Friday, March 15, 2019

A Millenial Dilemma?

As in all posts, descriptions of individuals are materially changed to assure confidentiality.

She's in her mid 20's and dissatisfied in her 3rd job since barely completing 2 years of college.  She still lives at home, despite her ability to afford housing.  Her parents hope she'll "find herself" and launch to independence.  She's never been able to maintain a romantic relationship for any length of time, finding those she dates as "not compelling."  She states she's anxious, sweating each and every detail that comes her way, yet (despite the Zoloft her doctor prescribed) seems to repeatedly make poor decisions, such as at work where she tries, repeatedly, to assign her own responsibilities to those who are not her subordinates. 

So I asked her recently, innocently, not realizing I was really on to something, "What are your expectations from life?"  She paused, thought for a minute and said earnestly, "I thought it'd be easier."  "You thought what would be easier?" I said, figuring out as I said it what she meant.  "Life" was all she said.  She thought life would be easier.

So there it is.  She's a bright woman, no learning problems or ADHD.  She did well in High School, never having to work to hard to get solid grades.  She's pleasant and has a good social group.  She gets asked out on dates from time to time.  But nothing seems to be engaging for her.

My concern for this person, and many (but certainly not all) with similar sentiments, is what they lose by underestimating and avoiding the critical life lessons of hard work.  They're bright, privileged, and struggle with how to get their life off the ground.  It's not just that folks like this hope to make the next best video game or app that takes off and sells for millions (or billions.)  It's that there seems to be no "plan B."  What happens when you don't become the next superstar?  This is, of course, not a new dilemma.  (I wanted to make it on Broadway after performing in a few HS musicals.)  But the lack of a realistic view of the world seems to be a common theme.

Alcoholics Anonymous is famous for the phrase "Accepting life on life's terms."  Acceptance, of course a primary theme of AA, is also a primary need in day to day life.  "It is what it is" is a cutesy current way of saying just that.  Reality.  Sometimes it stinks, but it is what it is, stinky or not. 

Viktor Frankl was a neurologist and psychiatrist and survived Hitler's death camps.  After the war he wrote a compelling book called Man's Search For Meaning, and while this forum is not close to being able to discuss such an important work, he encouraged people to consider more what life wants from them than what they want from life.  We are each charged with finding our own path to contribute - not sit back and wait for it to come to us. 

So I'm going to ask her (being a bit to dumbfounded at the moment it came up) to consider what Lord Rabbi Jonathan Sacks (former Chief Rabbi of The British Commonwealth) said of such issues in his book To Heal a Fractured World.  He suggests that in order to find meaning we find the place "Where what we want to do meets what needs to be done."  That seems to be as good a place to suggest to her to begin as any. 

Sunday, February 10, 2019

What Success Feels Like

As with all posts, no specific client is identifiable.  The topics being discussed are generic and combine those things that are common to many people. 

She struggled, mightily, in High School, being teased unmercifully and ultimately forced to transfer to a home schooling program in her junior year.  She passed the GED without much difficulty, but her lack of social skills being a young woman with High Functioning Autism made her an outcast, despite her academic strengths.  Middle school and high school were, she admits, pretty miserable for her. 

Not surprisingly she took in all of the social rejection given her and thought poorly of herself.  So poorly she ended up inadvertently sabotaging her first year in college.  Like many individuals with HFA, she (and, I suspect her family) were eager for her to start over in college, hoping the slate would be wiped clean and that she'd develop her own sense of herself and realize her own potential.  She traveled far enough to dorm but close enough to come home on weekends and holidays.  She sunk deeper into the depression and anxiety that had taken root in her middle school years, began skipping classes her first semester, but despite that passed all of her classes.  Which did nothing to ease the depression and anxiety, as she was no more socially accepted or comfortable in her own skin in college than she had been in HS.  By spring break she was home. 

I began seeing her about a year later after she had begun medications and was re-establishing herself academically at a local college.  Living at home with parents who struggled between how to best support her while struggling with their frustration at her failure to launch into adulthood.  As an only child, her parents were hoping so much that they'd be able, finally, to move on with their lives as she moved on with hers.  They'd worked hard, been on top of her needs as best as they could, but couldn't protect her from the unfortunate and predictable pain of adolescence as a person with HFA.  Nothing they did could help her cope with who she was in a way that helped her adapt to social life in HS and college.  They feared her return home might be permanent.

