tag:blogger.com,1999:blog-41267910944405309492024-03-12T17:08:05.960-07:00Issues in Mental HealthAnne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.comBlogger64125tag:blogger.com,1999:blog-4126791094440530949.post-48742748917880397322018-09-18T13:01:00.002-07:002018-11-04T16:40:08.518-08:00Goodbye New YorkAs my current patients know, I'm relocating to California next month.<br />
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I've always loved Northern California, and I have family there. I've been thinking about moving there for several years, and now is the time.<br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-66528160042302355532018-05-27T10:29:00.001-07:002018-05-27T11:33:44.153-07:00Is Marijuana Safe?I've long been suspicious about claims that marijuana is harmless. I was interested in this <a href="https://www.washingtonpost.com/news/posteverything/wp/2018/05/25/feature/legalizing-marijuana-is-fine-but-dont-ignore-the-science-on-its-dangers/?utm_term=.30f7192c2919&wpisrc=nl_most&wpmm=1" target="_blank">article</a> in the Washington Post, by a neuroscientist. Any drug changes the body's chemistry.Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-90361368224897273702018-05-15T17:25:00.000-07:002018-11-04T16:38:11.787-08:00College Students and SuicideRecently The New York Times published an article about a growing controversy: As more college students commit suicide, parents are frustrated by medical and academic confidentiality laws that seemingly have prevented the colleges from contacting them about their children who are having mental health problems. What should be done about these situations?<br />
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When new patients come to my practice, I have them fill out a form that includes space to list an emergency contact. So far, no one has refused to name an emergency contact. I've only called an emergency contact once or twice in 16 years, but it is necessary for me to have this information, because someone's life could be at stake. Why don't colleges and universities do the same? I don't know. Perhaps their administrators believe psychiatric emergencies aren't their purview.<br />
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An emergency contact person is ideally someone who is willing to escort the person to an Emergency Room or stay with the person until the crisis is over.<br />
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In a genuine emergency, confidentiality laws don't apply. If someone in my practice tells me that he or she is planning on committing suicide, I ask to escort them to the Emergency Room, and if they refuse I would call 911. I do not need a confidentiality waiver to call 911, but, I have in fact never needed to call 911, because every time, the person has agreed to go to the hospital. A college counseling center should be staffed by licensed clinicians who are obligated to work with their patients the same way that I am.<br />
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What about situations in which a college student is deteriorating, but it's not yet an emergency? The student should be asked to take a leave of absence for a semester and engage in mental health treatment. Then the treating clinician should be asked to sign off on a form stating that the patient is not at risk, before the student can resume classes.Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-60958413905238666912018-01-04T13:33:00.000-08:002018-11-04T16:32:05.694-08:00Some Important Tips About Being in PsychotherapyOver the past 30 years, the general public's understanding of psychotherapy has declined. This is because of the growing influence of health insurance companies and pharmaceutical companies, which prefer that people take psychiatric medications rather than going to psychotherapy. It's not uncommon for me to hear patients use the verbiage of pharmaceutical companies without realizing they are doing so. This societal change has caused problems for me and other therapists.<br />
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Here is a brief summary of some aspects of being in psychotherapy and how therapy works, that used to be common knowledge but are now mostly unknown among persons under 45:<br />
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1. You do not have to use normal social rituals with your therapist. You do not have to shake your therapist's hand, ask them "how are you?" or inquire whether they had a good time on their vacation. It's the one type of relationship that's about you and not the other person, and this is part of why and how psychotherapy cures.<br />
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2<span style="background-color: transparent; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"> Your therapist wants to hear everything. I discussed this in a previous <a href="https://notesonsanity.blogspot.com/2013/10/the-patients-responsibility-part-ii.html" target="_blank">post</a>. Your history of sexual abuse, your porn habit, your poor money management and bad credit--people go to therapy to talk about the things they can't talk about elsewhere--that's one of the reasons why therapists exist. If you tell lies to your therapist or avoid mentioning important information, your therapy will not be effective.</span><b></b><br />
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3. If your therapist confronts you on something you did or are doing in therapy, such as repeatedly showing up late, or behavior in the session, such as sexual provocativeness, the purpose is for the both of you to explore what the behavior means. You do not have to say "I'm sorry." Instead, you should ponder the meaning of your behavior and work with the therapist to understand it.<br />
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4. The reason for #3 above is that an important part of what's called "insight-oriented therapy" (also known as psychodynamic therapy or psychoanalytically-oriented therapy) is a discussion of the dynamic between the therapist and the patient. In longer-term therapy, particularly therapy that lasts more than two years, patients often undergo a regression and start re-enacting childhood behaviors with the therapist. This is a phenomenon known as "transference." In some cases it is very important for the therapist and patient to discuss the interaction between them and what it means, as behavior in the session may reflect long-standing behavioral patterns or relationships in early childhood.<br />
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Ultimately psychotherapy is about personal growth through a specific type of dyadic relationship. Psychotherapy harnesses the human tendency to grow and develop through interaction with another person. When psychotherapy is effective it is a permanent cure--perhaps not a 100 percent cure, but a cure that does not go away when the therapy ends--unlike medication.Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-40800572660268345542017-10-31T05:35:00.000-07:002017-10-31T05:35:43.818-07:00Brainwashed!Over the past year I had been experiencing the pervasive sense that large numbers of people in the US were going crazy. From neighbors, colleagues, patients and random persons on the internet I heard statements that sounded extreme in their despair, fear and rage. At times the statements entered the realm of clinical paranoia. I was told by left-of-center persons that America was full of Nazis, and by persons to the right that the "Left" was engaged in a purposeful campaign to destroy the Constitution and install a totalitarian regime. I blamed the media and our two main political parties for the incessant drumbeat of hysterical "news" stories, inflammatory language and demonization of others that fed this mass hysteria. But it turns out that the real story is even weirder: It was the <a href="https://www.nytimes.com/2017/10/30/technology/facebook-google-russia.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news&_r=0" target="_blank">Russians</a>. <br />
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Why do people succumb to propaganda and why can't they see that they are being manipulated? There are many factors:<br />
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<i>Conformism:</i> Humans are social animals and want to "belong." If a group of people with whom someone wants to associate insists on a shared belief system, many people will adopt the beliefs even though those beliefs have no basis in fact. The strong need to "belong" will override logical thought processes. <br />
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<i>Displacement</i>: Persons with histories of abuse or neglect in childhood deal with anxiety, anger and even outrage, but may be unable to connect those emotions with their childhood experiences due to wanting to protect the images of their family members. Instead, they direct their fear and outrage toward public figures or groups or imagined groups. It is emotionally convenient to fear and hate those you don't personally know.<br />
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<i>Self-esteem:</i> Many people revel in a belief in their own moral superiority. By aligning themselves with what they see as a virtuous or righteous position and condemning others who disagree, they feel better about themselves. <br />
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What can counter these dangerous tendencies? Here are some tips:<br />
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<b>1. Learn history</b>. The better educated and older people I know demonstrated less susceptibility to the propaganda, and not just because they don't use Twitter. It's that they (we) have seen it all before, and what we haven't seen personally we have read about. Propaganda and popular hysteria are nothing new. There have been waves of mass hysteria throughout history, often with atrocious, catastrophic or genocidal results.<br />
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<b>2. Use logical analysis to assess claims</b> made by groups, including established groups. It doesn't matter who made the argument or published the news story if it doesn't make sense. <br />
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<b>3. Listen to your gut instincts.</b> If something seems fishy, it probably is. If you can't put the pieces together, maybe it's because they don't fit. Ask yourself: Is something missing from the story? Does the story seem too bad or too good to be real? <br />
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<b>4. Live a healthier lifestyle:</b> Acknowledge your childhood traumas, build your self-esteem in healthy ways and seek friends who don't demand that you agree with their political beliefs. Talk to different types of people and listen to them. <br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-75902758159616828172017-10-17T15:58:00.002-07:002018-11-04T16:50:41.104-08:00Normalization of Pathological Behavior, Part One: Psychological Defense MechanismsSince the Harvey Weinstein revelations, I've been thinking about the normalization of pathological behavior. This is a common phenomenon in our society and in most societies. <br />
