Markham's Behavioral Health

Psychotherapeutic humanities - When to tell the children about the impending divorce?

Linda McCullough Moore's book of short stories, An Episode Of Grace, begins with the story entitled, "You choose," which begins with this paragraph:

"I’m driving on Route 91, going ten miles over the limit, on the way to my divorce, or, at least, to its announcement. My husband Jake and I decided we would tell the kids tonight. We’ve waited way too long. Our marriage died of natural causes years ago. We are planning that our children will be shocked beyond surprise, but we both know better. Any hesitation that we have about telling them isn’t fear of their surprise; it’s knowing that once we say the words, out loud, to them, it will be official, carved in stone, irreversible. But, of course, that’s what we want."

The childrens' names are Jonah who is 11 and Adam who is 6.

Of all the questions I get asked as a couple counselor and a family therapist by people going through a divorce are when and how to tell the kids?

My stock answer is "Don't tell them anything until you know specifically what the plan is unless they ask."

Kids being narcissistic in a healthy way first ask when told their parents are separating is "What's going to happen to me?" Parents need to have the answer to provide the child with whatever sense of security and predictability they are able.

The narrator in this story has her plan in place and has coordinated the telling the children with her husband and is on her way. But as she travels to the meeting with the children she gets stuck in a snow storm and as the various events unfold her ambivalence was divorcing her husband grows in poignant ways.

The ambivalence partners usually feel about a break-up with the concomitant anger, sadness, fear, hope, sense of failure and regret, are things the therapist witnesses and, hopefully, clarifies with the client(s) into some sort of coherent story that makes sense to themselves primarily and then to others affected.

The key question, often overlooked, in the emotional turmoil is, "What is the purpose of this relationship?" The genuine answers to this question usually lie at an unconscious level that the individual is not aware of and doesn't understand. 

The understandings of one's motivations, choices, and responsibilities are key to growth towards greater maturity so that the individual does not jump from the proverbial frying pan into the fire and engage in what Dr. Freud called the "repetition compulsion" to merely re-enact the same scenario over again.

The narrator of the story recognizes that telling the children about the impending divorce is a milestone in the process which she determines as a point of no return. It is an action which will make the rupture permanent and complete. The finality and the closure seems to heighten her apprehension about the decision to divorce rather than mollify it and liberate her.

You choose is a great story and much can be learned as we puruse our study of the psychotherapeutic humanities.

To be continued

12% of United States troops in Iraq and 17% of troops in Afghanistan are on anti-depressants

On June 5, 2008, Time Magazine ran a story entitled, "America's Medicated Army". Here is a snippet from the article:

The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.

It seems that fighting pre-emptive and immoral wars is not good for one's mental health. I wonder when we as a nation will realize the error of our ways and demand that our government do something about it?

I don't know of any other occupation that has this high a rate of mental illness. Would you want your loved one to enter such a career?

Prozac: The Military's Secret Weapon, MSNBC with Joe Scarborough. Video lasts 3:25

This is article #4 on militarism.

Purpose of marriage video 1

I am planning on doing a series of videos on marriage. I have been a licensed clinical social worker for 40 years and have accumulated a lifetime of experience which I think may be of benefit to people. Here is the first video in the series which I have entitled, "The purpose of marriage." Please leave your comments.

Purpose of marriage video 1, part 1 of 2. Video lasts 4:18.

Part 2 of 2. Video lasts 8:31

Children in U.S. 3xs more likely to be prescribed psychotropic medications than in Europe

Science Daily reported on September 25, 2008 on a study which will appear in an upcoming issue of the journal, Child and Adolescent Psychiatry and Mental Health, which found that children in the United States are three times more likely to be prescribed psychotropic medications than children in Western Europe. The authors speculate on the reasons for the difference in practice. If you would like to read more click here.

Unproven therapies used on traumatized kids

Reuters reported on September 9, 2008 on a CDC report which will appear in the American Journal of Preventive Medicine that a lot of therapies provided to kids with PTSD are not proven. Here is a snippet from the article:

Many doctors and therapists use unproven approaches such as drugs, art or play therapy on children suffering trauma when old-fashioned talk therapy has been shown to work, a report released on Tuesday said.

A review of a dozen different studies showed no evidence that alternative therapies helped children traumatized by violence or abuse, even though more than 75 percent of U.S. mental health professionals who treat children and teens with post traumatic stress disorder may use them.