She struggled, as do many people with HFA, with the executive functioning challenges from her concurrent diagnosis of Attention Deficit Hyperactivity Disorder (ADHD).  parents and while in HS her teachers, via her IEP made sure she received the support she needed to get her assignments done, handed in and for her to prepare on time for tests and longer term projects, she was loathe to utilize the student support services at her first attempt at college.  Her lack of organization had already been reflected in some very low grades in this second attempt and I encouraged her to reconsider utilizing the school's student support services.  She reluctantly obtained the permission she needed for extended time for testing - the only significant accommodation called for, and utilized it when needed.  And between that and the support I and her parents gave her, she developed a pattern of success. 

We spent lots of time discussing the issues she struggles with, similar to those many young adults have; the nature of her diagnoses and their impacts upon her as well as how to identify and understand her emotions; religion and philosophy, as her beliefs in these areas were significantly different from her parents'; sexuality; ; self worth; how to contribute in her academics and professional career in a way that was consistent with her strengths and, more importantly, not inconsistent with her weaknesses and challenges.  I have found her a thoughtful young woman, willing to deeply consider alternative narratives to the many assumptions she'd developed over the years. 

And now, with her undergraduate degree within reach, she has a new struggle, a new challenge that she's not faced previously.  She now is learning how to cope with, to understand and internalize the emotions wrought by the feelings of success, how they conflict with the inner narrative she'd developed over the past number of years.  How it feels to have job prospects for which she's qualified and, as it turns out, is a good candidate.  She deserves lots of credit and I share with her parents in particular a great pride in her growth and development.  The struggle of success - it has a nice ring to it. 

Wednesday, November 21, 2018

Kids, Exercise, Screens, Stress and Choice.

In mid November of 2018 the CDC published its newest studies on the connection between physical exercise and health - both physical and mental.  As has been proven in study after study, and again in this report (https://www.cdc.gov/physicalactivity/index.html), exercise is a critical factor in maintaining our physical and mental health.  And yet....how many of us take advantage of the easiest and most accessible of treatments for ourselves?  How many of us expect our kids to?

The study focused mostly on how much physical exercise helps medical issues, and mentions the mental health advantages almost as a secondary point.  Yet both are critical, to adults as well as children.  It states that "all cause mortality" is reduced with exercise.  Diabetes and insulin resistance.  Heart disease.  Hypertension.  Bone health.  Cognition.  All are helped.

Regarding mental health, the study confirms what has been studied, reported and replicated in the past regarding mental health.  Anxiety.  Depression.  Stress.  Tens of millions of us suffer from things that can be attenuated with exercise.  Sometimes significantly. 

We increasingly hear of the alienation that our children have from their peers.  Rates of suicidal thoughts and attempts have risen sharply, about 20% for 15-24 year olds since 2000, which roughly correlates to the explosion our use of devices.  People doubled their screen time in the 10 years from 2005-2015 and kids are a huge part of that.  The new report recommends that kids and adolescents from 6-17 get 1 hour of (mostly) aerobic activity daily.  (Meaning getting and keeping the heart rate elevated.)  The simplest way is by taking a brisk walk.  Yes, it's as simple as walking, for kids and adults.  (Can we even be so bold as to suggest that kids and parents walk together?) 

I've seen many parents act powerless in the face of their children's use of technology and I don't understand it, particularly in light of what we've been learning about how alienating excessive use of these technologies can be.  Parents: you are not victims of your child's devices.  You paid for them for heaven's sake.  It's OK to act like that.  Act surprised when your child objects to your exercising your rights of ownership, not defensive.

The evidence continues to mount.  Exercise helps both physically and mentally.  Screen time?  Well, it seems not so much.  But feel free to sit on your couch and surf the net (while your kid's in their room getting to the next level of the newest release of the must have video game of the month) and wait for a study that says increased screen time helps you and your kids both mentally and physically.  After all, it's your device.  Enjoy it.       


