By Paul L. Hokemeyer, J.D., Ph.D.

This article first appeared in Addiction Treatment Professional

In my book, Fragile Power, I’ve created a new paradigm of treating people of wealth, power and celebrity for a host of mental health, addiction and personality disorders. My work is based on empirical research that shows this minority group, like other minority groups, have distinct cultural markers that must be acknowledged and addressed in the therapeutic frame. In this article I wrote for Addiction Treatment Professional several years prior to the publication of Fragile Power, I address these issues in the context of treating adolescents for substance abuse disorders.

Key words: Addiction, addiction treatment, innovation, thought leadership, thought leader, adolescents, residential treatment, affluence, hnw, hnw families, uhnw, uhnwi, family office, next gen, next generation,  fragile power, nonfiction, mental health, millennials, Generation Z, next gen, substance abuse disorder, author, therapist, family therapy, wealth, success, celebrity, gaming, parenting, cannabis, THC  

*****

Perhaps the most prevalent cultural myth in America is that money and professional success are salves that heal what ails us. When substance abuse strikes in a culture of affluence, the American dream of wealth and power quickly turns into a seemingly unmanageable nightmare.

This article will address the treatment of affluent adolescents with substance use disorders through a family systems approach. This approach considers not just the “problem adolescent,” but also the family dynamic within which the adolescent is raised. To accomplish this objective, the major psychosocial risks unique to adolescents from affluent families, as well as the challenges that the professionals who treat them face, will be addressed. Finally, through a case study, this article will provide a real-life example, thus offering suggestions for working with this population.

High-risk group
Although it is commonly believed that children from highly educated, affluent families constitute a “low-risk” population, several studies have found that these youngsters are as susceptible to substance use disorders as adolescents from lower socioeconomic “high-risk” populations.^1,2 There are several reasons for this. The first maintains that children from affluent families must manage achievement pressures from their successful parents and siblings. In this context, the message that affluent children receive from their perfectionist parents is that failure to succeed equals personal failure.

This overemphasis on accomplishments while underemphasizing personal character and resiliency leads to increased rates of anxiety and depression, which in turn lead to higher rates of substance use. The theory is that these pressured children use substances to “self-medicate” intolerable emotions.³

The second reason offered for increased rates of substance abuse among affluent youth is that these children frequently are isolated from the parental figures in their lives. This isolation manifests itself both in a literal and emotional context. While wealthy parents are out of the house pursuing their careers and the trappings of wealth, their children frequently are left alone or in the care of professional caregivers. Without parental figures in their lives, these children are hungry for firm yet authentically compassionate role models.²

In addition, studies show that affluent children frequently feel emotionally isolated from their parents even when their parents are physically around. In their own self-absorbed drive to succeed, affluent parents fail to provide their children with the unconditional nurturing that is so essential to their growth as assured and confident human beings. Again, this isolation leads to increased levels of anxiety and depression, which in turn lead to unhealthy ways of coping with unacceptable feelings.^4,5,6

Just as affluence is too frequently celebrated as a substantive quality possessed by the privileged, substance abuse and imperfection are still too frequently stigmatized as a moral failing or character weakness that affects lower socioeconomic classes. As a result, affluent parents feel a great deal of shame in admitting that there may be a substance abuse problem in their family. This view keeps the problem hidden deep behind the family’s manicured façade, impairing the willingness to seek treatment.²

This misplaced belief that “if it looks OK, then it is OK” leads to affluent families turning a blind eye to telltale signs of problems and denying when problems exist. One of the most common ways this denial manifests itself is in overscheduled days and additional academic pressures. Although often grounded in the family’s genuine concern to see the child succeed, these pressures continue in spite of the child’s cries for help. In these families, an idle mind and body are seen as the “devil’s playground.”

At the heart of this hyperactivity is the fear that if they slow down or stop, family members will be overwhelmed by the truth and will be forced to address issues that they are unwilling or unprepared to handle. So instead of addressing nascent problems when they emerge, families driven to succeed try to cover unwelcome tracks with a whirlwind of activity.

And it is not just the affluent family system itself that is challenged by wealth and success. The outside systems that treat affluent adolescents are often faced with obstacles to effective care. These challenges include dealing with the families’ exaggerated privacy concerns, overly pressured lifestyles, and denial of the problem.^7,8 As a result, these professionals frequently hesitate to report their concerns to affluent parents for fear of resistance, intimidation, or even the threats of a lawsuit.