But cognitive therapy -- a type of talk therapy aimed at changing negative thoughts -- does work, the group at the U.S. Centers for Disease Control and Prevention said.

"The good news is there is substantial research showing the effectiveness of group or individual cognitive behavioral therapy in treating children and teens experiencing the psychological effects of trauma," the CDC's Robert Hahn, who led the study, said in a statement.

"We hope these findings will encourage clinicians to use the therapies that are shown to be effective."

Children can be traumatized by many things including physical or sexual abuse, witnessing domestic violence, community violence or natural disasters.

In my office, I use cognitive based therapy and, when relevant, include parents and/or caretakers in on the sessions. I find that children and adolescents usually do very well. I am chagrined to hear about the play therapies, sand tables, EMDR, and other things my colleagues are doing with kids which they usually learned at some workshop and now have become born again disciples of the technique. I have often wondered, as the research report above suggests, why they didn't take a workshop and learn how to do therapy that works instead of the latest fad? Like many things in life we are enamored with the new, the novel, the gimicky approach which promises quick and almost miraculous success.

I find it increasingly difficult to find good therapists to refer people to. The mananged care system and the atrophy of the community mental health centers have made it difficult for young therapists to find adequate training environments.

MedlinePlus: Unproven therapies used on traumatized kids -study.

Cheerleading causes majority of female athlete injuries

Reuters HealthDay reported on August 25, 2008 on this year's report from the National Center for Catastrophic Sports Injury Research at the University of North Carolina at Chapel Hill that the most female sports injuries are sustained in cheerleading. Almost 2/3rds of all female sports injuries to females occur in cheerleading. Often denigrated as even being a sport at all, most people greatly underestimated the physical demands of cheerleading. Here is a snippet from the HealthDay article:

Over the past 25 years, cheerleading accounted for two-thirds of all catastrophic sports injuries experienced by high school and college females in the United States, a much higher proportion than previously thought, a new report says.

Cheerleading accounted for 65.1 percent of female high school athlete injuries and for 66.7 percent of female college athlete injuries.

It was previously believed that cheerleading accounted for 55 percent of injuries among high school females and 59.4 percent of injuries among college females. But the percentages increased when new data was used for this year's report from the National Center for Catastrophic Sports Injury Research, based at the University of North Carolina at Chapel Hill.

Center director Frederick O. Mueller, a professor of exercise and sports science who's authored the annual report since it began in 1982, said catastrophic injuries to female athletes have increased over the years.

Abstinence based sex ed programs don't work - Bush Administration gets it wrong

  Reuters HealthDay reported on August 21, 2008 on a study which appears in the journal Perspectives on Sexual and Reproductive Health which found that abstinence based programs don't work.

In 2007 alone the Bush administration spent 176 million dollars on abstinence only sex education for our young people and nothing for comprehensive sex education. Here is a snippet from the HealthDay article:

"Interventions that have been created to encourage abstinence have treated abstinence and sexual activity as opposites. However, teenagers say they don't think of them as opposites," lead author Tatiana Masters, a doctoral student in social work, said in a university news release.

"These (abstinence-only) interventions are less likely to work than more comprehensive sex-education programs, because they are not meeting adolescents where they are, and they are speaking a different language," Masters said.

The study included 365 adolescents (230 girls, 135 boys) in Seattle who took part in an intervention to reduce HIV risk behavior. The participants filled out questionnaires asking them about their attitudes and intentions about abstinence and sex, and about their sexual activity in the previous six months.

At the start of the study, 11 percent of the boys and 4 percent of the girls had had sexual intercourse. That increased to 12 percent of the boys and 8 percent of the girls six months later, and to 22 percent of the boys and 12 percent of the girls one year later.

"This paper demonstrates that increasing abstinence intention does not lead to less sex. In fact, when abstinence intention and sex intention interact with each other a teenager is more likely to have sex," Masters said.

The study was published in the journal Perspectives on Sexual and Reproductive Health.

In 2007, the U.S. government provided $176 million for abstinence-only programs, but there is no federal funding for comprehensive sex education programs. This study's findings "raise serious concerns about the abstinence-only approach as a risk-reduction method for adolescent sexual behavior," Masters and colleagues concluded.

Marriage counseling with dummies

My friend Don sent me this joke. I wondered if people who read this list would find it funny?