Tuesday, October 9, 2018

Engineers: Where Does Autism Begin?

A colleague of mine jokes (I think it's a joke) that NASA, at its height was the largest employer of special needs people - people with autism - in the world.  She was equating, essentially, engineers of a certain stripe, with having autism.

Indeed I've heard and read with some frequency that there's a correlation between parents who are engineers and their children who have autism and, in actuality, I've seen that often.  I've also seen children with autism whose parents are anything but the fact based, cerebral, math based, fascinated with complex problems and categorization making folks who are less emotionally based than the non-engineering population.  This is how we colloquially think of engineers.  This is not a piece on the objective research - some has been done without, to my knowledge, clear findings.  It is a piece on the spectrum of, well, of the spectrum.  Now I'm not assigning everyone at MIT and Georgia Tech with diagnoses, but rather am noting observations.

I know lots of engineers (some of my best friends....really.)  Many fit the same profile of strong analytic with weaker emotional capacity, including one who spurred this piece.

I'll call him Dave.  He's smart, successful, creative, kind, thoughtful, an overall great guy.  We've been friends for decades.  His wife is a mental health professional colleague of mine and she called me to discuss her frustration at his lack of emotional availability regarding a certain situation she was experiencing.  She noted that it had been a pattern through the decades of their marriage.  He was more of a "the facts are the facts, accept them, cope and move on" type of guy.  An engineer.  She's more of a "I'd like to discuss this, and then I might like to discuss how we discussed this.  What's the process we've gone through and the patterns we have about how we discuss our emotions...." type of gal.  Typical for many, including many therapists (not said critically - I'm the same type of guy.) 

I pointed out to her that as an engineer, his emotional bandwidth might be constrained a bit by his engineering sensibilities.  He didn't dismiss her emotional needs.  Rather, he heard them, acknowledged them and then expected some amount of "move on" from her.  I explained to her that Dave loves her (and their kids) dearly and would do anything for her (indeed, I could list many many things he's done for them all that were clear and open signs of love and compassion.)  But there were times, she said, that she just needed more emotionally. 

I offered to her the thought that she might consider getting some of her emotional scratches itched elsewhere.  In therapy, with friends or a consultation group, for example.  I suggested that as an engineer he might well be one of those guys who is built a bit differently regarding how he experiences the emotional realm.  He has emotional bandwidth and articulation, just not enough to meet all of her needs.  She appreciated the thoughts and, at least for the meantime, seems to be OK with a different understanding of her loving husband. 

So Dave and his wife got me thinking.  How similar is Dave to folks on the spectrum who often struggle with identifying their emotions, not to mention with empathy, the ability to consider and join in another's emotional experience, often to such a degree that it really gets in the way of their social success?  And I don't know that I have an answer, but rather, a reflection. 

It seems that there may be a spectrum, pardon the word, for how folks have emotional capacity and range.  Again, I'm not suggesting this as a diagnostic issue, but rather as one of emotional style, admittedly a slippery description that is open to vast interpretation.  But we all know of folks whose emotional range and reserves are stiff and limited.  Folks who are quite uncomfortable, unaccustomed and even unable to describe their emotional responses to things with subtlety and precision.  Does that define them as having autism?  Hardly.  The accepted diagnostic criteria discusses many more aspects that surpass this relatively restricted issue of emotional availability. 

And yet, it makes me wonder where we'll be in 50 years as we learn more about how to make these definitions?  And how will we determine with accuracy the dividing line between functional and less functional emotional capacity and its intersection with the other aspects of what we understand autism to be? 


Sunday, May 27, 2018

Please Don't Wait

It's happened again.  A couple married for 15 years comes in to see me and begins their story.  Embedded in the narrative is the phrase I hate to hear.  "We've known there's been problems for a long while now, but just thought we could get through it."  When working with couples, these are the words I fear. . 