As a result, research has found that affluent youth too frequently have less access to school-based counseling services than economically disadvantaged students.⁹

Case study
Several months ago I received a call from a 46-year-old mother of an adolescent son and daughter. The mother requested a family session “to get her husband into treatment.” In a pressured voice, she told me her husband was using cocaine and she saw his use as a negative influence on “her” children. Apparently, the 14-year-old son had been caught smoking marijuana in the bathroom of his exclusive prep school and was in serious academic trouble.

The mother warned me that her husband was “difficult” and that they “had been down this road before.” Although she had never met me, she asked during our initial call “if I thought I could handle [her husband].”

The father was a handsome, successful physician with a thriving Park Avenue medical practice and a solid gold Rolex. He was charming and in charge, angry for being called to task, but willing to “do what he could” to resolve his wife’s “hysteria.” The mother was a fit, blonde and immaculate stay-at-home Mom who showed up at our session clinging to an expensive handbag and two perfectly manicured children. She was brittle to the point of breaking, and her anxiety manifested itself in the look of terror deep within her children’s eyes.

When asked why it was the father’s drug use we were focusing on instead of the son’s, both parents were quick to dismiss me. The husband placed the blame on his wife and dismissed our meeting as an obligation he had agreed to in order “to keep the peace.” The wife’s dismissal was more painful. She directly attacked my credentials and me. According to her, I lacked the experience and clinical acumen “to see that the problem was not with the son, but with the husband.”

“Look,” she said in a harsh and pointed tone. “If you aren’t up for this, I can find someone who is.” She continued, “Don’t you get it? My son is fine. It’s my husband who has the problem here. You need to put him into treatment.”

Somehow this very intelligent and sophisticated woman thought I could throw a net over her husband and send him away to treatment for 30 days while she and her children returned to their affluent nirvana. Essentially, she saw me as a pawn in a game that she paid for and controlled.

Before the completion of the session, however, the husband left the room. He had a standing poker game with his friends and didn’t want to keep them waiting. With the father out of the room, the mother realized that her attempts to control him through me were pointless. In response, she too decided to end the meeting and regain control. With ice literally dripping from her lips, she told me how “disappointed” she was with the session and me. Several days later, she called my supervisor to complain about the “service” she received.

Fortunately, my supervisor had been down this road many times before and had a deep understanding of the dynamics in affluent families. So instead of taking sides, he simply suggested that she schedule another appointment and talk this out alone with me. Recognizing that her ego would prevent her from making such a call, he advised me to wait a day and call her myself. I followed his advice. Although my call was received with an indignant tone, the woman agreed to another appointment.

When I met her this time, however, she was nearly unrecognizable. Without her family around, the stress of her life was apparent. Instead of hiding behind a façade of perfection, she revealed the frayed edges of her pain. In the privacy of my office, she allowed herself to talk honestly about her fear of failing as a mother and wife, and also how she loved her son and her husband but felt betrayed and devalued by them. She felt alone and mute, angry and sad, humiliated and defeated.

This honest admission by the mother was a huge step in her family’s recovery. It was my professional responsibility to provide her a safe space where this transformation could occur. By removing my pride and ego from the equation and allowing the mother to express her concerns about my “performance,” I modeled the vulnerability and humility that enabled her to reveal the pain around hers. In so doing, we formed an alliance based on truth, empathy and trust that we were then able to take into the family system.

It took a while, but eventually each family member joined in our weekly therapeutic sessions and became willing to express fears, vulnerabilities and concerns with one another. Instead of operating from a hard and shallow veneer, the family began to cultivate care and compassion that provided the nurturing soil that allowed them to heal as individuals and as a family unit. It was a long and often rocky road, but one they were able to travel together respectfully.

Conclusion
I relay this experience to illustrate how challenging working with affluent families can be and how important it is to stick with the process and to be alert to one’s own hostile reactions. In this case, the family system initially refused to acknowledge the true origin of the problem or to allow an outside intervention. Because the family was successful and rich, the family members viewed the people they paid as the “hired help” who were there to do their bidding. In so doing, they undermined the therapeutic process and perpetuated a self-destructing family order. But by honoring the mother’s voice and meeting her in her reality, we were able to move forward to a place where honesty, vulnerability and healing could occur.

As professionals who treat these families, we must remain open and available for this process to happen. To do this, we must watch our own egos and be aware of our own feelings and reactions toward wealth and power. It is easy to fall into a cultural trap and either deify these people for their wealth or resent them for it. Both ends of the spectrum present problems.

