thought that SAD is less invasive when there is snow on the ground.  This is interesting and makes me think that if there is a “reason” for the darker nights (such as – it is snowing/Christmas time), or if there is something to focus on such as holidays celebrations, then there is not as much of a depressive feeling around this time of year.

It’s a positive thing that we can now put a finger on what is felt by 25% of the US population and that we don’t have to blame it on the “wintertime blues”.  We can now get help for the symptoms of SAD, which may be increased feelings of hopelessness or helplessness, fatigue, crying spells, weight gain, or irritability.  A common misperception of SAD is that it occurs only in the wintertime months.  There is a form of SAD that can happen in the summer time (almost a ‘manic’ to the wintertime’s depression), where you may feel overly energetic, and experience periods of restlessness and racing thoughts.  To me, it appears that for many of us the sun’s presence can ignite a new sense of energy in us and its absence can drain the energy right out of us.  This also may link to the increase of suicides in dark and rainy climates and the general census of enthusiasm and openness that bursts from us as spring and summertime arrive.  We have learned that the sun’s presence and the intensity of its light suppresses our body’s production of Melatonin (sleepy time hormones) and helps our internal clock (circadian rhythm) become in sync.

How can we overcome the effects of SAD?  First thing is to know that you are not alone and that it is very possible that the symptoms you are feeling are only temporary.  I would suggest investing in bright, florescent lights and keep them on consistently.  These can take the place of sunlight when it is not present and can help your brain regulate emotions in a healthy manner.  Light treatment is called phototherapy and uses light boxes to synthesize natural light.  It is most effective when used consistently during the winter months.  Increase your social support and social functions during the dark periods of the year.  Make an effort to plan get-togethers with friends and celebrate the many wonderful things about the winter months.  Be aware of the general cycles of your emotions and how they react to changes in sunlight and temperature.  You don’t have to let SAD make you sad! 🙂

Got holiday anxiety? Here are 10 Tips for Coping with Holiday Stress

Thursday is Thanksgiving — the initial and official marker that the holiday season has arrived.  For many, this holiday brings warmth and love as we are thankful for family and friends.  For others, the holidays may bring grief and sadness as we remember friends and family that were with us last year but are not here this year.  The holidays almost certainly bring some degree of stress to each and every one of us.  Whether it is financial (how am I going to afford gifts for my loved ones this year??), personal (I feel overwhelmed easily and do not handle holiday pressure particularly well), familial (how am I going to spend all holiday with Uncle Steven, when he insulted my religious beliefs last year??), or logistical (how are we going to get two adults, two small children, and all of the gifts, luggage, and baby gear on an airplane in the airport madness??), we all can relate.

So, today in honor of Thanksgiving week, I am going to try to offer some bits of calmness and serenity — and definitely some practicality — as we all try to navigate this wonderful, beautiful, emotional, stressful time of the year.  You know, Christmas is just around the corner!

Here are Kate’s Ten Tips for Surviving the Holiday Season (and hopefully these tips can help you cope with many overwhelming periods or feelings):

1.) Try to prepare yourself for events/people/feelings that may be difficult for you.  Are you aware of what digs at you? If you know that money is one of the biggest reasons you stress over the holidays, you can prepare for this in advance by saving money or budgeting exactly what you know you can spend.  Same thing goes for other triggers: is it being with the whole family that is overwhelming? seeing in-laws? having to prepare a huge Thanksgiving dinner at your house (which means cleaning, organizing, sorting….not to mention cooking!)? How about trying to manage the first Thanksgiving without your grandmother, who passed away after the holidays last year?  Even if you have no idea how to handle these intense feelings, just defining what they may be (it helps to write them down) can give you a sense of power and control over them and set you on your way to finding solutions.

2.) Schedule self-care time.  The holidays come fast and they come intensely.  There is no such thing as “halfway” doing the holidays.  So this means that you will not be able to “halfway” do it when it comes to self-care.  Many of us (me included) have a difficult time scheduling time for ourselves to do the things we love and the things that relax us.  Never is there more important of a time to schedule a massage, see a favorite movie, or take a long walk with your dog than the holidays.  Take care of YOU!

3.) Voice your feelings and needs.  So often when we feel overwhelmed, we might feel as if the only solution is to retreat inside of ourselves and try to hide. Or we may feel our emotions explode out of us, but not in the way we intended.  If we can speak up to ourselves and others about what we feel and need, we can take the next step towards getting those needs met.

4.) Make a list.  I love making to-do lists.  It can ease my anxiety if I see what I need to do written down.  You might have several lists: gifts to buy, arrangements to schedule, events to attend.  Put them up on your wall so that you can see them and know what to expect — and by when.

