A Tough Time Being Wrong
August 7, 2010
When I was in my twenties, I knew that I was right. Other’s observations were really just opinions and didn’t take my full situation into account. Well, I wasn’t always right, but I was rarely absolutely wrong.
One day when I was 19, a group of people explained that I was just dead wrong in my perception of why I did a certain thing. I explained that they didn’t know me well enough to know the whole story. They said, “Give it up!” There were eight of them so I just let them talk and then tried to let it go.
30 minutes later I was walking down the street when I got hit so hard by the truth that I had to stop and sit on the curb until my legs could hold me up again – they were right, I was wrong. I was never able to be as confidently right again. That conversion experience opened up a rich life-long self exploration path.
Kathryn Schulz, in her new book, Being Wrong: Adventures in the Margins of Error, takes the whole issue of being wrong and gives it the attention it deserves. Hers is the most balanced look at rightness and wrongness that any of us non-philosophers could want. She is entertaining, easy to follow and asks provoking questions, the kind that start to creep into the rest of your life in interesting ways.
One of her key points is that we need errors to help us learn. If we can’t be open to alternatives, if we don’t dare explore possible dead ends, we limit our growth. Coaching, therapy and any other kind of exploration of the truths of our lives puts us at risk to discover that we’ve been wrong.
But if we feel we can’t afford to be wrong, we’ll block the reality that is right in front of our eyes. I say to myself that the only way to be wrong is to not learn. An interesting idea, but it may be wrong. I’ll keep my eyes open and see what there is to learn.
CAM for ADHD
July 27, 2010
I recently saw an interesting statistic reporting more than 50% of parents use complementary and alternative medicine (CAM) to treat their children’s ADHD. Many parents of ADHD children and adults with ADHD opt to combine conventional treatments, such as stimulant medication, with CAM while others prefer to use nonpharmacological therapies alone. Although most nonpharmacological interventions have limited data to support their benefit, 80% of patients who use natural products consider these to be their primary treatment modality. Yet few disclose this information to their treating physician. If you are using any alternative therapies I would urge you to discuss these with your doctor. The goal is to promote optimal integrative treatment and avoid any potential pitfalls.
Given the frequent use of CAM, I thought it would be helpful to review the common nonpharmacological treatment options for ADHD. Currently the most popular nonconventional ADHD therapies are as follows: dietary changes, herbal supplements, trace elements/vitamins, neurofeedback, essential fatty acids (EFA’s), and yoga/massage for ADHD.
In my experience complimentary and alternative treatments can be safely and effectively integrated with conventional approaches to treating ADHD. Despite the limited data, nonpharmacological treatments have indeed shown some benefits. For example in one research study using dietary changes to treat ADHD, 75% of children showed improvement in their symptoms when food colorings and additives were removed from their diet. Another study showed children and adolescents with low blood levels of ferritin (the storage form of iron in the body) experienced higher rates of ADHD-type symptoms, which improved with taking 80 mg per day of iron. More specifically the kids hyperactive and impulsive symptoms improved with the iron supplementation, but their inattentive symptoms did not.
In a separate small study, ADHD children practicing yoga demonstrated improvements in their symptoms over time compared to the group of ADHD children who did conventional exercise. In support of the argument for combined treatment, children who continued to take simulant medication simultaneously while practicing yoga showed the greatest benefit.
In summary, an integrative care approach - combining conventional with nonconventional therapies – may offer the best potential outcomes for those with ADHD. I encourage patients to talk with their doctors about all treatment options. It is important to inform your treatment providers of any and all interventions you are utilizing (or wish to utilize) so that safe and appropriate care can be implemented and the greatest benefit received.
A Reflection on Acceptance
June 18, 2010
“To succeed, it is necessary to accept the world as it is – and rise above it.”
Michael Korda
I recently sat with a young man who was telling me why he was feeling so down, discouraged, and guilty. “It’s all that acceptance stuff” he said. “All that acceptance stuff” sounds pretty important, doesn’t it? In fact, the notion of acceptance is a fundamentally crucial step in the development of all people. By this, I am not promoting the notion that we all just need to simply accept everything in our lives, but rather stop beating ourselves up for the human limitations that we all have, while being aware of and celebrating our unique gifts.