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This <a href="https://www.nytimes.com/2017/04/10/upshot/its-not-just-fox-why-women-dont-report-sexual-harassment.html?action=" target="_blank">article</a> in The New York Times summarizes the reasons why women often don't report sexual harassment--mainly, that they fear retaliation. There are other factors, however, that make people in general turn a blind eye to harmful and pathological behaviors. These include psychological defense mechanisms such as denial, rationalization and dissociation, effects of mass culture, and deliberate propaganda by vested interests that uses rhetorical tricks to minimize atrocities. I'll address psychological defense mechanisms today. <br />
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Psychological defense mechanisms serve to ward off anxiety by distorting reality. In rationalization, the mind invents "reasons" why something happens that aren't really logical, but serve to distract from an unpleasant or frightening reality. In dissociation, consciousness is altered so that an experience isn't perceived at all in daily consciousness, but may be acted out unconsciously, or remembered while in an altered state (such as hypnosis). Denial is a phenomenon in which "the existence of unpleasant realities is disavowed; [it] refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety" (Kaplan and Sadock, "Synopsis of Psychiatry," 2007 edition).<br />
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The mind resorts to defensive maneuvers in order to preserve physical health. Overwhelming stress can cause great damage to the body--altering hormones, damaging the immune system, interfering with sleep and worse. The survival instinct will undermine the mind's ability to accurately perceive reality in order to avoid the physically damaging effects of overwhelming fear.<br />
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People who have been victims of rape or other traumas not infrequently experience dissociation. Aspects of the trauma may be blocked from conscious awareness.<br />
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Sometimes trauma survivors invent "reasons" why the incident occurred (rationalization). As the general population is made aware of behavior such as Weinstein's, others may also engage in denial or rationalization. People don't want to believe that another human could be that horrible, and perhaps especially, when that human is the same gender as they are. It's too frightening. <br />
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The way to overcome denial, dissociation and rationalization is to speak about the crimes and traumas. Overwhelming evidence eventually destroys the use of distorting defense mechanisms, for most people.<br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-9724872110149654812017-10-11T07:41:00.002-07:002018-09-29T11:52:49.457-07:00Raising Resilient ChildrenThere have been a plethora of books and articles written in the past few years about the lack of "resilience" among members of "Generation Y" (people born from approximately 1985 to 2000), what has caused it and what to do about it. But now, the millenials are starting to have their own children. How can they avoid the mistakes of their parents? Here are some tips:<br />
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<b>1</b>. <b>Have more than one child and make sure that siblings aren't more than 3 or 4 years apart in age.</b> I know this might not be feasible for all parents, but it is worth mentioning, because the advantages of siblings outweigh the negatives, and the advantages are significant.<br />
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Although some studies in the past indicated that only children have higher achievement, some studies also found a greater incidence of drug addiction among only children. <br />
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People who grow up with siblings learn crucial skills of negotiating, sharing, advocating and taking turns, earlier and more consistently than only children do. More importantly, a sibling close in age is a "buddy" who provides peer identification, which is important for personality development. Only children often feel lonely because school friends and play dates aren't a substitute for a sibling, and worse, when the parental marriage is dysfunctional, an only child can become a parent's best friend, an unnatural situation that interferes with personality development and in the worst cases leads to incest. <br />
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Although I've heard stories of dysfunctional sibling relationships (including abuse), the majority of my patients who have siblings have benefitted from those relationships. Siblings too far apart in age often don't function as siblings, however, with the older sibling often taking on a quasi-parental role that may not be appropriate. <br />
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<b>2. Allow your child to engage in unstructured, unsupervised play</b>. It really is true that hovering parents interfere with a child's developing sense of autonomy. Let younger children play by themselves (or with siblings) in their rooms, and let older children play by themselves in the backyard, if you have one. <br />
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<b>3.</b> <b>Send your child to sleep-away camp if you can afford it</b>. Do this when your child is 11 or 12 years old. Sleep-away camp can be a way for only children to get some of the benefits that children with siblings get. A good sleep-away camp offers challenging outdoor activities that build confidence. <br />
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<b>4.</b> <b>Remember that academic achievement alone doesn't guarantee success in life.</b> The Unabomber went to Harvard. Prestigious academic degrees don't guarantee mental health or social functioning. I have found that many of my patients who are the children of immigrants were kept home after school to study, study, study. The end result is often anxiety disorders and worse. Just today I read an article in <i>The New York Times</i> about the skyrocketing rate of adolescent anxiety disorders, with one teen profiled taking 3 Advanced Placement classes as a high school junior. I don't understand why this is allowed by the school, much less by the parents. <br />
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<b>5. Be a role model of mental health.</b> The best way to be a good parent is to be a healthy parent. Parents with untreated depression or those who engage in substance abuse tend to have emotionally disturbed children. Nine times out of ten, when I worked with children, I found that there was either abuse or neglect or a parent had an untreated disorder.Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-82868340468807952212017-09-24T09:02:00.000-07:002017-10-24T05:38:05.892-07:00What is Co-Dependency?I've discovered many people do not know what the word "co-dependency" means. It's a somewhat complex clinical term.<br />
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"Co-dependency" was coined in the addiction treatment field to describe a phenomenon observed among family members of alcoholics and addicts. Treatment professionals and others noticed that spouses of addicts and alcoholics frequently were high-functioning individuals, but that they often helped the addict/alcoholic cover up their addiction and "enabled" the addiction through "caretaking." These "enabling" and "caretaking" behaviors sometimes allowed the addict/alcoholic to continue their addictive behaviors past the point where they might have been forced to change, had they been on their own. These observations led to a belief among treatment professionals and others that family members of addicts needed their own treatment. <br />
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"Enabling" and "caretaking" can take a variety of forms. The spouse/partner might make excuses for the addict/alcoholic to employers, "explaining" that the person is "sick" and can't come to work, for example. If the addict/alcoholic is fired from employment, the co-dependent may take on additional work to make up the difference, instead of demanding that the addict/alcoholic stop the addictive behaviors and find a job. The co-dependent in some cases may even facilitate the addiction by keeping alcohol in the home or by driving the addict/alcoholic to social events or perhaps even the liquor store. Why do people engage in these behaviors? <br />
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A theory began to emerge that the co-dependent was "dependent" on the spouse's addiction the same way that the addict/alcoholic was dependent on the substance. By comparing her/himself to the addict/alcoholic, the co-dependent could feel superior. The care-taking behavior was seen as making the co-dependent feel important. In some cases, the co-dependent behavior led to a "martyr complex," in which the co-dependent believed that he/she was a valiant and long-suffering individual. Underneath these behaviors and beliefs there is typically a lack of self-esteem. Treatment for the co-dependent involves helping the person get in touch with his/her feelings of low self-worth, and guiding the person to finding productive ways to raise their self-esteem instead of through comparing themselves to a dysfunctional person whom they need to remain dysfunctional in order to fulfill this purpose. <br />
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Because so many alcoholics and addicts are men, for a long time the stereotype of the co-dependent was that of a wife. However, it's been my observation that more men than women have co-dependent traits, and that these traits are often normalized in men--the "White Knight" who rescues a damsel in distress, or the man searching for an "Angel with a Broken Wing." We are so familiar with these characterizations that we may think of this as normal male behavior. Needing to feel superior is a sign of low self-esteem, and just because it may be common in men doesn't mean it isn't pathological. <br />
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Even though the co-dependent may "help" the dysfunctional partner or family member, the relationship doesn't serve anyone's interests. It enables the dysfunction and stresses the co-dependent. The dysfunctional person often starts to resent the co-dependent, sometimes sensing consciously or unconsciously that the care-taking behaviors are a form of control. <br />