Effective treatment requires clarity and focus, and remaining grounded in our talents and purpose. We must remain aware of the power of wealth and not be distracted or seduced by it. By remaining grounded in our ethical and personal goal to help those in need, we will be available to provide the empathy and compassion these families require while modeling vulnerability, authenticity and truth.

We must be tough and kind, flexible and firm, and understanding while expanding awareness. In short, we must honor the professionals that we are and not fall into the cultural trap that these families erect around them.

The work is challenging. The work is frequently tough on our own egos. But like most challenging things in life, the rewards from persistence and honest effort are great. I encourage you to allow yourself to stick with an uncomfortable process and fully engage in the endeavor. Here are some suggestions:

•    Give the process time. Don’t be discouraged if the first few sessions are rocky.
•    Bring a colleague into the process to check your reality and support your interventions. Wealth and power can be blinding. Constantly check your vision with another person through supervision.
•    Look beyond the veneer. The pain lies hidden deep within. Be patient in your exploration.
•    Model vulnerability, compassion and empathy. People heal in nurturing relationships. Provide one for the family.

Dr. Paul L. Hokemeyer, a licensed marriage and family therapist, consultant and author, is one of the world’s foremost experts on resolving the complex, sensitive and highly nuanced issues that arise among the world’s most prominent families. He is a founding principal of the London based Drayson Mews International, a mental health and addiction treatment collective, and is listed as one of the world’s top “Problem Solvers” in Tatler’s High Net Worth Address book.

In his groundbreaking book, Fragile Power: Why Having It All Is Never Enough (Hazelden, 2019), Dr. Paul sets forth a new standard of culturally competent and clinically effective care for UHNW individuals and families who struggle with mental health, personality, relational and addictive disorders.

His work has been utilized by the World Economic Forum and featured in a wide range of academic and popular publications including The New York Times, The Wall Street Journal, Harvard Business Review Arabia, The Johns Hopkins Newsletter, WebMD, The Journal of Wealth Management, London’s Daily Mail, U.S. News and World Report, Time and others. In addition, he appears regular on both American and International News outlets including CNN, CNN International, FOXNews, Al Jazeera, The Today Show, and Good Morning America to provide expert commentary on the wide range of issues that arise at the intersection of power, celebrity, wealth and well-being.

References
1.    Luthar SS, D’Avanzo K. Contextual factors in substance use: a study of suburban and inner-city adolescents. Dev Psychopathol 1999 Fall;11:845-67.
2.    Luthar SS, Latendresse SJ. Children of the affluent: challenges to well-being. Curr Dir Psychol Sci 2005 Feb;14:49-53.
3.    Luthar SS, Becker BE. Privileged but pressured? A study of affluent youth. Child Dev 2002 Sep-Oct;73:1593-1610.
4.    Csikszentmihalyi M. If we are so rich, why aren’t we happy? American Psychol 1999;54:821-7.
5.    Kasser T. The High Price of Materialism. Cambridge, Mass.: MIT Press; 2002.
6.    Myers DG. The American Paradox: Spiritual Hunger in an Age of Plenty. New Haven, Conn.: Yale University Press; 2001.
7.    Puura K, Almqvist F, Tamminen T, et al. Children with symptoms of depression: what do the adults see? J Child Psychol Psychiatry 1998 May;39:577-85.
8.    Wolfe JL, Fodor IG. The poverty of privilege: therapy with women of the ‘upper classes.’ Women Therapy 1996;18:73-89.
9.    Luthar SS, Sexton C. The high price of affluence. In Kail RV (ed.), Advances in Child Development. San Diego: Academic Press; 2004.

While doomscrolling is not officially recognized as a clinical condition, it exists in large measure around the globe and among people of every social, economic, and age group. In my clinical practice, I treat doomscrolling as a behavioral addiction that manifests as a host of negative affective states that include both depression and anxiety. While doomscrolling initially provides relief to a person’s discomfort, in short order the behavior elevates to a point in which the individual suffers severe and negative consequences.

From a physiological perspective, a person who doomscrolls experiences elevated levels of the stress hormone cortisol and suffers from impaired cognitive functioning due to the hyperactivation of their limbic system. Most people who doomscroll have disrupted sleep patterns, engage in some form of substance misuse, and suffer from mild to extreme eating disorders. The patients I’ve treated complain of symptoms ranging from chronic fatigue to insomnia, from stomach cramps to constipation, from hyperactivity to a sense of floating through life in a dissociative trance.

The treatment of doomscrolling should follow the same clinical protocol as other behavioral addictions. For starters, people need to acknowledge it exists. Once they recognize it’s a disorder shared by many others, they can begin see how it is detracting from the quality of their lives and set boundaries around their online media consumption. To be effective, these boundaries must be clear, firm, and achievable. So, rather than prescribing online asceticism, a person must cultivate healthier online practices and develop healthy mechanisms to process their angst over world affairs.