Acceptance comes in many forms. The young man sitting across from me was talking about his sense of how accepting his parents were of him, which in turn had shaped his self-image, and his ability to be self-accepting. If you met this young person, you would likely see what I see. He is intelligent, quick, artistic, verbal, handsome, gentle, caring and loving. So why on earth would he need to struggle with the notion of self-acceptance? As we work to better understand this question, we are increasingly clear on one fact: He did not create that sense of being “less” or like a “failure.” Others did that for him, especially his father.
It is never my intent to vilify a parent for a child’s pain. It serves no purpose to do so, but it is important for this young man to know where these feelings came from. His sense of not being good enough come, in large measure, from the messages he received, and continues to receive, from his father.
As Father’s Day is upon us, I am reminded of a reflection I sent out one year ago. In part, I included the following:
Men tend to be “bottom line” thinkers. They don’t want to talk around something; rather, they want to get to the point. This kind of short-circuited dialogue can create obvious tensions in any relationship because too many important things are left unsaid.
If inadequate communication between adult partners can be problematic, between fathers and their children, it can be toxic. Children, whether they admit to it or not, anxiously watch for signs of approval from their fathers. In my practice, many young people report an easy going and open relationship with their mothers while they frequently describe the exchanges with their fathers as limited or absent. This leaves many children wondering what their fathers are thinking and sometimes assuming the worst.
So, why don’t fathers come by this connection thing more easily? Many men were raised to think that expressing how they felt was a sign of weakness. Men often tell me that they can express emotion but that the range of emotion is frequently limited to anger & frustration. While men can identify feelings of hurt, love, insecurity or frailty, it almost always comes out as anger, or it doesn’t come out at all.
The young man in my office wants, and needs, what we all want and need…validation. Validation is most importantly provided by those paternal and maternal figures in our lives. Without that sense of unconditional love and acceptance, we leave our sons and daughters to, at the very best, wonder if they are “adequate” in our eyes, and at the very worst, struggling with “all that acceptance stuff.”
No one should have to struggle with the notion of acceptance as children and yet too many children do exactly that. And those children grow into adults who carry that overwhelming fear of not being “enough” to relationships with their bosses, partners, and their children.
So, it is time to stop right where we are and challenge ourselves to be more self-accepting, whether we received that message from our parents or not. And if we are parents, we can begin to undo damaging messages of the past and help our children gain the kind of self-acceptance that all of us need in order to survive, and thrive, in the world around us.
With the passing of another Father’s Day, I would encourage fathers (mother’s too) everywhere to consider how they might want to communicate differently with their children. Considering the well-being of a child who knows they are abundantly loved and cherished, it certainly seems worth the effort. And it’s really not that difficult to do…just sit down each of your children tonight for two minutes, hold them and tell them that they fill your heart with pride and love. (THEN REPEAT DAILY) I guarantee that the children who hear that message go on to discover unqualified adult happiness.
Best,
Walter
Walter Sherburne, Psychotherapist
walter@sherburnecounseling.com
www.sherburnecounseling.com
978-470-HOPE
Calming Strategies for Children
June 7, 2010
“He’s a terror when things don’t go his way … We’re always worried that he’s going to make a scene and embarrass us … We find ourselves walking on eggshells, trying to avoid one of his meltdowns.”
I hear a lot of that kind of thing from parents of children I work with in my practice. They tell me they often feel stressed, overwhelmed and exhausted from their child’s frequent struggles and outbursts. Parents jump at the opportunity to learn some effective strategies for coping with this common challenge.
As children move through their day, they are bound to bump into situations that are potentially upsetting. Some children are born with calmer temperments and better self quieting skills, while others need to actively learn and be taught how to cope with everyday disappointments and frustrations in a positive way. This is one of the most important things a parent can help a child do. No child enjoys being out of control … it’s simply the only tactic he knows. The good news is you can help your child learn strategies to cope with his emotions constructively and have an easier time getting along in the family, with peers and in school. The bonus — you get to have stress relief, too!