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Anyone who has a close relationship with an alcoholic or addict should seek their own counseling. Any man who searches for an "Angel with a Broken Wing" as a partner should take a serious look at his own feelings of insecurity and inadequacy. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-7231737562930718892017-08-08T18:29:00.001-07:002017-08-08T18:29:22.876-07:00If Psychotherapists Ran the WorldIf psychotherapists ran the world, it would look a lot different. <br />
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Let's start with the U.S. We would have universal healthcare, because all psychotherapists know that the patchwork system we have doesn't work and isn't fair. We work every day, in one capacity or another, with the healthcare system, and as most of us are self-employed, we know from personal experience that the current system is unworkable for self-employed individuals. Obamacare helped many people, but didn't resolve many of the underlying problems. <br />
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We would require large businesses to have onsite daycare, because psychotherapists know that there's no substitute for an early parent-child bond. All businesses would be required to offer both maternity and paternity leave. <br />
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We would have a different foreign policy. All psychotherapists who have worked with children or with dysfunctional families (all of us) know that the cardinal rule of behavior modification is "ignore the negative behavior." Paying attention to negative behavior rewards the behavior, and the child (or adult) is encouraged to continue or even to escalate the behavior. Responding to provocative behavior and threats from other world leaders by making threats in kind and engaging in provocative rhetoric is exactly the opposite of what you want to do. <br />
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Should I run for office? Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-45852568572524701502017-07-22T10:45:00.001-07:002018-04-14T06:40:41.493-07:00When You "Assume"...There used to be an old saying about assumptions: "Never assume; it makes an "ass" of "you" and "me."" This piece of wisdom seems to have fallen by the wayside. <br />
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Assuming can lead to social bloopers. But it has worse effects: It can lead one into dangerous situations. One of the most common assumptions, in my observation, is the one held by many women that if a man seems like a nice person, he is a nice person. <br />
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Women are socially trained to be "nice" and accommodating and to not be "critical." Although many women don't adhere to these norms and stereotypes, all women are to some degree affected by this social conditioning.<br />
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Even with my decades of professional experience and training, I don't always know in the first session that a patient I'm working with is a sociopath or a dangerous person. Sometimes such individuals reveal themselves quickly, but others mask their dangerous traits--in a psychotherapist's office, the disguise is in the form of other symptoms. In real life, the disguise is in the form of charm, sociability or verbal skills. <br />
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Both men and women can be sociopaths. In women, being pretty can be the "disguise" (disguises aren't necessarily deliberate). There's been research showing that physically attractive people are assumed by many people to be morally superior. This assumption--like most assumptions-- isn't based on facts. <br />
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Making assumptions won't make you popular with other people. It might sound like a compliment to say to someone, "But I thought you were much younger!" but depending on the person, it might not be heard as a compliment. It might also make you look like you're not very observant or that you are being dishonest. <br />
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People respond more positively to questions and interest in the responses. Most people, particularly women, are attracted to others who show interest in finding out who they really are. The generic compliments some men give women on dates might puff up the self esteem of a woman who is insecure, but a woman with better self esteem responds more positively to questions about who she is and what she likes. <br />
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Professionals, including mental health professionals, aren't immune to assumptions. An amusing (or not) example is the following experience I had while working in a residential treatment program for men with mental health and substance abuse problems, in the 1990s: One of my tasks was to write up summaries for patients' post-discharge housing resources. I scanned the initial assessments of one such patient, and saw that the psychiatrist and other professionals had consistently described the patient as "white" or "Caucasian" in their assessments. I didn't know the patient well as I didn't do individual counseling at that job, but I had been trained to never make assumptions and to never go by another clinician's assessment. "How would you describe your ethnic or racial background?" I asked him. He looked confused. "I'm black," he responded. I decided not to tell him that he had been assumed to be white by numerous persons.<br />
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I don't assume I know people's race, their age, or even their gender, unless the facts are extremely obvious. I certainly don't assume I know their personalites just by looking at them. It's always better to act from the standpoint that you don't know than to assume you know things about people based on outward appearances. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-21113342396052332302017-06-25T07:18:00.000-07:002017-07-22T07:25:52.905-07:00Snappy Answers to Stupid Questions (or Comments). Or, How to Defuse Conflicts Without Really TryingWhen I was 10 years old, my favorite reading material was MAD Magazine. For those of you who don't know, it was (is?) a humor magazine that's somewhat lowbrow, although nothing I read in it in those days was offensive. One of my favorite features was called "Snappy Answers to Stupid Questions." Unfortunately, I can't remember any of the snappy answers I read in MAD more than 40 years ago. But, I've come across gems of snappy answers over the years. <b>These type of retorts serve to defuse potential conflict through humor, a useful skill.</b><br />
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Probably the best snappy answer to a stupid question of all time was voiced by Mohandas ("Mahatma") Gandhi, India's national liberation leader: A journalist once asked him: "What do you think of Western civilisation?" He replied "I think it would be a good idea!" (For those of you who don't understand this, read up on the history of the British Empire). <br />
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Another of my favorites comes from Pablo Casals, the famous cellist. When in his 90s, he mentioned that he still played the cello, and someone (another journalist, I think) asked him: "Why are you still practicing at this age?" which is an ageist and clueless remark. Casals replied, "Because I think I'm making progress!"<br />
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Obese people have told me that they've had experiences of being in a fast food restaurant when another customer said to them something like "You shouldn't be eating those fries." A standard retort: "It's true I'm fat, but I could lose weight. Unfortunately there's no cure for stupidity/bad manners." (That may not be completely true, as people can learn better manners, but they usually don't). <br />
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A sense of humor is considered an important psychological strength by psychotherapists. In fact it is classified as an adaptive defense mechanism.<br />
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I've noticed that despite a plethora of comedy on tv and in movies, many people today are taking themselves too seriously, are easily offended, and at the same time are often afraid to use the type of snappy answers I've cited above because they are wary of offending others. But snappy answers can be a way to put people in their place so that you are standing up for yourself without arguing or throwing a temper tantrum. They are more likely to be heard than direct reprimands or lectures. <br />
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There are times when it's best to hold one's tongue, such as when dealing with your boss at work. But in most cases it is better for one's mental health to respond to offensive remarks. Practice some snappy answers to the type of insults that you encounter so you'll be prepared for the next time. <br />
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<b>Addendum 7/15:</b> And for my patients who work in media, I found the following:<br />
https://www.mcsweeneys.net/articles/greeting-cards-for-your-online-trolls<b></b><br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-43758850620681359572017-05-28T16:27:00.001-07:002017-07-06T16:21:09.970-07:00How to ArgueAfter last November's election, I saw a number of media articles about disastrous arguments that had erupted among family members and even between couples. There used to be an old saying, "Never discuss religion and politics" in conversation. But today, people sometimes have difficulty finding non-controversial subjects to discuss, partly because the media likes to enhance controversy and division, and partly because entertainment has become so splintered many people aren't watching the same tv shows or movies as their friends or family. To make matters worse, many people today don't know the rules of debate. The rules of what used to be called rhetoric certainly are not modeled by our politicians or by the media. Here are some of the basic rules:<br />
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<b>1.</b> <b>Arguments must be supported by facts.</b> Facts are pieces of information that are demonstrably true. Something isn't true based on the number of people who believe it. A billion people could believe something and it could still be false. Many beliefs throughout history have been believed by the majority of the population of a country or region yet were found later to be utterly false. Truth is supported by observable evidence. The evidence might only be observable with an electron microscope, or it might only be indirectly observable (psychotherapists can observe the workings of psychological defense mechanisms, even though the mechanisms themselves are caused by brain patterns that we haven't yet been able to pinpoint, for example) but there must be observable evidence to support the argument. <br />