Central to this work are Cognitive Behavioral Therapy (CBT), interpersonal psychotherapy, physical exercise, changes in diet, and practices that soothe the central nervous system such as acupuncture and deep tissue massage.

We are living in a profoundly unsettling world. Uncertainty, disruption, and danger seem to lurk around every corner. To manage the angst of our modern world, we need to learn when it’s healthy for us to move intentionally and with guardrails into the darkness that surrounds us—and when it’s healthy and productive avoid it completely.

 Late- blooming lilac-

Perhaps we, too, have something

Marvelous about to flourish

–Rosemerry Trommer

Over the past several months, there’ve been times when I felt as if I was sinking in a bog of apprehensions about the state of world affairs; at other moments, I’ve felt lifted by the hope that humanity is evolving toward a higher state of consciousness. In my role as a clinician, I’ve been helping my patients negotiate these stressful times by providing a consistent and structured frame where they can explore their fears and reclaim their strengths. As an author, I’ve written about physical exhaustion, relational stress, national trauma, economic uncertainty, and the menace lurking in our halls of power. As a human being who too feels untethered by an uncertain future, I’ve had to actively seek other human beings for hope and inspiration.

At the top of the list of humans who’ve inspired me are those known as Generation Y, Gen Y, or simply the Millennials. According to the Pew Research Center, Generation Y are people born roughly between the years of 1981 to 1996. What makes this generation so unique is that they are the first generation to have developed in an ethos of technological connection. Their access to the internet, mobile phones, and social media has profoundly changed the way they view themselves, their relationships, and the world they are in the process of inheriting. More impactful, however, has been their need to develop their identities through a series of life altering events such as 9/11, the Great Recession of 2009, and—now—the mélange of COVID-19, which includes another great recession, acute partisan politics, as well as unresolved racial and economic inequities. If ever there was a generation of people who had to cultivate both resistance and resilience, this is it.

Many critics look down on this generation with disdain. People lob hackneyed terms at this generation claiming they are “narcissistic” and “commitment phobic.” They claim “these kids” demand special treatment and don’t want to work for markers of success that prior generations value. [1] They declare that they are self-absorbed and entitled. And in some ways, they are right. What they’ve gotten wrong, however, is the way critics define these traits as something that is bad. The truth of the matter is that what makes this generation so remarkable is that their sense of entitlement and concern with self, evidence healthy and adaptive traits of resistance and resilience.

Let’s start with the first. Historically, the term entitlement has referred to a demand for an unearned right or privilege. Millennials are certainly entitled to live in a world that mirrors their cultural markers and allows them to exist in a way that’s consistent with their values. Researchers have found that Millennials are most concerned with issues that impact their values of living in a healthy, financially secure, diverse and respectful world. Unfortunately, the world they are inheriting challenges these values through the following issues:

1. A lack of access to health care, including mental health services. Millennials are 2x more likely to be uninsured than their parents. At the same time, they are more concerned with preventive health measures[2] and suffer from the highest rates of stress and depression than any generation before them.[3]
2. Being highly educated, unemployed, poor, and drowning in debt. Millennials were raised in a culture of aspiration. While their parents were able to benefit from vestiges of class transcendence and a robust middle class, millennials have not. In addition, those who are fortunate enough to find work realize that they are earning less than generations that have come before them even as the cost of living continues to increase. [4]
3. Being highly educated, they trust science and find special-interest politics repulsive. As such, climate change, [5] Black Lives Matter,[6] and women’s empowerment[7] matter greatly to them. Millennials are willing to accept a lower material standard of living than their parents, but they refuse to accept a lower standard of the value of a human life.

Rather than seeing the Millennial rejection of previously held markers of success as pathological, we need to see them for what and who they are. They are manifestations of a robust resiliency and a return to altruistic values of concern for others, the well-being of our planet, and a return to civility, compassion, and respect in our leaders and institutions of power. In this regard I’m consistently impressed by the altruistic consciousness of my millennial patients. In contrast to their parents, these individuals are “fed up” with the state of world affairs. One of my patients, a 21-year-old who held down two jobs and worked 7 days a week to save up for a home, spoke of his disdain for the status quo of modern politics. “These old white men have f*cked things up royally.” When asked what he intends on doing about it, he immediately responded, “Vote!” Then he added, “Even though I’m not thrilled about the options we’ve been left with, we—my friends and peers—need to reclaim the world we are about to inherit.” Yes, in many ways, this patient felt entitled to a better world, but he wasn’t going simply bemoan the state of world affairs, he was going to take action to change it.