Creating a “My Hard Times Board” (suggested by Peg Dawson EdD and Richard Guare PhD in their book “Smart but Scattered”) with your child utilizes an excellent tool for teaching him new calming and coping strategies. Remember these few tips before you begin:
- Child and parent collaborate throughout this entire process.
- Choose a time to design this plan when your child is calm and receptive. Nothing constructive can be developed during an outburst!
- Make sure there’s plenty of opportunity for practice each day. After all, Tiger Woods could never make those spectacular putts without lots of it. Even he misses on occasion and so will your child. Mistakes will happen – you can bank on that. But, your child will be reassured when you let him know that there’s always another chance to try again later.
STEP I: Together with your child, identify and record a couple of the most common triggers to your child’s outbursts (i.e. parents say “no,” plans don’t work out as anticipated, your child is told to stop doing something fun to do something less enjoyable, your child thinks things aren’t fair).
STEP II: Together, list and record your child’s “can’t do” behaviors that he often uses when he is frustrated (i.e. yell, hit, throw things).
STEP III: Together make a list of your child’s “can do” behaviors to replace the undesirable ones that occur when he is beginning to feel upset. This list is most effective when your child’s personal interests are represented so that his choices are engaging and interesting to him. (Examples of “can do” strategies follow after Step IV).
STEP IV: Now that the board or chart has been designed and your child is invested in the process, it’s important to keep it going by implementing the following concepts.
- A good way to get started is to have your child choose one of these strategies (that follow) and practice the technique with your child for a few minutes each morning and after school. During each practice have your child pretend he is getting upset, describe the body sensations he feels when he is angry and rehearse his calming strategy. Expect to practice these strategies many times before seeing your child using them successfully. Research tells us that it takes 21 days to make a new habit.
- You and your child might want to develop a special signal, a visual or verbal cue, that is a reminder to use one of his calming strategies. Remember, when your child chooses one of the positive behaviors on his “can do” list, it’s time to offer up enthusiastic praise and even tangible incentives such as stickers, rewards or special activities. Everyone loves a prize for a job well-done!
Here’s a sampling of “can do” strategies for calming and redirecting behavior. Personalize this list by creating names that resonate with your child.
- Happy Birthday: Teaching children to take deep breaths when they begin to get upset may seem simplistic, but it’s a lifelong skill for managing stress that has emotional, behavioral and physical benefits. Explain to your child that we all have warning signs that tell us we are getting angry. Help your child recognize the signs his body is sending out that lets him know that he’s getting angry (i.e. face gets red; fists clench; heart pounds; breathe faster). When he feels the warning signs, have him take three deep breaths. Next have your child hold up his hand, palm toward his face with fingers spread. Coach your child to blow on each finger as if he is blowing out five birthday candles, one at a time and very slowly. When you see your child getting frustrated, you might say, “Now might be a great time to blow out the candles.” In the beginning you might want to do the breathing along with your child. Set the pace, modeling for your child and letting your calm presence soothe him.
- Cozy & Cool: With your child’s help, create a “safe spot” where he can go to regroup. This special, positive place in the house is where he can go to calm down, sort things out or just chill out when he needs to be alone. It could be a teepee, a beanbag chair, a hammock, or any space your child sees as comfortable and inviting. In the “safe spot” include soft items like blankets, stuffed animals and a basket of quiet time activities that he can play with while relaxing (books, puzzles). Encourage your child to go to his “safe spot” when he feels himself becoming upset. Teach him that sometimes in an angry situation it is best to walk away, go to his “safe spot” and cool down.
- My Never Never Land: Use relaxation visualization to design an imaginary place that makes your child feel calm. Help your child create a mind picture of a special place that makes him feel peaceful with all of the colors, sounds, textures, and smells that go with the memory. For example, a child may have a happy memory of a time at the beach. When he feels upset, he can take a “trip to the beach.” He can close his eyes, smell the ocean air, feel the sand between his toes, and feel the sun shining on him. Given the opportunity to run with this, your child may add props to further enhance the experience. One child I know took his towel and sunglasses to his “beach retreat” whenever he needed a “beach break.” How clever is that!