A husband and wife came for counseling after 20 years of marriage. When asked what the problem was, the wife went into a passionate, painful tirade listing every problem they had ever had in the 20 years they had been married.  She went on and on and on: neglect, lack of intimacy, emptiness,loneliness, feeling unloved and unlovable, an entire laundry list of unmet needs she had endured over the course of their marriage.

Finally, after allowing this to go on for a sufficient length of time, the therapist got up, walked around the desk and, after asking the wife to stand, embraced and kissed her passionately as her husband
watched with a raised eyebrow. The woman shut up and quietly sat down as though in a daze.

The therapist turned to the husband and said, "This is what your wife needs at  least three times a week. Can you do this?"

The husband thought for a moment and replied, "Well , I can drop her off here on Mondays and Wednesdays, but on Fridays, I play golf'."

Catholic church has got it wrong on birth control - catholic critics ask pope to lift contraception ban

Yahoo News, using a piece from Reuters, reports on July 25, 2008, about a paid advertisement in a major Italian newspaper placed by 50 Catholic organizations to lift the Vatican's ban on birth control. Here is a snippet from the article:

More than 50 dissident Catholic groups published an unusually frank open letter to Pope Benedict on Friday saying the Church's ban on contraception has been "catastrophic" and urging him to lift it.

The letter was published as a paid half-page advertisement in Corriere della Sera, Italy's largest newspaper, on the 40th anniversary of the late Pope Paul VI's controversial encyclical "Humanae Vitae," which enshrined the ban.

While criticism of the Vatican and its views is fairly common in articles and editorials in Italian newspapers, it is unusual for a group to take out paid advertising against the pope, particularly in a large-circulation mainstream newspaper.

The letter, written in Italian, said the Church's anti-contraception policy "has had a catastrophic impact on the poor and powerless around the world, endangering women's lives and leaving millions at risk of HIV."

Of course, changing the teaching is long overdue. The church has been wrong about this teaching for decades since Humanae Vitae, the encyclical in the 60s by Paul VI, that started the controversy and dissent by the laity. Since that time the church has lost credibility and the faith of the people it professes to lead.

How about considering the standard discernment question, What Would Jesus Do? I think Jesus would fully support the use of birth control.

Print Story: Catholic critics ask pope to lift contraception ban on Yahoo! News.

The boot camp of life

In the book, Daily Afflictions, Andrew Boyd uses many concepts and phrases which are eye catching. One such phrase is "The boot camp of life." In the glossary at the back of the book, Boyd, defines this phrase as - "A traditional child-rearing practice in which the child is trained to handle the dysfunction of adult institutions by being relentlessly drilled in dysfunction by his own family." p. 91

As a therapist as well as in my personal life, I am continually struck by the observation that parents don't deny the dysfunction that their children are subjected to but excuse it as being good for them. There are many phrases such as "what doesn't kill you will make you stronger." "Compared to what I have to endure this is nothing." "He better get used to it now so he is prepared for real life." etc.

I have referred to this as the callous theory meaning that parents excuse the abuse that their children suffer as "toughening them up" so that he/she can better deal with abuse later on in life.

I don't think there is any research evidence to back up this callous theory - that abuse and dysfunction earlier in life makes one more resilient later on in life. In fact, the research evidence appears to be the opposite, that abuse and dysfunction earlier in life is a risk factor for problems later on in life.

This callous theory is part of what John Bradshaw named "poisonous pedagogy".

One of reasons that my wife and I decided to homeschool was to protect our children from the institutional dysfunction that occurs in Middle school. Schools are bureaucratic institutions which are very self serving and subject children to dysfunction which mirrors the dysfunction in families, - bullying, cliques, playing favorites, mind numbing worksheets and busy work, obedience and compliance with requirements that are artificially imposed, loss of control over one's own life, disrespect, and fear being used as a motivating factor.

In the criminal justice system, boot camps began being popular 25 years ago where rigorous physical exertion and browbeating inmates for compliance was thought to  bring about compliance, obedience, and self discipline. Research has found that boot camps don't work. The belief that dysfunction and abuse is somehow good for people is similarly erroneous. Whilte the boot camp of life is an eye grabbing metaphor, one would do well to question, deconstruct, and dismiss this idea as beneficial for facilitating the development of a high quality, healthy, happy life.