5.) Ask for help.  Reaching out to a partner, friend, parent, or therapist can relieve some of the intensity of holiday stress.  We all need support during busy times and the holidays are definitely no exception.

6.) Learn to say no.  Often times we get so overscheduled during the holidays, that there is no time left to enjoy them.  You don’t have to do everything.  You don’t have to be everything! If you are exhausted and feel like a night in, then speak up and say so – and don’t feel guilty about doing so.  Your friends and loved ones will admire your efforts at listening to your inner voice.

7.) Treat yourself.  One of the most stressful things about the holidays (in my opinion) is the emphasis on “so much food, drinks, and treats — how will I ever keep it in check?”  I encourage you to give that little voice in your head a swift kick out the door and to let yourself have some eggnog if you want some.  There is so much delicious food this time of year, and so many family members and friends to share it with, — would you want the negative voice to ruin that for you? I know this is harder than it seems.  Don’t take it to either extreme, but I think that allowing yourself to enjoy every part of the season will be worth it.  You don’t get the chance to have gingerbread men with your nieces again for a whole year 🙂

8.) Search out the free and fun activities!  If finances are a big part of your holiday stress (and I think we all can empathize on this one), focus your holiday fun on free activities and events in your area.  There are always lights displays that you can admire, carols you can lend an ear to, or hills that you can sled down.  One of the highlights of the holiday season is all of the opportunities it brings, and there is something for everyone. I suggest scoping out your local newspaper for ideas.  Making crafts with family members is a meaningful and cost-effective activity that heaps unlimited rewards.

9.) Try to remind yourself what the holidays are really about.  Whether you celebrate Christmas, Hanukkah, Kwanzaa, or other cultural holidays, it can be all too easy for us to get caught up in the frenzy of gift-buying and traveling and forget what we are truly celebrating.  Think about what the holidays represent to you, how you would like to celebrate that meaning, and try to plan activities that will create special holiday memories for you and your loved ones.

10.) Cuddle with a loved one.  I may be biased because I am an animal lover, but I feel as if there is no better way to calm down than to hug or cuddle someone you love.  No matter if it is animal or human, a special companion can help you to relax and unwind from the fast-paced holiday craziness and help you to appreciate this beautiful time of year (see #9).  Go ice skating with an out-0f-town friend, drink hot chocolate with your partner by the fireplace, decorate your Christmas tree to the tunes of holiday music with your sister, or watch Frosty the Snowman under a blanket with your dog.

Happy Holidays to everyone!

An unconditional love: the healing powers of animal-assisted therapy

We have all experienced the emotional, sentimental, and almost gravitational pull of an animal’s touch.  Whether it is playing tug with your dog with his favorite rope toy, cuddling with your cat on the couch — even watching an elephant pull her daughter out of a mud pit in Africa on a television show…animals have a special healing power that transcends any sort of boundary.  More and more mental health professionals are incorporating Animal Assisted Therapy (AAT) in their practices, to phenomenal results.  AAT is designed to improve the cognitive, social, emotional and physical functioning of a client — and the animal presence is so simply soothing.  Often referred to as “comfort animals”, a wide variety of animals such as dogs, dolphins, birds, rabbits and even lizards are used to help clients heal from emotional and physical difficulties that may be too painful to talk about.  AAT is often used with horses, in a special type of AAT called Equine-Assisted Psychotherapy (EAP).

The divide between the human and animal worlds is much less separating than we might have believed.  There is a wisdom and power that animals hold, and when interacting with humans they can soften feelings and problems that their human might have felt were all too overwhelming.  I think one of the most magical aspects of the human-animal connection is the unspoken language that can be shared between them, fostering a trust and affection that never wavers.  Some might argue that animals “know what their human is anticipating and thinking without needing to be told”, says a noted psychotherapist in the Denver area.  This therapist talks about a client she had, a family whose beloved dog was getting sick, her health deteriorating rapidly as the days went by.  The family members were scattered throughout the state, and were not all together as the dog’s condition was worsening.  As the family gathered to try to determine the best option for the dog’s care, the dog passed away on the lap of one of the daughters.  It was almost like the dog “waited until everyone was there, and then passed on in a space where she felt most comfortable and loved — in her home of 12 years, not a hospital”.  The therapist recounted that the family felt the dog’s strong presence in the room as she passed, almost as if she was telling them all that it would be okay to let her die.  One of the most significant things about this story is the way it impacted the family; they came together in grief and happiness as they buried the dog and traded stories about how she impacted each of their lives.  Her life healed theirs.