- Picasso’s Playground. Build a spot that includes an array of art materials that can be used independently as a calming and quieting activity. For some children, working with clay, drawing, or doing crafts is soothing and distracts them from the dilemma at hand. As time goes on, try adding new items to keep up the novelty and high interest of the center. Parents, keep a ready supply of items to have on hand so that you can change and rotate art supplies as needed. Keep your eye out for those treasures that might hold your child’s interest.
- Shake, Rattle & Roll: Your child can take a walk, shoot baskets, jump rope, swing on a swing, kick a soccer ball, bounce a ball, or dance to his favorite music. Some children get calming benefits from physical release.
- Beatles & Beethoven: Create a listening center with a CD player and earphones where your child can go to listen to music, books on tape or sing a song into a microphone. Dust off that old karaoke machine!
- Splish Splash … Takin’ a Bath? For some children, water is soothing and comforting and gives distance from the problem at hand. Try bubbles in the sink, sprinklers in the yard or an old fashioned bubble bath.
There is no single strategy that is good for every child and every family but with lots of practice, role playing, and simulations, children learn new calming techniques that can help them think before they act. Over time, the goal is for your child to develop both the skill and confidence to handle difficult situations on his own without getting upset and losing control. Remember the best way to teach kids how to manage upsetting feelings constructively is to model calmness through your example. Together, and with a lot of patience, much love and lightheartedness, you and your child will find a calmer and more joyful path.
Doreen Fay EdD
How Not to Train the Brain
May 24, 2010
A study called “Brain Test Britain” is receiving a lot of attention because of its findings that discount the effectiveness of cognitive training. Close inspection of this study reveals many gaps in its methodology and what they consider “brain training.”
They had no screening for suitable candidates with a specific problem, no focus on a specific cognitive function, no proven exercises based in neuroscience (only a series of games), and a haphazard, low-effort training protocol. Finally, there was no coaching provided to the users – of course leading to very poor compliance.
If the British study had managed to create any useful improvement in the test subjects with this kind of “fun and games brain training,” it would have been remarkable. This study is actually a good example of how not to train the brain. It takes specific, intensive, and sustained training to change cognitive performance.
News on Neuroplasticity
May 23, 2010
The Brain That Can
After reading the book The Brain that Changes Itself, by Norman Doidge (2007) I have been convinced that my longstanding views on the capacity of the brain to change are frankly, wrong.
I have worked in brain injury rehabilitation for a good portion of my career in neuropsychology which included stroke, brain injury and aneurysm patients. Patient would typically spend 1 – 2 months in inpatient rehabilitation receiving cognitive remediation and physical therapies daily, then transfer to outpatient therapies for treatment several days a week for several more months. We would typically see a plateau in functioning for stroke patients after 4 – 5 months, and between 1 – 2 years in brain injury patients, depending on the severity of the injury.
New research has clearly indicated that localization theories were misguided. Areas of the brain, previously felt to be ‘designated’ to perform sensory functions (vision, hearing, motor functioning, touch) or language areas, are remarkable plastic and eager to take on new functions if the information is provided to them under certain guidelines. He describes patients years after stroke, who can begin to restore motor, sensory or cognitive functioning, under the right conditions.
What are these conditions? “Neurons that fire together, wire together”. In other words, information presented repetitively, and frequently, over a lengthy duration, will create new circuitry. So a stroke patient, using his paralysed hand in various tasks, for an hour a day, 5 days a week, for several months, in most cases improves the functioning of that hand. The length and repetitiveness of the task, eventually causes new neuronal sprouting (which in the case of learning Braille only begins to occur after 4 months) causing permanent changes in the brain. With the limited therapy provided in rehabilitation settings, no wonder no one saw continued progress and improvement; the duration and frequency were not enough to create the new circuitry.
How does this apply to ADHD? Therapies, such as CogMed, meet such criteria due to the frequency, duration and a third factor which is also critical, the engagement or motivation factor. One has to be attentive and actively engaged in the task for these circuits to occur, and the engaging, self-competitive nature of a therapy, such as CogMed, can provide the motivation, to improve working memory systems and enrich and enhance the circuitry.