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<b>2</b>. <b>Arguments and positions must be evaluated on their own merits, rather than being judged by who did the arguing or who holds the position. </b>This is the classic distinction between an "ad jure" and an "ad hominem" attack. An ad hominem attack is a personal attack. For example: Sen. Smith supports a controversial bill. Someone argues against his position by saying "Sen. Smith cheated on his wife who divorced him." This is an ad hominem attack. The problem isn't so much that the attack is personal, the problem is that it is irrelevant. Sen. Smith's marital history is only important if one is planning on dating him or marrying him. It has no relevancy to the legislation he supports, even if the legislation concerns marriage. The validity of the legislation has to stand (or not) on its own merits. The personal attributes of its sponsors have no relationship to the validity of the legislation. <br />
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<b>3.</b> <b>Guilt by Association is a smear tactic and should not be used.</b> Guilt by association is often used as part of an insinuation or innuendo. For example: "I saw Sen. Smith talking in a parking lot with the Grand Wizard of the Ku Klux Klan." Unless we know what transpired in this conversation, this is an irrelevancy. Even if the Grand Wizard of the Ku Klux Klan endorsed Sen. Smith for public office, this does not mean that Sen. Smith holds the same views as the Klan, unless Sen. Smith asked for an endorsement from the organization or its leader. Although one might assume that an endorsement is done because of similar beliefs held by the endorser and endorsee, that may not be true. The important question is what does Sen. Smith believe and support? Sen. Smith's political positions have to be evaluated based on their own merits or lack thereof. <br />
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<b>4</b>. <b>A "Straw Man" argument is an innuendo/insinuation that manufactures a controversy; it is a dishonest tactic that should not be used.</b> Wikipedia has a good entry about Straw Man arguments:<br />
https://en.wikipedia.org/wiki/Straw_man<br />
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<b>5</b>. <b>Sources cited must be credible.</b> Here are some basic rules for sources that I learned as a journalist in the 1980s, before the profession sank into the mud: a) Information should come from more than one source, especially information that is politically sensitive, incendiary etc. The standard rule for reporting sensitive stories is that the same information must come from two independent sources, in other words, two sources who aren't in collusion with each other b) Sources must lack bias. In other words, they cannot have an ulterior motive. c) Sources cited as experts must actually be experts. Having an opinion does not make one an expert. Experts are persons with extensive training and/or professional experience in a given field. <br />
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If one reads many of today's news outlets (many of which are not actually newspapers or magazines but agenda-driven websites) one can find stories written based on only one source or based on sources with bias. The most notorious recent example was the Rolling Stone magazine campus rape story that was retracted. It was almost entirely based on the account of the victim with no corroboration. For other examples, look for news stories that quote agenda-based organizations on the same topic that the organization promotes or attacks. Anything such sources claim should be taken with the proverbial grain of salt. Just because their spokesperson is being quoted in a newspaper does not mean that what the spokesperson says is credible. In fact their bias discredits them. Many news stories try to sidestep this rule by printing "opposing views." They publish (or broadcast) two persons' views that are in opposition to each other. But both viewpoints could be false, if they aren't based on facts. If the subject is technical or scientific or requires professional expertise to understand, the viewpoint is only credible if the person is an expert. <br />
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Many ordinary people when arguing a point will base their argument on what they read in the media. Unless the media source you are citing follows the above rules, your argument may be based on false information. <br />
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<b>If ordinary people followed all five rules I've cited above, arguments would be less volatile. Because they would be fact-based, the opponent may catch on that listening is an opportunity to learn. If the opponent has no facts, he or she may discontinue the argument and head to the library to find some. Both parties might learn to have more respect for each other, because we tend to respect people who know facts and who avoid insinuations and personal attacks.</b> Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-7740164001224699822017-05-13T19:25:00.003-07:002017-10-10T11:41:51.734-07:00Reading Fiction for Better Mental HealthDoes reading improve mental health? There's evidence that it does.<br />
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It's long been known that reading improves overall cognitive ability. Studies have shown that there's a correlation between early literacy in children and higher IQ scores later in life, and that reading in older adulthood delays cognitive decline to some extent. Reading involves the decoding of symbols (letters) and forces the brain to interpret words in context--perhaps the brain requires this exercise to stay fit. Pictures don't have the same effect, because understanding them doesn't use the same brain functions. <br />
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But what about emotional health? There are several ways reading may improve emotional well-being. This rather long <a href="http://www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier" target="_blank">article</a> in The New Yorker<br />
on bibliotherapy cites some studies indicating that reading fiction improves the capacity for empathy and also, can be a "mindfulness" activity (see my previous post on mindfulness). <br />
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This brings up the issue of what type of reading we're talking about: Any type of reading may increase general cognitive function, but reading fiction, particularly the best fiction, may have special benefits: Good fiction convinces the reader, temporarily, of the "realness" of the characters, setting and events (thus inducing a trance state that removes the reader from his/her real-life troubles). Good fiction also includes well-developed, multi-dimensional characters and immerses the reader in the character or characters' inner and outer worlds, helping the reader see through their eyes. It's easy to see how this could increase the capacity for empathy. <br />
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The best writers portray villains who perhaps weren't always evil, and heroes who are flawed. These nuanced explorations of human nature may especially help readers with personality disorders. Persons with Borderline Personality Disorder in particular typically divide the world into polar opposites: Good v. Bad people, and simplistic or extreme interpretations of events. These tendencies are found in people with Borderline Personality Disorder even when the person has a high IQ, because these distortions are caused by dysfunctional ego defenses, not by low intelligence (see my previous post on Borderline Personality Disorder from Oct. 14, 2015 ). <br />
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Reading fiction might also help persons with depression: The characters in the best fiction grapple with conflicts and make mistakes, even when they are the novel's "heroes." Reading about their struggles might help self-critical persons moderate their self-criticism. <br />
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In short, reading is important, but it matters what you read. Many of the opinion essays, Facebook posts etc. that I come across on the internet are nothing but recitations of popular slogans and catchphrases. They often demonize opponents by using hyperbolic language. They often promote a code of "correct" language that is remarkably reminiscent of the "newspeak" of Orwell's classic dystopian speculative fiction novel "1984." The purpose seems to be to increase fear and hatred of opponents, as well groupthink and submission to self-promoted "authorities." These are the tools of authoritarianism and totalitarianism. This type of reading can have a negative effect on mental health by increasing anger. It might even negatively impact overall cognitive functioning by encouraging simplification. <br />
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I've noticed over the years that although reading complex novels doesn't prevent mental illness, my patients who read fiction often seem to cope better with their disorders, including serious disorders. <br />
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To increase general knowledge, I recommend reading reputable non-fiction books written by academic experts or by reputable journalists who are basing their works on facts and research, not on opinions. To increase emotional well-being, I recommend reading fiction (in any genre) that includes multi-dimensional characters. Maybe a book club is a therapy group!<br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-41377720129172904842017-04-12T06:00:00.001-07:002017-04-12T06:00:34.991-07:00MindfulnessThe word "mindfulness" is coming up more and more in the popular vocabulary. What does it mean? <br />
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"Mindfulness" means simply a state of being aware. The practice of mindfulness is an element of Zen Buddhism that has been incorporated into some Western treatment programs, especially Dialectical Behavior Therapy. I can't comment on mindfulness as a spiritual practice because I am not Buddhist, but I can explain the ways it works psychotherapeutically: Focusing your attention on something stops anxious ruminations. Focusing for a prolonged period of time can induce a trance state, which is relaxing and also is a component of hypnotherapy. In addition, mindfulness can increase appreciation for the world around you. <br />
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Mindfulness is an essential part of meditation. <br />
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Marsha Linehan, the founder of Dialectical Behavior Therapy, developed a series of mindfulness exercises to help persons with Borderline Personality Disorder manage their emotions. Mindfulness is a component of DBT, along with interpersonal skills training and elements of cognitive therapy. Since Linehan developed DBT in the early 1990s its use has expanded and DBT is now used to treat people with anxiety, depression and PTSD. Here's an excerpt of a mindfulness exercise from Linehan's DBT workbook:<br />