In this regard, we need to begin to follow the lead of the Millennials rather than criticize them for not being us. We need to recognize that they deserve a better world than the one we are leaving them. We need to start ceding our power to them and to a new generation of leaders who’ve been forced to wait outside the corroding gates of power, watching through the cold impenetrable steel as the world they will inherit devolves into ruin. We need to be inspired and filled with hope for their tenacity, intelligence, and compassion rather than criticizing them for not being like us.

[1] https://time.com/247/millennials-the-me-me-me-generation/

[2] https://www.transamericacenterforhealthstudies.org/health-care-research/2019-millennial-healthcare-research?gclid=Cj0KCQjwgJv4BRCrARIsAB17JI6waqQdroT3_0f_tqSc8PQdadpq6Ho4QiIPnSNBSRpsd15zXAfpqUYaAmSlEALw_wcB

[3] https://www.usatoday.com/story/news/nation/2013/02/06/stress-psychology-millennials-depression/1878295/

[4] https://www.nytimes.com/2015/08/02/opinion/sunday/were-making-life-too-hard-for-millennials.html

[5] https://www.mckinsey.com/industries/social-sector/our-insights

[6] https://qz.com/774960/more-white-millennials-are-supporting-blacklivesmatter/

[7] https://www.theatlantic.com/sponsored/prudential-sleeping-giants/millennials-and-gender-a-major-attitude-shift/467/

“I’m exhausted and overwhelmed and I don’t know what to do. I’m struggling under the weight of this.”

 Two days into the protests over George Floyd’s death, I received the above WhatsApp message from a young man—a millennial—who I’ve been working for the past several months. It wasn’t that he wanted to shut the event out and pretend it didn’t happen. Actually, the opposite was true. He was so consumed by the tragedy that his central nervous system went into overload. Fortunately, his message came in at 10:00 PM, so it made sense to offer up a simple and a concrete action step he could take. “Can you go to bed and call it a day? Things will look differently in the morning.” He shot back with an equally simple response, “K.”

The next morning, I checked in on him. Quite intentionally, I crafted a message that would enable him to become an objective observer of himself and reframe his thoughts on manifesting resilience. “So, what’s Jack’s [not the client’s real name] plan this morning for making meaning and taking action to address this tragedy?” He responded back immediately, “A group of my friends and I are creating a social media campaign to address racial injustice.” I shot back the affirmation, “#Brilliant.” It was one of those moments that allowed me to marvel at how human beings—even those who live with heightened trauma responses to stressful events—are able to move themselves, their relationships, and the world around them in a reparative direction.

Identifying What We’re Experiencing

Through my patients, I’m able to learn what’s affecting individuals and what’s affecting our national collective. My current patients have helped me understand that the world we live in has become individually and collectively traumatic. One of my patients—a CPA at a large accounting firm who is a single mother of two adolescent boys—relayed over our last Doxy session that she, “Feels like I’m living in the film Zombieland. Only I’m one of the characters who gets eaten. Just when you think things can’t get worse, they do.” Fortunately, this woman has a strong social support system, which includes a mother who lives a few minutes away, supportive colleagues, and reliable friends. In this regard, she is more fortunate than most of my patients. But even with these strong systems around her, she’s suffering from a host of trauma-induced symptoms, including sleeplessness, feeling overwhelmed and hopeless, digestive disorders, and exhaustion. In other words, she’s suffering from the common symptoms of trauma.

According to the American Psychological Association, trauma is an emotional response to a distressing event. The long-term responses to this event include unpredictable emotions, feeling disconnected from one’s self and the world around them, disturbed sleep patterns and nightmares, strained relationships, and physical symptoms such as headaches, nausea, and gastrointestinal issues like constipation or diarrhea.

It’s important to note the distressing event causing a traumatic response can manifest itself directly and indirectly. The most apparent direct form of causation is a single event that overloads our nervous system. Events that fall into this category are fairly obvious and include: the sudden or violent death of a loved one, physical abuse, and being a victim of a crime or accident. But we also experience trauma though more indirect ways, such as simply being by or living in an environment where we feel unsafe and destabilized by events that are out of our control.