I have always been on the pessimistic side, when it comes to thinking people can change personality traits, or noxious habits. After reading his clearly presented summation of research, however, I am much less pessimistic. If one is truly motivated to change an identified trait, therapies can most certainly help if, there is daily work addressing the positive trait to be acquired, (e.g., through journaling, prayer, meditation, a diary, counseling meeting), and patience. Eventually, the unwanted traits (circuits) weaken, and the positive traits (circuits) strengthen, leading to good riddance. His successful work with obsessive-compulsive clients are a testament to this.
Unplug to Plug In
April 10, 2010
Entrepreneurs and business people I work with often ask me for help “being a better dad,” or “being a better partner/spouse.” These high-energy, on-the-go people want to find ways to have more connection with their children and spouses.
I asked one owner of a mid-sized business, “Do you have any chance to talk with your son in the evenings?”
My client responded, “Some, but by the time I get free he’s getting ready for bed.”
Another dad told me his daughter “wasn’t that interested in talking.” And a third sighed and reported that he was treated like a stranger by his kids.
When I followed up with specific questions I discovered that each of these men brought major work home with them every night and on weekends. I’m not talking about the traditional briefcase full of papers, I mean responses to be made to emails and phone calls – Blackberry jam – you know the sticky stuff that gets all over your family time. Though they didn’t intend it, their kids were relegated to (and likely felt like) second class citizens.
My suggestion is pretty simple, unplug!
I’ve encouraged these successful men (and women) to experiment with 5-10 minutes of being unplugged from their Blackberries— shut it down or put it far enough away that you will not here it. Yes, ignore it. It doesn’t work to just set it for vibrate – you’ll probably keep checking to at least see who called.
You need time to look into your children’s eyes and say (with words or your attention), “Nobody’s more important than you! How’s your life going?” Or in the case of young children, “How’s Elmo doing?”
I get laughed at when I suggest 5 minutes. My high standard clients think 20 minutes is a more realistic time, until they get home and try it. After 5 minutes they start feeling the “gotta check it” withdrawal symptoms. You know the signs—hands in the pocket, Blackberry being played with or quick glances just to see who it’s from.
If you’re really going to “be there” with and for your children, then you need to create a strong motto for your home life, something you can use as a touchstone when the going gets tough. Something like, “My kids deserve this uninterrupted time with me alone.” “My email isn’t more important than my kids, wife or husband.”
Most of my clients quickly adjust and keep themselves free, well, for at least 6.5 minutes.
Good luck.
Szifra (Shifra) Birke
ADHD and Sleep
March 21, 2010
Children and adults with AD/HD may frequently experience problems with sleep. You may know this all too well in your family. Many people have difficultly falling asleep while others nod off easily, but then wake frequently during the night. Unfortunately the resulting lack of sleep exacerbates the primary AD/HD problems with attention, concentration, and impulsiveness.
Phase delayed sleep is the most common sleep disorder that accompanies AD/HD. Phase delayed sleep disorder is a fancy way to say the person goes to bed too late and then has trouble getting up in the morning. The hypothalamus in our brains helps to regulate sleep/wake cycles and is basically malfunctioning in an individual with phase delayed sleep.
Is your family short on rest? Try good sleep hygiene including consistent sleep/wake times and creating comfort around your bedtime routine. Reduce energizing activities a few hours before going to bed. Leave the shades open so sunlight shines through early in the morning; light tells the brain it is time to get up!
When behavioral strategies fail, consider over the counter remedies such as melatonin or valerian root. These are natural supplements that help induce sleep and have some clinical research studies to support their benefits and safe use.
You may also want to talk to your doctor about medication. There are newer non-addicting sleep medications such as lunesta and rozerem that have been FDA approved for chronic use in adults and other medication options for children with sleep issues. In our practice I do prescribe sleep medications temporarily to assist patients in getting on a good sleep schedule. Once sleep is well regulated, we recommend weaning off the medication and using behavioral strategies to continue getting your zzzz’s.