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" `Awareness Exercises' 1. Awareness of the Positions of the Body: This can be practiced in any time and place. Begin to focus your attention on your breath. Breathe quietly and more deeply than usual. Be mindful of the position of your body, whether you are walking, standing, lying, or sitting down. Know where you walk, stand, lie, or sit. Be aware of the purpose of your position. For example, you might be conscious that you are standing on a green hillside in order to refresh yourself, to practice breathing, or just to stand. If there is no purpose, be aware that there is no purpose." <br />
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Another excerpt: "Awareness While Making Tea or Coffee: Prepare a pot of tea or coffee to serve a guest or to drink by yourself. Do each movement slowly, in awareness. Do not let one detail of your movements go by without being aware of it. Know that your hand lifts the pot by its handle. Know that you are pouring the fragrant, warm tea or coffee into the cup. Follow each step in awareness. Breathe gently and more deeply than usual. Take hold of your breath if your mind strays." <br />
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Mindfulness can help anxious or depressed persons get out of their inner world in which they may be dwelling on negative thoughts. Obsessive preoccupations are common in anxiety disorders and also for some persons with depression. These internal experiences often become disconnected from external reality. Mindfulness exercises can help re-connect the anxious or depressed person with the greater context of the world around them.<br />
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People who play sports or engage in artistic activities often practice mindfulness without realizing it. Perhaps that's why those activities are referred to as "recreation" (re-creation).<br />
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Too often we mindlessly engage in our daily activities. Eating mindlessly not only leads to weight gain but also denies oneself the pleasure of flavor, aroma and other sensory experiences of food. Many people walk through parks without fully appreciating the natural world around them. <br />
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On a vacation last year in Vermont I spent an hour in the afternoon doing nothing except sitting in a grassy area by the woods. I focused on the touch of the grass, the dark mystery of the woods, the blue sky, some unidentified plants and an occasional butterfly. I sat alone, which allowed me to experience the natural world without the distraction of conversation. I had the sensation of being in a timeless place in existence apart from daily life. In hypnotherapy, we often teach people to mentally escape to a "safe place" in their minds. But I believe real-life experiences may be necessary for many people to be able to imagine a safe place.<br />
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Anyone can benefit from mindfulness exercises and perhaps we all need them as an antidote to our frantic, distracted contemporary lifestyles. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-14485055944023786112017-01-14T05:36:00.000-08:002017-01-18T06:16:31.013-08:00Winter BluesSome people get depressed in the winter, and in the 1980s this was identified as an illness called Seasonal Affective Disorder. Today SAD isn't used as a diagnosis per se, but is described as an aspect of a mood disorder for some people. It's been theorized that reduced exposure to light in wintertime triggers depression for some people (perhaps by increasing sleep?). But could there be other reasons why people get depressed during wintertime?<br />
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Another possible reason for winter blues could be wintertime respiratory infections. Being sick isn't fun, and also, the body's immune response involves inflammation, and inflammation has been linked to depression (see my post "Can Vitamin D Improve Your Mood" from June 29, 2013). <br />
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Many people don't pay attention to infection control, and in a city like New York, this can be dangerous. It's important to wash your hands after taking public transportation--or, wear gloves. <br />
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The most recent issue of Eating Well magazine suggests a few dietary tricks to reduce wintertime colds: Cinnamon has a property that inactivates viruses according to one study. Try putting it in coffee instead of sugar, and mix it with unsweetened applesauce. The article also recommends Shiitake mushrooms, which have been found to improve immune cells (possibly because they contain selenium and other minerals and vitamins). If you don't like mushrooms, you could take supplements. Probiotics may also be helpful, so regular yogurt is a good idea. <br />
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Perhaps another reason for wintertime blues is that people spend more time indoors during cold weather. Exposure to nature has been found to be beneficial to mental health. The Japanese sometimes practice a therapy they call "Forest Bathing"--which just means spending time in the woods (a wooded park is probably just as good). It's been found to reduce stress. This makes sense, because for millions of years before modern humans evolved, our ancestors found safety in trees. In addition, trees may give off organic compounds that promote health. <br />
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The way we live in New York City isn't natural. Dark apartments, fluorescent lighting, overcrowded public transportation and lack of contact with nature all promote ill health. But infection control measures, good dietary habits, and perhaps taking a winter vacation to someplace like a national park in a warmer state or a Caribbean or Latin American rainforest could help. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-59457616968036663402016-12-11T11:10:00.001-08:002017-04-27T08:49:35.387-07:00Forgiveness v. Moving OnOften I come across statements from members of the clergy, politicians, and ordinary people quoted in the media, linking "forgiveness" with "healing." Forgiveness isn't a concept from mental health treatment. It's a concept from religion, and in particular, from Christianity. A religious concept has utility for religious persons. For those seeking mental health, a better concept is "moving on." <br />
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The purpose of forgiveness in the monotheistic religions is to become more godly or pious. As a psychotherapist, my goal is to help people feel and function better. No psychotherapist should suggest to a patient that he or she forgive those who have hurt them, because such a statement implies that the patient adopt the therapist's religious views. In addition, such a statement could be heard as minimizing the patient's trauma and emotions. <br />
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"Forgiveness" implies a change in attitude from the victim toward the offender, and is a statement that the victim no longer seeks retribution. "Moving on" simply means that the victim no longer obsesses or dwells on the offense and seeks to live a normal life unencumbered by emotions generated by the trauma. It is possible to move on without "forgiving" the offender. It is even possible to move on while still seeking retribution in the form of criminal justice or civil law, depending on the amount of time and energy required to pursue justice. <br />
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Obsessing over past hurts contributes to depression and PTSD symptoms. The obsession may cause the offender to loom large in the victim's mind and this can contribute to feelings of disempowerment. A saying I heard often when I was a substance abuse counselor--from one recovering patient to another--was "You're letting him rent space in your head!" Actually this is a generous interpretation, because the perpetrator isn't paying any rent to live in the victim's head. <br />
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"Moving on" means practicing the old adage "Living well is the best revenge." Psychotherapy for trauma can involve many different techniques, but the ultimate goal should be a better life for the victim. This involves empowering the patient and helping him or her put the past in the past. Many different techniques can help traumatized persons accomplish this. They include various forms of cognitive and behavioral therapy, EMDR, insight-oriented therapy to help the person gain self-understanding and supportive therapy to help the person focus on current goals.<br />
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If it's important for you to forgive because of your religious beliefs, then by all means do so. But forgiveness is not a requirement for healing and mental health. <br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-61571964872335607622016-06-19T12:55:00.000-07:002017-04-27T08:51:39.031-07:00Psychopaths Among UsAs the number of mass shootings seems to be on the increase, many have wondered what types of people commit these acts. As I noted in my June 20, 2015 post, some of those who are racially motivated may have Delusional Disorder. I noted in my May 31, 2014 post, some may have Narcissistic Personality Disorder and/or Bipolar Disorder perhaps exacerbated by the wrong type of medication. But the diagnosis most often correlated with violent behavior is Antisocial Personality Disorder, which is better known by its earlier terms, sociopathy and psychopathy. All three terms refer to the same condition.<br />
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It used to be believed that psychopathy (I'll use that term for this blog post) was a rare condition. It isn't a rare condition. Studies referenced in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V) indicate the rate of Antisocial Personality Disorder, or psychopathy, is somewhere between .2 and 3.3 percent of the population.<br />
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It is commonly and inaccurately believed--including by some members of my profession--that psychopaths are found mostly in the criminal justice population. I used to work with people paroled from state prison, in the 1990s, and I have seen a rate of psychopathy in my private practice that is about the same as what I saw in my job with the parolees. Most of the parolees weren't arrested for crimes committed to gain psychopathic thrills; most were arrested for selling drugs or committing burglaries or robberies in order to support heroin addiction or crack cocaine addiction. Our prisons aren't overcrowded with psychopaths. <br />
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Psychopaths have come to my private practice for a variety of reasons including having been arrested, having committed a serious crime that did not result in arrest but resulted in interpersonal problems, and because of job problems, educational problems, addiction, and depression.<br />