Recognizing a Toxic Culture

Ready or not, we’ve experienced a series of disrupting events in the past several months that have shaken our collective and made us realize how vulnerable we are, how unsafe the world is, and how contentious, vitriolic, and outright dangerous our leadership has become. COVID-19 has forced us into quarantines where we rely on virtual connections to the outside world. While certainly valuable, the technology makes us painfully aware that our humanity and our need for physical connection has not kept up with these technological advances. For the vulnerable and impoverished within our collective who may not have been able to rely on technology, quarantine and sheltering-in-place has only further amplified the isolation and lack of support they experience. This gap in which we’re living is precisely what many of my patients describe as an “alternative reality”.

Current events have forced us to recognize that we live in a toxic and traumatic culture plagued by social unrest, economic instability, injustice, prejudice, and lingering threats to our physical health and emotional well-being. While in the past, many of us expected social and political systems to ameliorate these ills and enhance the quality of our lives, but now we are seeing that these systems never supported our collective equally. They either contributed to or perpetuated imbalances and injustices that kept the scales titled toward those who manifest toxic power. This creates a collective culture of confusion, isolation, uncertainty and stress for many people as they awaken and develop awareness that the very systems that were meant to provide “protection and governance” have systematically caused trauma, isolation, and even death to human beings who are marginalized in our society.

Cut off from our personal networks, and with our systems revealed as unjust, we currently live in a nation defined by division and isolation. The resulting angst and stress we experience is only amplified by the isolationist, impulsive, and vindictive policies being chaotically implemented by our nation’s leaders. The net effect is the splintering of the foundations upon which we have established supportive, protective, and nurturing relationships, found safety and comfort, and built our individual and collective lives.

National or Collective Trauma

This state of acute instability and distress that is shared among people united by a cultural identity is known in clinical circles as collective or national trauma. In her article for Psychology Today, Danielle Render Trumaud, M.S. defines collective trauma as follows:

Whereas the term “trauma” typically refers to the impact that a traumatic incident has on an individual or a few people, collective trauma refers to the impact of a traumatic experience that affects and involves entire groups of people, communities, or societies. Collective trauma is extraordinary in that not only can it bring distress and negative consequences to individuals but in that it can also change the entire fabric of a community (Erikson, 1976)

As I discuss in my book Fragile Power, psychological constructs of any kind, including collective trauma, impact individuals and groups united by a shared cultural identity on three levels of their existence:

(1) The personal

(2) The interpersonal

(3) The cultural

As this relates to the patient I mentioned above, current events were disrupting her day-to-day life to such a degree, that she started experiencing a disintegration of her sense of self; she was becoming more and more disconnected from the scaffolding that historically had kept her life together.   On a personal level, as a successful, smart, and strong single parent bearing the roles of both a father and mother for her children, she saw it as her sole responsibility to provide financial stability for her sons—as well as her mother. As her long-term ability to carry on these responsibilities came into question, she experienced a diminution of her self-concept and self-esteem. In the interpersonal sphere, while her home and relationship with her mother had historically provided her safety and a refuge from life’s stressors, her home became, literally and figuratively, a boxing ring for her testosterone-saturated sons. Having to constantly referee her boys, her home lost its place as a sanctuary and became a site of stress and conflict for the first time in years. Finally, from a cultural standpoint, this life-long republican suddenly felt misrepresented by a political party in which she had historically taken great pride. While still committed to her party’s economic and libertarian policies, she was intellectually and ethically conflicted by the rapid transformation of its values. “Sure, I’m loving the gains I’ve made in the (stock) market, but I’m feeling it’s not worth the price of the loss of integrity and peace of mind. I thought we could create positive change for everyone, not chaos, division and hatred…”

While my client felt alone in her feelings, data shows she is far from alone in being riddled with anxiety from a life destabilized. A recent study found that more than half of Americans have suffered from at least one mental health issue during the COVID-19 pandemic. For individuals and families who lost part or all of their income, the incidence of mental health problems increases to 65%. These systemic shocks to our collective haven’t ended with the COVID-19 epidemic though; as I mentioned, the serial changes we’ve experienced from the deadly and pernicious use of power has shattered the foundations of our lives.

Finding Our Footing, Repairing Damage, and Moving Forward

Whether it’s experienced individually or nationally, trauma is destructive; but trauma can be healed. Just as we grow in the process of healing other disorders, our recovery from collective trauma can enable us to create a stronger, transformational foundation for our lives and the world in which we live. The first step in establishing this foundation is engaging in a tangible process of reconnecting with our power by reclaiming our personal, relational and cultural values. Through this intentional process, we can be guided by our internal compasses instead of being cast adrift and bewildered by the pandemonium of modern systemic forces.