What happens when there are problems in a relationship?  We build defenses.  We distance emotionally.  We try (our same, tried, old and generally unsuccessful techniques) to communicate with our partner in the best way we know how.  We reason.  We avoid, hoping it'll go away.  We express our frustration.  Ultimately, we express our anger.  Forcefully.  Hurtfully.  We set ultimatums.  Which helps resolve the problem not at all.  Or we can be just silent, usually in anger.  Any of these poor coping styles can last for decades.  All of them create ongoing hurt and emotional callousing to the hurt they are creating, callousing to the hurt of their partner and, so often, to their own hurt. 

Elsewhere in these notes I've referenced the connection between hurt and anger, and these dynamics are often a part and parcel of the struggles between people who try to avoid problems they've been having for a long time.  So what happens when the hurt/anger cycle goes on for years?  It's such a simple question even those couples in the midst of it can answer it, no matter how deeply they may be rationalizing their remaining in a relationship in which conflict is chronically not resolved. 

Remaining in such a relationship in which people distance themselves emotionally from one another on a frequent bases, in which they can't find workable, agreeable and mutual resolution to problems creates a breach that is difficult to bridge.  Indeed, many in these long term chronic distant marriages are vulnerable to extra-marital affairs.  Relationships in which emotional closeness, warmth and acceptance seems readily available.  Which, of course, muddy the marital waters exponentially.

If I could give a new couple one piece of advice it would be to contract with one another that they will always, under every circumstance, find, create or adopt some method of conflict resolution that is acceptable to both parties.  It sounds simple but it's often not and might need to be reviewed and worked on frequently.  Creating relationship is hard work, a lot harder than courtship or romance.  But the communication upon which creating that relationship is founded is structural cement that allows for enduring connection for a lifetime.

That couple I mentioned?  One's not sure they want to continue in therapy.  And the other says if they don't continue in therapy, it's all over.  So, if you know somebody who's struggling in their marriage, particularly if they're young in their marriage.  Tell them to not hesitate.  It won't get easier than it is now.

Monday, March 26, 2018

To An Old Friend: Attachment


I ran into an older friend - he's almost 90 - I've known for almost 35 years.  He's moved out of town and only visits on occasions and we chatted briefly.  He's always been a man with great insight.  And thus it was unsurprising that he asked about my work.  "So, what kind of things do you find in your work?  What issues, what themes do you find with your clients?"

His question triggered a lot of thought as I've been wondering myself about that.  Carl Jung discussed the term "collective unconscious."  It's considered to be a part of what, unconsciously, connects us.  It has its almost mysterious aspects, as one wonders what we, all different people, might have unconsciously in common.  Yet we indeed do often have a sense that there are underlying themes of awareness that are shared among us, regardless of the disparate nature of our lives. 

In response to my old friend's question I popped off something from the top of my head.  But after a bit returned to his question.  I realized that what I've been seeing a lot of lately is a lack of the ability of people to connect, deeply, to one another.  John Bowlby wrote of "Attachment Theory" in response to his experience in England during WW II when he worked with children who had been separated from their families in the chaos of war.  He saw then that the primary aspect of a child's attachment to parents is a fundamental need for children's security, stability and mental health. 

The sources of the attachment issues I've seen are varied, but with some common themes.  The most profound is the damage done when children are abused or neglected.  Those are easily discerned, if troubling and difficult to treat.  And, of course screen time, video gaming and social media are a part of it.  They can provide a pseudo sense of attachment.  Emotional nourishment of a sort, but it falls shy of actual emotional connection and attachment.  It can mimic the aspects of what so many of us recall from childhood as the need to be "in" the group.  The latest Tweet or Instagram often replaces the sense of connected-ness we felt on the playground or in the school cafeteria.  If you're "in" you have that sense of security and validation that we crave as humans.  If not, well....you're just as "out" as when you were picked last for the neighborhood touch football game, or not included in the birthday party of the most popular kid.  Rejection is a horrible feeling, but one that is all but inevitable in the process of social growth.  So the rejection a child today endures when their smart phone or computer time is withheld by a parent as a consequence can almost doubly isolate.  Not only is the child cut off from their perceived source of connection, their device, they've endured that cut off at the hand of a parent, another source of rejection.  And while that might not be terribly different than the "grounding" that had the same effect a generation or so ago, somehow it seems different.  Kids "attachment" to their devices feels addictive, and we know what happens when we cut off an addict.