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It is commonly believed that psychopathy is untreatable or barely treatable. Some therapists like to say that "the only reason psychopaths come to therapy is to learn how to be better psychopaths." Is this true? The psychopathic persons who came to see me who were struggling with depression or early recovery from addiction definitely wanted help for those problems. I do believe that I helped them, but the underlying personality disorder remained more or less intact. The persons who came to treatment due to outside pressure were less treatable, but I do believe we were able to work on some issues when the patient was being honest with me. I only recall one psychopathic patient who I became convinced was simply making up stories, perhaps in order to get a thrill out of manipulating someone.<br />
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Psychopathy, or Anti-Social Personality Disorder, is usually characterized by difficulty following rules and social norms, deceitfulness, lack of empathy, impulsivity and aggression. It is thought to be more common among men, but I question that statistic, because half the psychopaths who have come to my private practice have been women. But perhaps female psychopaths are more likely to seek treatment.<br />
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The best treatment, as it is in many disorders, is prevention. The DSM-V notes "Adoption studies indicate that both genetic and environmental factors contribute to the risk of developing antisocial personality disorder." Past studies have correlated psychopathic behavior with childhood abuse and neglect and with inconsistent parenting (parents who disagree over rules or a parent whose discipline seems arbitrary). Ideologies that provide a rationale for violence help psychopaths commit violent acts. Societal alienation may exacerbate the characterological lack of empathy. Anyone who sees him or herself as having little to lose is more likely to commit a violent act that ends in his or her own death or arrest. This last factor indicates that depression may exacerbate psychopathic behavior, although I am unaware of any scientific research on this subject. <br />
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The DSM specifies that for antisocial personality disorder to be diagnosed, the person must have had some symptoms starting before age 15. Perhaps if we did better screening, referral and treatment of children and teens exhibiting psychopathic behaviors we would not see so many acts of mass violence. Treatment should include treatment for parents or other significant family members as well as parent training to teach appropriate discipline. In some cases, removal of the child from the home may be necessary, but because such removals are usually done long after the damage is done, and because foster and adoptive homes are also often not optimal, this may not result in prevention of violent acts.<br />
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Many factors contribute to psychopathic behavior. To prevent acts of mass violence, reasonable gun control laws should be combined with early intervention for children exhibiting serious conduct problems and lack of empathy for others. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-20514709229939519402016-06-05T17:26:00.001-07:002017-01-26T18:46:19.663-08:00Obesity and DepressionAre there links between obesity and depression?<br />
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People used to think that the link between obesity and depression was that fat people were depressed because they didn't like how they looked. Later it was theorized that some people overeat <i>because</i> they're depressed--although depression often makes people lose their appetite. I believe there may be a biological link between obesity and depression: Depression has been linked to inflammation (see my June 29, 2013 post on Vitamin D and mood) and obesity can increase inflammation. Therefore, it is possible that obesity can biologically contribute to depression by increasing inflammation.<br />
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There are other negative psychological effects from obesity. It can make people give up (or never try) activities that might make them feel better, such as exercise. It can make people self-conscious, which can lead to social withdrawal. <br />
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It's possible, although not easy, to lose weight. Unfortunately, I come across misinformation about weight loss in the media: Recently I read a news article that implied losing weight is next to impossible. It was based on the experiences of contestants in "The Biggest Loser" who gained most or all of their weight back. The reason was that their metabolism slowed to a crawl after they lost weight. I don't think "The Biggest Loser" is a model for weight loss, because the weight loss program it advocates, extreme exercise, probably isn't feasible for many people and may not even be healthy. The show also uses public humiliation as a tool, and that doesn't help people.<br />
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It is possible to lose weight and keep it off. I've worked with several persons who lost large amounts of weight that they managed to keep off--and none went to a weight loss camp. The most important elements in weight loss may be motivation and the taking of personal responsibility (which could be undermined by reliance on a trainer). <br />
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Several persons who came to see me had already begun or completed their weight loss program before coming to therapy--perhaps change in one area motivates change in another. Here are some of the various methods with which they lost weight:<br />
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1. Weight Watchers--50 lb weight loss (I also knew someone in school who lost 100 lbs through Weight Watchers). Weight Watchers teaches portion control and healthy eating while providing social support. <br />
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2. Nutritional Counseling--60 lb weight loss. The nutritionist provided education as well as support. <br />
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3. Daily gym workouts (no trainer involved!) combined with eating only a Greek salad for dinner--100 lb weight loss. Exercise not only burns calories but also relieves stress. Exercising while listening to music may be especially effective and may provide a "safe space" where one escapes the stresses of daily life.(The person's main exercise was the elliptical machine, which avoids excess stress on the feet)<br />
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Therapy can help. I helped someone lose weight by having her write in a journal everything she ate, along with when she ate it and other relevant information. We would discuss what she wrote, in our sessions. This method allows for the analysis of emotions and thought patterns that trigger overeating. Hypnotherapy may also be helpful for some people. <br />
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I believe overeating is an addictive behavior no different in its psychological basis than addiction to alcohol or cocaine. Obese persons who aren't interested in losing weight can be observed to use the same sorts of denial and minimizing statements that one hears from active alcoholics and drug addicts. Behaviors such as secret use/bingeing, arranging social activities around the substance and avoidance of others or activities that interfere with use, can be seen in both chronic drug users/alcoholics and the obese. Both drug addicts and morbidly obese persons have higher than average rates of childhood trauma according to some studies and many grew up in households in which addictive behaviors were common. After giving up drugs or alcohol, some people turn to food, and there's been some evidence that people who have had weight loss surgery are at increased risk for problem drinking.<br />
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Given the similarities between overeating and alcohol/drug addiction, can a 12-step group help? I've heard mixed reports of Overeaters Anonymous, the 12-step program for food addicts. The 12-step model was originally based on abstinence, and abstinence from food isn't possible. However, some may benefit from the support in OA.<br />
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Obesity isn't a problem because of how it makes you look. It is a serious health condition that not only raises one's risk for fatal conditions including diabetes, heart attack and stroke, but also can increase depression through increasing inflammation and reducing recreational and social activities. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-77879127296350400482016-05-17T05:45:00.001-07:002016-05-18T19:50:59.114-07:00Preventing SuicideIn the past year or so, the news media have reported on a couple of disturbing research studies that showed rising suicide rates. The latest study reported that suicide has been increasing in every age group except the elderly. What is prompting this increase and what can be done about it?<br />
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Many have speculated that economic hard times are behind increasing suicides. This could certainly be a possibility for the increasing rates of suicide in middle-aged people, many of whom lost retirement savings and jobs, or lost homes, during and after the crash of 2008. <br />
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Increased suicides among girls age 10-14 is more of a puzzle. One theory is that increased social media bullying is the cause. If this is true, an easy way to decrease these suicides is to not give your daughter a smartphone until she is old enough to tolerate or stand up against bullying. That kind of personal strength is unusual in people under age 15. Facebook supposedly doesn't allow accounts for people under age 13, but I don't know if this is enforced at all. It's really up to parents to protect their children. Likewise, it's important to ask your child about bullying and take steps to address it if it occurs, including speaking with the school principal, switching schools and/or taking legal action. Harassment and stalking are against the law regardless if the perpetrator is a teen, and Title IX of the Civil Rights Act forbids sex discrimination in education, which could make sexually-related bullying a federal violation if it is tolerated by the school.<br />