As I outlined above, trauma occurs on three levels of our human experience. As such, we have to reclaim power first over the intrapersonal aspects of our lives, and then move out into the interpersonal and cultural spheres of our existence.

Over the years, I’ve developed a simple, but highly effective, exercise that I ask my patients to complete as we embark on the therapeutic process of healing and rebuilding from individual and collective trauma. This exercise is one that I’m currently prescribing to everyone I’m treating, regardless of the length of time we’ve been working together or their presenting issue. It’s also one that you can do in the privacy of your home, alone, or with your family or group of friends.  To do the exercise, spend 30 minutes focusing and writing down three values you have in the four key areas of your life listed below. In the wake of the collective trauma we’ve experienced, for each of the four areas listed below, I encourage you to consider at least one value that represents the collective. For example, when it comes to relational health, what is a value you want to see represented by the collective? To assist you in the process, I’ve listed mine in parentheses.

1. Physical health: (Discipline)
2. Relational health (Trustworthiness)
3. Financial health: (Honesty)
4. Spiritual health: (Humility)

I chose these four key areas (physical, relational, financial, and spiritual health) on which to focus based on empirical evidence that shows health is attained holistically rather than myopically. In addition, I’ve found personally and professionally that healing and transformation come intentionally as a result of cultivating meaning, purpose, and direction in life—and have encouraged patients to do the same. In times of stress, pain, and confusion—seasons in our life when we feel thrashed about in an existential sea—[re]claiming our values helps us establish a deep and meaningful anchor.

The past few months have been trying for humanity. Lives have been lost and shattered. Systems put in place to protect have proved—yet again—to be dangerous and deadly. At the same time, the intimacies of our lives have been strained to the point of breaking, shattered by the intensity of the unknown and menacing. As a result, we are living in a state of acute national and collective trauma. Unfortunately, unlike times in the past when we had leadership that could help guide us through the distress, today’s leaders are more concerned with creating division and disruption than healing through unity and respect. Fortunately, we have everything we need within our personal sphere of influence to heal ourselves as well as the people we love, and to rebuild the world upon which we are privileged to exist on a footing of compassion and grace. The first step in the process is reclaiming our personal values and striving each hour of every single day to live a life consistent with them. In this regard, we can all take a page out of the play book from my millennial patient who I referred to in the opening of this post. Yes, he was exhausted and untethered by the state of world affairs. Yes, he was shocked, disappointed, and fearful of the actions of our leaders and the systems they controlled. But one thing was certain: he wasn’t going to wallow in their malevolence, stumbling around waiting for them to change.  Instead, he would awaken each morning to greet his values, find a community of others who shared them, and use them as a guide to repair a world in desperate need of reparation. Let’s join him.

[The clinical examples used are composites of cases of patients and intentionally altered to protect client confidentiality and the integrity of the therapeutic relationship.]

Although imposter syndrome is not officially recognized by the DSM-5 as an official clinical diagnosis, a growing number of psychologists and other mental health professionals report encountering it time and time again—and not just among women. Professionals increasingly detail that “imposter phenomenon” occurs across gender, race, and socio-economic class, and may be affecting approximately 70% of the general population. This pattern of thinking and feeling about the self has become so highly prevalent that while I first understood it to affect patients who were struggling under the weight of their own achievements and aspirations, I’ve come to see many aspects of the phenomenon affect a broader number of my patients. Imposter syndrome seems to affect people who start seeing a therapist for everything from anxiety and depression to general feelings of dissatisfaction. People who feel “stuck” in their lives, as well as those with great potential but who can’t quite get it together to pursue their dreams, all suffer from it in equal measure to those who “have it all” but still report feeling “fake.”

Why We Feel, Fake

Imposter syndrome manifests consciously and unconsciously as a result of messages people internalize along their developmental path. Because these messages come from the people, feelings, and conditioning that we experience over time, imposter syndrome impacts women and people of color more perniciously. Both gender and racial inequality have contributed to people internalizing messages that include that they are “unworthy,” “undeserving,” and “incapable” of success. Over time, when people are marginalized, negative messaging takes root as beliefs people hold about themselves; later, those unconscious beliefs can manifest as limiting and destructive behaviors.
The net result is that imposter syndrome constrains a person’s ability to enjoy peace of mind, claim their rightful place in the world, and see their own value. By “hijacking” a person’s sense of self, imposter syndrome leads people to operate from a place of deficiency rather than abundance. Living through their weaknesses instead of their strengths, people encounter ongoing roadblocks that sabotage relationships, prevent plans, and detract from fulfillment.