Have a restful night!
Theresa Cerulli, M.D.
The Power of Connection
March 10, 2010
As a therapist, one of my primary professional responsibilities is to help others see the need for, and to seek out, connection to others. Being in “relationship” with other souls is at the very heart of emotional health. We are social beings and therefore we require a sense of intimacy with others. By using the word intimacy, I am referring to relationships that allow one person to be truly vulnerable with another. This type of connection allows us to put our guards down, be honest and feel understood.
Connection comes in all shapes, sizes, and flavors. My daughter is about to graduate from nursing school and she shared a writing assignment with me that powerfully illustrates the power of connection even when connection appears unwanted. She wrote the following:
“Abraham Lincoln once said “I don’t like that man, I must get to know him better.” Never in a million years did I think I would find that statement truer then on an Oncology floor during my second medical surgical rotation at a large Boston Medical Center. Mike (not his real name) was a middle aged man, with a life I immediately deemed as average. He was married, had three children, and worked as a laborer. Mike was receiving chemotherapy for spinal cancer he had believed was in remission and he did not want a student nurse.
After begging my instructor to change my assignment, many unsuccessful attempts to engage Mike in conversation, and nearly getting my head bitten off when I gave him an injection, I finally used the oldest trick in the book and gave him a foot rub. He slowly dropped the “tough guy act” and started to tell me how angry he was that he was back in the same bed, with the same illness tugging at him. Mike longed for a chance to once again do the simply things, like watch his son playing football. I sat quietly and just listened.
The next week when I returned he had taken a turn for the worse and was very confused, but amazingly remembered me. I spent all my free time during that shift sitting next to him and he told me I had surprised him. A few hours later, he was placed on comfort measures only and died after a brief time. After his death, his family told me that he had spoken all about the student nurse that he didn’t like who ended up being his greatest caregiver in the hospital.”
Laura learned a great deal from her time with Mike. She learned not to be discouraged by seeing someone’s anger and defenses. She came to see that underneath it all, Mike, just like all of us, had a soft and tender need to be cared for, loved, heard, understood, and held. Laura had a life-changing experience with the power of connection.
Consider for a moment what type of connection others may need from you, AND, what connection you may need from others. Don’t be afraid to ask for connection. We all need it…we all require it! Why then, do so many of us sit alone with our suffering? Why do we worry so much about “burdening” others? Why do we think it’s up to us to figure out everything for ourselves? Maybe it’s time to put our fears aside and ask others to listen to us, be patient with us, hold us, and comfort us. That is how we become a part of something larger than ourselves.
Best,
Walter
“Instant connection! Our teenage daughter had been professionally diagnosed with ADHD at a young age and had been struggling with self esteem and anxiety for years. We met with many different professionals, had team meetings with educational consultants, neuropsychologists, teachers and tutors. They all said that this child was carrying around too much stress and absolutely needed to have someone to talk with, who could help her with this heavy burden. This was easier said than done, she simply did not connect with anyone until she met Walter. He has been an invaluable resource to our daughter and our family ever since.”
Parent of an ADHD Child
Walter Sherburne, Psychotherapist
walter@sherburnecounseling.com
www.sherburnecounseling.com
978-470-HOPE
Mindfulness Training
February 21, 2010
When I began studying mindfulness, what struck me most interesting was how regular practice in “paying attention” allowed one to be more efficient. When you’re in the present tense you’re hot on the task at hand. But a recent review of my books by Ellen Langer ,in particular her 1989 book “Mindfulness,” refreshed the scope of my understanding of mindfulness to include “flexible mind.” I think that there are those who want to embrace mindfulness, but their brains are in a place where they are incapable of such thoughtful engagement.
On the brain maps of some patients we can see regions of the cortex that are suppressed. Interviews with these patients reveal patterns of rumination, one track thinking and automatic responding to people and situations. When suppression is released, or when these regions begin to show greater variability, via relaxation therapy or neurofeedback for example, awareness increases, and there is greater cooperation and less resistance to new ideas. At this point the brain is more flexible and better able to benefit from mindfulness training.
Subscribe In A Reader