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Teen girls are now subjected to more degradation than ever before. Besides social media harassment, they also now have male peers who view internet pornography, and who may as a result view girls and women as subservient or degraded sex objects. Some girls may be pressured into sex acts as a result, and viewing of some types of pornography is a trauma for a young person. Pop music stars such as Beyonce and Miley Cyrus perform burlesque acts that may confuse 11 and 12 year old girls, who are told that these sexually objectifying performances are acts of empowerment, while at the same time they are derided as "sluts" if they dress the wrong way or date boys. Overweight girls are teased, but thin girls are also derided in popular culture--take a look at Meaghan Trainor's hit video "All About That Bass," a profane, vicious, bullying rant that is promoted as "happy" music on Amazon. Trainor's songs are marketed to young teen girls. <br />
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The more I think about it, are we really surprised that suicide is on the rise? Perhaps the reason the suicide rate of the elderly is not rising (despite the fact it historically has been higher than for other age groups) is because elderly people are more likely to have assets that weren't as affected by the 2008 crash, Social Security incomes, and a lack of involvement in degrading aspects of popular culture.<br />
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In terms of specific risk factors and prevention, something that we know about suicide is that it is often an impulsive act and often based on cognitive distortions. Even when times are bad, most people are able to recognize that things can get better.<b> People commit suicide because they don't see a way out. They develop a narrow way of thinking that blocks out options. </b>They also often don't believe that others can or will help them. They don't "reach out" for help. These thought patterns and behaviors are referred to as "hopelessness and helplessness," and mental health professions screen for suicide risk not just through asking patients how depressed they feel and whether they have had thoughts about suicide, but also by assessing whether the patient has any plans for the future and whether the patient has a social support network. People can be very depressed and feel like they don't want to live, but if they feel connected to others they are less likely to commit suicide. Someone who does not have anyone in whom to confide is far more likely to commit suicide than a depressed person who reaches out for help. This brings up another possible reason why suicide is on the increase--some studies have found that more people are reporting few or no close friends, in comparison to previous decades.<br />
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If we want to live in a society with a low rate of suicide, we need to have a stable economy that provides some security for everyone, we need to encourage friendship and mutual trusting relationships, and we need to protect vulnerable persons such as young girls from degradation via the internet. <br />
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<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-34865865633064548102016-04-28T15:23:00.001-07:002016-11-13T06:01:42.495-08:00Why I Left the Aetna PanelIn February, I made a decision to terminate my relationship with Aetna, the health insurance company, and also decided to terminate my relationship with the 1199 National Benefit Fund. Some patients have asked me why I did this. The truth is that I'd come to the realization that I was in abusive relationships with these entities, and the only way to deal with being in an abusive relationship is to leave that relationship.<br />
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Aetna does pay providers a bit more than some other insurers, but in every other way they demonstrate contempt for the providers who actually do the work for which Aetna takes the profit. Aetna messed up my credentialing twice, first when I initially applied in 2008, then again in 2014 when I changed my tax ID number. These screw-ups meant I wasn't paid for months and that I wasted hours of my time on the phone and writing emails as well as resubmitting claims, in order to resolve the problems. Aetna also denied claims for bogus reasons, such as in one memorable case when they told me my patient's auto insurance might have already paid the claim. The patient didn't own a car. I eventually spoke to someone at Aetna who was as puzzled as I was by this bizarre statement. She resolved the issue, but only after both I and the patient wasted time trying to resolve the unpaid claim.<br />
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The last straw for me with Aetna was in early February, when I received a phone call from a third party, "ArroHealth," saying that I needed to turn over case records on four patients. I inquired as to the reason and was told "it's the annual risk assessment." I'd been credentialed with Aetna for almost 8 years and had never heard of an annual risk assessment. Moreover, all of the cases were closed, so a risk assessment was beside the point. I don't turn over confidential health records without a good reason. I informed "ArroHealth" that the cases were closed, I was no longer in touch with the patients, and their confidentiality waivers for Aetna were now out-of-date. Of course, what many people don't know is that when you sign up for health insurance you sign a statement allowing the insurance company to look at all your health records. Regardless, this is never something I would do without consulting with the patient. I found out later some of my colleagues dealt with this by asking patients to write letters to Aetna or to ArroHealth saying they were refusing the release of their records. But I didn't want to involve former patients at all. Moreover, because of the consulting work I do as an auditor, I know that payors are capable of finding bogus reasons to take back money from providers. I am not giving back one cent of any money paid for work that I have done. I told ArroHealth that I wasn't going to release the records. Within one week I had decided that if I maintained my relationship with Aetna, I would be subject to more of the same, so I faxed them a termination letter.<br />
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As for the 1199 National Benefit Fund, which ironically is a plan for health and hospital workers in New York, they processed by tax ID change application by immediately eliminating my old tax ID number, but waiting six weeks to instate my new tax ID number. This meant that I was listed as an "out of network" provider for six weeks. I don't know if this was extreme incompetence or done deliberately, but the end result is that they owe me hundreds of dollars for a patient's incorrectly processed claim. Although I filed an appeal, I have not been paid.<br />
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I counsel my patients not to tolerate abuse and disrespect and I would be a poor role model if I allowed myself to continue to be mistreated by these organizations. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-39860560957949885712016-04-05T12:17:00.002-07:002016-04-09T05:44:22.984-07:00How Music Helps Your BrainI was intrigued by this article in Guitar Player, and more so by the TED video that is embedded in the article:<br />
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http://www.guitarplayer.com/lessons/1014/10-reasons-why-playing-guitar-is-good-for-your-mind--body--video/51929<br />
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According to the article and video, listening to music stimulates the brain, but playing a musical instrument enhances brain functioning even more. It makes sense--music is both emotional and logical, expressive and structured, mathematical and sensually stimulating. It links the brain's two hemispheres, and the brain's "executive functioning" would be enhanced by the processing of the large amount of linked information. ("Executive functioning" refers to mental processes of ordering, sorting, linking and prioritizing information).<br />
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Does music help prevent dementia? The article and video imply that it
could. I'm wondering if there's a possibility learning a musical
instrument might also help persons with ADHD, although, as far as I
know, there is no research regarding this. (People with ADHD have
difficulty with "executive functioning.")<br />
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Although music may be especially helpful in improving brain functioning and stimulating the brain's reward centers, any artistic activity can improve focus and involve what psychotherapists are currently calling "mindfulness"--a state of focus that relieves anxiety and stress.<br />
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Performing one artistic activity can also stimulate activity in other artistic areas ("Violon D'Ingres"). My favorite example is William Blake, one of the greatest English poets, who was by trade an illustrator and graphic artist. Although he didn't achieve renown as a visual artist, anyone who reads his poetry is struck by its vivid imagery, especially in his most famous poem, "The Tiger."<br />
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<b>There are multiple benefits to engagement in artistic activities. </b>Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-2697333446191009422016-03-25T06:32:00.003-07:002016-03-25T06:32:40.630-07:00Before Saying 'I Do"I thought this was a pretty good list of issues to discuss and consider before getting married:<br />
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http://www.nytimes.com/interactive/2016/03/23/fashion/weddings/marriage-questions.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=mini-moth&region=top-stories-below&WT.nav=top-stories-below&_r=0<br />
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(I'm sorry that I can no longer figure out how to put in links on this blogging platform)<br />
<br />Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-3645440075488134312016-01-18T06:09:00.001-08:002016-03-21T14:10:00.291-07:00How Frequently Should Therapy Sessions Be? When people come to see me, they usually assume I'll be scheduling them for a weekly appointment, probably because this is the norm for psychotherapy these days. But is this really the best format?<br />
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When psychotherapy first began, as psychoanalysis, patients attended sessions 4 to 6 days a week. It was thought that this was necessary to allow for the "free association" to reveal the patient's unconscious material. On the other hand, no one came to psychotherapy for 10 years, as happened later. Patients who were suffering wanted to be cured as quickly as possible.The original purpose of treatment was to cure neurosis, and once cured, it was thought it would not re-occur.<br />
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As I've outlined in previous posts, these days people come to therapy for a variety of reasons and some people have personality disorders that are chronic.<b> I believe the format of therapy should fit the individual patient. I see most people weekly, a few people every other week or in rare cases less frequently, and occasionally I have scheduled people for twice weekly sessions. </b><br />