And the poor parents, what are they do to?  Screens have become so ubiquitous that they are the obvious and tempting target for consequences.  Yet despite parents' efforts to monitor or restrict kids' online activities, kids today are so computer savvy that they can often outwit parents' interventions with a few simple key strokes which creates an escalation in the war of control and a resultant decline in the child's sense of trust and connection to both friends and family.  It's a spiral that has no clear answer or resolution, (though the interested reader would be referred to Ross Greene's work on Collaborative Problem Solving discussed elsewhere in these blogs and on his website www.livesinthebalance.com.) 

And as if this weren't enough - the distraction of these same devices, screens, apps and alerts is a huge distraction to parents.  We've all seen the jokes reflecting the sadness of a parent (or kid) wanting, longing for the connection with their family member only to be sidelined by the trance of a device in another's sights.  Multitasking has all but become an expectation of modern life, a skill in which most of us have experience, sadly often to the detriment of actual concentration and focus, of attention and presence.

I've also seen the cost to marriages.  People who are so devoted to their devices that they literally do not have time for their spouse.  I remember the first time - long ago, it seems - when I was with someone who didn't automatically pick up a ringing phone (they used to ring.)  It was an amazing awareness - we're not obligated to obey the ring.  So too now.  We're not obligated to obey the alert.  Our obligation is to be present in the relationship we are in.  At the moment.  Now.  Kids need to learn that.  Our wives and husbands need to see and feel that.  We need it as well.  There's no greater foundation in a relationship than the attached intimacy that develops over time.  We can easily see attachment in the magic that occurs between newborn and child.  In the inches between an infant being fed and the parent, we look, we communicate.  We love.  We experience the closeness and beauty of connection and attachment. 

To my friend, this is what I've not been seeing lately, and what concerns me.  And yes, it's hard to connect and be intimate.  It makes us vulnerable, and vulnerability can lead to rejection and pain.  It demands greater effort at communication.  But that's a part of the process, part of what enables us to reach out and grow, to develop attachment.  It's a primary task that we have to master in order to succeed in this world. 


Thursday, January 11, 2018

The Most Vulnerable


For years it's been known that people with developmental disabilities are much more likely to be victims of sexual predators than the general population.  National Public Radio's Joseph Shapiro is in the midst of a series on this topic that is important for families and loved ones of our vulnerable populations.  If you have a member of your family with a developmental disability, you will benefit by listening to it.  (Copy and paste this link to access the series https://www.npr.org/people/2101159/joseph-shapiro)

16% of  typically developing men and about 25% of  typically developing women are known to have been sexually abused as reported by Perez-Fuentes et al in a 2012 study.  Think of that for a second.  One of every four women and more than one of every 6 men you meet have been sexually abused.  That's folks without any disability.  It's an astonishing number, one that's been known for a long time.

Now think of people with developmental disabilities.  It's a broad term including people with autism, Down syndrome and other chromosomal anomalies, intellectual disabilities.  It's a population of about 56 million people in the US.  Out of  321 million, it's almost one of every 5 persons in our country.  People with developmental disabilities are sexually abused at a rate that's 7 times higher than the general population.  And the victims are often, as Shapiro noted yesterday, unable to testify against their assailants as they are non-verbal.  Shapiro's report involved the incredulous account of a staff member in a residential home caught in the midst of a rape by a co-worker.  He's pleading innocent in court.  Imagine. 

I have worked with families who  have taken the responsible, but tragically sad decision to petition the courts to have their adult daughters with significant DD's sterilized so they can avoid the trauma of pregnancy should their children be raped when in residential care.  The sadness of having to take such measures to protect one's developmentally disabled child is incalculable. 

Due to the level of needed care, some people with DD's need residential care.  Public policy has encouraged de-institutionalization, the merits of which can be debated.  What is not up for debate are policies that limit the proper staffing, training and supervision of staff to ensure proper levels of care. 

It is said that as a society, we will be judged on the basis of how we treat our weakest members, how we care for those who cannot care for themselves and how we protect the vulnerable.  Protecting children and the disabled isn't a mission that has its time.  It is the mission of society for all time.