Many therapists and treatment centers are developing Animal-Assisted therapy programs in the Denver area — and it is so amazing how all parties (human or otherwise) are significantly benefited by the therapy!  The Mental Health Center of Denver, in conjuction with the Denver Dumb Friends League, runs BARK (Behavior Reduction in Kids), a program in which kids can help train dogs up for adoption and in return work with the dogs to learn coping skills for emotional distress and regulation.  The Animal Assisted Therapy Program of Colorado has psychotherapists who work with trained animal partners to accomplish therapeutic goals in cost-effective and timely manners.  Kerry Borcherding, a psychotherapist in Boulder, works with clients to enhance centeredness and grounding, build trust and intimacy, improve breath and body awareness, and other goals — all while on the back of a horse! She also facilitates horseback yoga, which helps heal the body as well as the mind.

Whether you are seeking professional help to work on mental health issues, or if you are an animal lover who spends time and energy connecting with your animal companions, you can be gifted by the healing presence of an animal.  You probably already have — who can forget the noble and kind nudges of Lassie’s nose?  Research has shown that petting an animal automatically reduces the levels of stress hormones running through your body — and the more love and attention that you reap on your animal companion, you will receive exponential amounts of devotion in return.  There is nothing quite like the unconditional love of an animal and I believe that we all have lots to learn from them.  Where else will you be accepted just as you are?  Who else will welcome you — NO MATTER WHAT — with a nonjudmental, excited, and eager presence the moment you step through the door? We all may make our best efforts to offer this type of love to our partners, friends, and family members (and might often be able to give it), but no one can drop everything else and lavish you with adoration the way that an animal can.

I suggest we all take a moment to think about what we can learn from our devoted animal friends, and to pet them, talk to them, and lavish them with love as much as we can.  You know they will do the same for us until the day that they die (and after).  You probably will feel calmer, more rested, and happier than you did before you started petting that cute and furry little being!

A personal and clinical reaction to the documentary “What’s Eating You?”

As an eating disorder therapist, I have taken a keen interest in E!’s six-part documentary “What’s Eating You“, airing on Wednesday evenings.  This series features two individuals each week and follows them for an hour through their decision to seek treatment, some inside looks at therapy sessions, and efforts they are taking towards recovery from an eating disorder.  I have found the series fascinating, and very real — featuring a range of people who are affected by eating disorders and not just the “stereotypical” upper middle class white young woman.  The subjects have been male, female, married, parents, and have been a variety of ethnicities. 

I have to admit that when I first heard about the series, I worried that it would be the type of show that glamorizes and shines lights on EDs in ways that are not prone to recovery– but perhaps prone to “giving ideas” to viewers.  This was a common reaction amongst other blogs and therapists with whom I have consulted about the series.  A popular blog wonders if the series is giving an incomplete  or overly simplified picture of what an eating disorder is, and what treatment and recovery can look like.  I have to say that I appreciated that each client was not “recovered” by the end of the episode (two new people are featured each week), and that the sometimes years-long struggle to find peace and healing was depicted for the most part, realistically.  Other positive aspects of the show include involving the families in treatment (imperative!), visiting doctors and nutritionists, and showing the high probability of relapse and ambivalence in recovery.

Other factors of the show worry me.  I am viewing this from both a personal and clinical perspective.  As a human being, is it healthy for me to watch a show that reveals what eating disorders do to impact relationships, physical health, self esteem, and families?  Is it encouraging me to not go down that road and to be grateful for my own health, or is it putting (perhaps subconscious) ideas in my head about what I could do to lose weight and “fit in” and “be popular”, if that is what I’m longing for? 

For years there has been talk about the Pro-ED websites, which give susceptible men and women ideas for how to “successfully” develp an ED.  I am going to write a whole blog post about those sites next week — but is there any commonality to tv shows that depict what EDs are truly about?  You could argue that What’s Eating You is aimed to help folks get resources if they are going through similar issues, but I could very easily see someone watching the show who is fragile, depressed, and lonely, and they might feel like this “coping mechanism” could free them from their pain.

I have watched all five episodes that have aired so far, and have noted the different treatment approaches by each of the therapists featured on the show.  Some adovcate for inpatient treatment, some recommend an outpatient philosophy.  This is true of therapists in every city in the country — we all have different ideas and reasoning about what is best for our clients.  Consulting doctors, psychiatrists, and nutritionists is essential, of course.  Yet viewing the choices that the therapist make and that the clients make causes me to wonder (again): what is the best treatment for an eating disorder? 