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I pick the format that seems to fit the individual patient and I expect that therapy could last anywhere from a few sessions to a few years, depending on the individual. <b> </b><br />
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I generally start out with weekly sessions because this is usually enough to start therapy and fits most people's schedules. Some people ask to be seen less often and I evaluate this on a case-by-case basis, but I rarely agree to see people less than once a week within the first couple of months. I have found that some persons who ask for infrequent sessions at the start of therapy have intimacy issues or are afraid of making changes. Although fear is to be respected, it may be important to discuss the source of this fear rather than simply acquiescing to it. I've also found that people who request right away to be seen less frequently than once a week are often people who don't want to come to therapy at all but are being pressured by someone else, or for another reason not related to wanting to be in therapy. Change <i>can</i> occur in therapy at any frequency, however.<br />
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I have had a few cases in which I moved the patient to twice weekly sessions because I thought we were stuck and weren't getting to something important. Increasing the frequency of sessions can lead to a breakthrough in some cases. Psychoanalysts believe that therapy at least twice a week is necessary to generate something called "transference," which is really just a jargon term for the emotional relationship between the patient and the therapist (although technically it means the patient transfers a relationship from childhood onto the therapist). I'm not sure this belief is true, as transference can occur in the very first session. But some people may achieve breakthroughs in more frequent therapy because they need the more consistent presence of the therapist to feel safe in making changes or dealing with difficult material.<br />
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In a few cases I have reduced the frequency of therapy because I thought the patient felt pressured to make changes he or she wasn't capable of. It's important for the therapist to respect the patient's limits. The more experienced that I have become as a therapist, the more clearly and rapidly I can see a patient's problems, but that doesn't mean the patient is ready to see what I see.<br />
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<b>In general, people improve more quickly if they attend therapy sessions more frequently, but it is possible for some people to benefit from infrequent sessions. </b>Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-33760087758797379152015-12-08T04:51:00.003-08:002016-02-27T13:41:01.793-08:00Holiday Cheer? It's the time of year when many employers hold holiday parties for their employees. Some of these parties will be held in venues that serve alcohol, despite the fact that approximately 10 percent of people are alcoholics or have the disposition to become alcoholic. <br />
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I've had at least one patient who was fired from a job due to alcohol-related behavior at an office party. Why would employers create situations that facilitate problematic behavior and raise liability risk for the company? Because often managers are people without common sense.<br />
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Even without alcohol, office parties may be problematic, because co-workers aren't necessarily friends. People choose their friends, but they rarely choose their co-workers.<br />
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The office party may be an attempt by the management to create an image of bonhomie among workers, an image that may not correspond to reality.<br />
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<b>If employers choose to hold holiday parties, they should be optional events and in no circumstance should alcohol be served. </b><br />
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Increased diversity in the workplace in recent decades has not always meant increased harmony in the workplace. Many male or white employees have not made the mental transition to a diverse workplace.<br />
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Free-form banter among persons who have nothing in common except their place of employment is likely to lead to disharmony. In what may go down in history as the worst possible outcome of this type of disharmony, the recent San Bernardino shooter may have been involved in a heated conversation with co-workers prior to the attack. (Although the couple was planning a terrorist attack for some time, it's not clear that the office party was the original intended target). One newspaper report I read indicated the conversation may have been about "Israel." Why on earth would someone initiate or continue a conversation about a controversial foreign policy subject with a co-worker he or she isn't friends with and especially, if it's likely the co-worker will disagree? In fact it looks like a deliberate attempt at provocation. I've observed, over the course of my life, that many people enjoy provoking others with whom they disagree. This isn't smart behavior, but many people do not use good judgment in social situations. <br />
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Having lived and traveled around the world, I've observed that many issues that are life-or-death to persons in foreign countries are viewed as abstractions and appropriate topics for social conversations among Americans. There used to be a commonly-repeated dictum in American social etiquette, "don't discuss religion or politics," but this dictum has fallen by the wayside.<br />
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<b>If you don't know your co-workers well, it's best to avoid any controversial topics of conversation. </b>Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0tag:blogger.com,1999:blog-4126791094440530949.post-1529449501804197412015-12-04T13:24:00.000-08:002015-12-07T07:42:14.133-08:00What Questions Should You Ask A Prospective Therapist? The most common question people ask when they contact me is "Are you taking new patients?" In most cases, the person is seeking to make an appointment, so it would save time if the person just said 'I'd like to make an appointment." This would result in my saying "do you need an evening slot or can you come during the day?" or "I have a time available at 6 p.m. Monday" or "I'm not taking new patients right now." All of those responses answer the question of whether I am taking new patients or not, as I would never enter a conversation about scheduling unless I was taking new patients. If I am taking new patients, we can get right down to the details of scheduling.<br />
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What type of questions should people ask when they contact a therapist? First of all,
people should ask whether I take their insurance or what type of fees I
charge. I am often surprised how many people ask for an appointment without asking first for
this information. When I tell some people that I don't take their
insurance, they are surprised. I'm often not sure where the
misinformation has come from. I am on some HMO panels and not on others. Many times people have found me through their insurance directory, but sometimes people find me through the internet or personal referrals.<br />
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A few people pay cash for their sessions. I have a sliding scale fee based on income/net worth. On a few (thankfully rare) occasions, a patient who reports a high income has tried to "negotiate" a lower fee. I offer lower fees for people with low incomes, not for people with high incomes. <br />
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I sometimes I get a question along the lines of: "What is your orientation?" People aren't asking about my sexual orientation. They're asking about my theoretical orientation. I'm never sure how to answer this question. If I gave a complete answer, it would sound like gibberish to most people. It would sound something like this: "I believe Object Relations Theory,
Self Psychology and Ego Psychology are all important. I sometimes use
DBT techniques for anxiety disorders and borderline personality disorder. I've been trained in Family Systems Therapy, but when I do couples counseling I mostly just take a problem-solving approach." (that isn't even a totally complete answer). If you understood all of that, you are probably a therapist yourself.<br />
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What I usually say instead is "I'm mostly an insight-oriented therapist, but I sometimes use DBT and other techniques as appropriate." But I don't think most people understand that either. <br />
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<b>There are some questions on subjects other than payment and scheduling that someone might want to ask a prospective therapist: </b><br />
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<b>1. Do you have experience treating (name of problem)?</b><br />
<b>2. What are the typical types of patients you work with?</b><br />
<b>3. Are there any types of patients you don't work with? </b><br />
<b>4. How many years have you been practicing psychotherapy?</b><br />
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The answers to these questions are more important than the theoretical orientation to which a therapist subscribes. <br />
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Newspapers, TV and the internet are full of articles about new types of therapy, often accompanied by claims that the new treatment works miracles. Never forget that today's miracle cure is tomorrow's debunked failure. Almost all of these articles are written by people who aren't mental health professionals. Some of these articles may give a false impression that one can understand different types of therapy by reading articles in the media.<br />
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All types of psychotherapy adhere to some basic principles and most therapists today use a variety of techniques. In fact, if you come across a therapist who is wedded to a particular theory or technique, you should be suspicious. That type of specialization only works if the therapist is willing to refer out all patients who need a different type of therapy, and in today's economy, most therapists need more patients, not fewer patients. I do refer out people who need a type of therapy I don't do. But mostly I have a general practice that allows me to see a wide variety of patients. Most of them get better. Anne Rettenberg LCSWhttp://www.blogger.com/profile/08924529514196589677noreply@blogger.com0