The sixth and final episode is set to air this Wednesday, and the previews of it terrify me.  I have not seen it yet so I cannot judge, but it appears that the episode is about people who have learned their ED behaviors from their mothers — and in line, blaming the mothers for the devestation of the ED in their lives.  This is the WORST message to send to viewers, because an assumption that mothers cause EDs already exists and this may exacberate it.   From a clinical approach, this is a negative message to send to all families and individuals affected by eating disorders and proves to worsen the epidemic, not lessen it.

Final note:  After watching last week’s episode, I was left with many conflicting feelings.  This may be because I have so much knowledge about EDs, but it also may be because the episode was very emotional and triggering.  I encourage anyone who may have emotions stirred up by this show (even if they can’t quite put a finger on what they are or mean) to talk to someone — a friend, family member, therapist.  That may be one of the best results of the show.

The many faces, spaces, and paces of grief and loss

We have all endured some type of loss.  Some of us, multitudes of loss.  Mine might be a completely different type of loss than yours, and I may feel it most in my aches and pains, while you feel it in mood swings and emotional responses.  There are thousands – millions – of losses that we all endure each and every day and not one person on this planet has not known what it feels like to lose someone or something that they hold dear.  With all of this commonality — though it has diverse strands — why can’t we connect easier over our grief?

We all grieve in different ways….and we may not know our grief process until we experience a loss.  Many people in mourning grieve in healthy and healing ways.  Some of us close in on ourselves in protection; others yearn for open connection and community.  Some of us shut down in hopelessness and depression; others lash out at loved ones with anxiety.  Some of the most ineffective grief patterns….those folks who may not know what they are feeling or believe that they can feel better….can turn to violence against themselves or others in an effort to numb the pain.

A friend of mine, a bright and inspirational woman who was only 29 and pregnant when she was diagnosed with breast cancer, died last summer.  This was an enormous shock to everyone who knew her.  How do you deal with that kind of news?   As the disease spread rapidly and viciously and took her life, just as she was starting out an exciting new phase of first-time motherhood.  I cannot even imagine the loss that her husband, family, and newborn child have felt, and I know that I was shaken down to my very core by the unfairness and devastation of the event.  To have the life of a beautiful, kind, and intelligent young woman (who was also just beginning her career as a counselor) taken away is an especially tragic loss, and the experience of it taught me a lot about myself.  While nothing can take away from the tragedy of her illness, there was a ray of light in the process of coping with her situation, as people all across the country rallied to raise money, send love, and show their faith in her every step of the way.  My friend knew how much she was loved.  This was a gift!

A loss brought so many people together, and we are now helping each other grieve.  This is the type of grief and loss that can have a silver lining, as community is formed in an effort to cope.  Unfortunately, loss can have the opposite effect on some people, and it can actually divide families, foster anger and resentment, and result in further tragedy.

Loss can be defined in every color of the rainbow.  Loss can encompass the death, illness, or other type of sudden change of a loved one — human or animal.  Loss can be felt around the ending of a relationship or a job or a house.  Loss can come at the change of a situation, such as moving to another state or shifting an emotional response.  Loss does not need to be specific to a person, place, or thing — which makes it both easy and hard to define!  What I am trying to relate is that everyone defines loss in his or her own way, and grieves for that loss in his or her own personal fashion.  There is no “time limit” on grieving (though the DSM might want to convince you otherwise).  There is no “right way” to mourn.

Many professionals have developed models that define stages of grief, such as Elizabeth Kubler-Ross’ model from her book On Death and Dying. This can be helpful and define some structure for mourners who are looking for guidance in uncovering their feelings.  Kubler-Ross describes the five stages of grief as: Denial, Anger, Bargaining, Depression, and Acceptance.  I have used this model in my work and have seen it be effective in helping clients define their own personal grief processes within the larger structure of the model.  There are many such ideas about methods and stages of grieving, and if you find that this is an area which may be relevant for you, I encourage you to research them.

I have witnessed some clients shut in and dwell in solitude for a bit as they grieve; I have seen other folks reach out for support as they mourn; I have also seen many combinations of methods of coping.  There is no paint-by-number answer to getting through one of the toughest things we will experience: losing a loved one, a special relationship, a lifelong dream.  We are all unique individuals and we all cope in our own personal ways.  I caution that destructive tendencies (addiction, substance abuse) can feel like effective coping mechanisms, but if they are used to extreme the loss only intensifies.  If depression or anxiety take over and daily functioning is becoming more and more challenging and exhausting, I encourage you to seek professional help.  Remember: you are not alone and you will get through this!  It will get better.