Some common signs of imposter syndrome include:

1. Having nightmares of being unprepared and shamed: Chances are that if you’ve ever had a dream where you show up naked for class, or find it’s time for an exam for which you’re totally unprepared, you feel like an imposter. Dreams that make us feel full of shame or deficient in some way are triggered by our own unresolved emotions.

2. Finding it difficult to accept and hold a compliment: Accepting compliments with grace is easy to do when you feel secure with yourself. However, when people feel insecure their identity, they are more likely to feel uncomfortable with attention of any kind and compulsively discount or throw away a compliment.

3. Feeling success is a function of luck rather than talent: When people attain success of any kind, it’s common to express gratitude for the circumstances that supported a positive outcome. People who feel like imposters are quick to discount and discard their hard work, innate talent, grit, and resilience. In fact, many people with imposter syndrome find it impossible to see how they contributed to their own goals or successes, and just explain it all away as “dumb luck” or being in the “right place at the right time.”

4. Deflecting success on to someone or something else: Humility and graciousness are important, but so is owning one’s accomplishments. Success doesn’t occur in a vacuum, but people suffering with imposter syndrome often severely disregard their own hard work or talent. When you feel like an imposter, if it wasn’t just luck that helped along the way, then other people have to be responsible for your successes.

5. Rejecting professional labels: It can feel weighty and validating to be a well-respected executive, lawyer, doctor, photographer, author, or designer. When people feel like imposters though, the weight is more than they can bear. Like the patient I referred to at the beginning of this blog, people often struggle with the titles they’ve worked so hard to attain.

6. Criticizing external markers of success: A humble approach can be taken too far, and a person who feels like an imposter may criticize any decision or action that leads to socially accepted markers of success. It’s not uncommon for people with imposter syndrome to criticize commercial success as “selling out” or reject validation of any to maintain “integrity.”

7. Self-sabotaging success: When it counts the most, people who feel like imposters often can’t deliver results. They might call out sick, tell of an emergency obligation, or otherwise be a no-show. Why? Their unconscious over-rides their conscious intent to do the right thing or demonstrate their talents, so they blow up or abandon the opportunity they’ve been given to prove their worth, value, and competency.

It’s important to recognize that people who feel like imposters are profoundly influenced by their unconscious. For this reason, recovery from imposter syndrome requires a deep and holistic dive into the three levels of our human existence. These include the socio-cultural, the interpersonal, and the intrapersonal aspects of our being.

The Socio-Cultural, Healed:

First, we must understand the messages we’ve internalized by the dominant culture in which we live, as well as those we’ve internalized from our families of origin. For minorities and disenfranchised people, who have historically been stigmatized, marginalized, dehumanized, and traumatized at every step along their developmental path, this healing work is critically important and challenging. When we’ve internalized negative messages about the color of our skin, who we love, what God we worship, or our sex and gender, we grow into people who think less of themselves. Healing starts when we identify the patterns, and it grows when we can articulate the messages we’ve internalized; when we can crawl out from under the weight of harmful conditioning and stereotyping, we can embrace self-actualization.

The Interpersonal, Redefined:

Once we truly feel like ourselves, our healing shifts to our interactions with others. The second area we need to explore is the geography of our interpersonal relationships. We need to spend time mapping out what we learned from our families of origin about success: what it means, what it costs, what it looks like, and who is entitled to it. In addition to taking a historical look at these messages, we need to evaluate our current relationships. Many individuals who suffer from imposter syndrome have relationships with people who are threatened by their success, so they both actively and passively work to sabotage it. Understanding how other people, feeling threatened, have conditioned and sabotaged our own sense of self, is a crucial part of breaking the cycle of imposter syndrome.

The Intrapersonal, Embraced:

Finally, we need to dig deep to uncover what motivates us and makes us feel like a person of value who is worthy of being seen and heard. The best way to do this intrapersonal work is in partnership with someone safe and compassionate—a person you trust and with whom you can be strategically vulnerable. To get started, I often ask my patients to tackle a simple, but powerful, exercise that kickstarts this stage of work. By sitting down and documenting what’s important to us, we begin to redefine ourselves.

Try this exercise now by answering the following:

1. Success means the following three things to me:
a. ___
b. ___
c. ___
2. I’m limited in attaining these three things because:
a. ___
b. ___
c. ___
3. To be successful I need the following three things to occur:
a. ___
b. ___
c. ___
4. The personal traits that will support my success are:
a. ___
b. ___
c. ___

Whenever we embark on the process of healing, it’s important to pay attention to any feelings of resistance that arise. If you suddenly hear yourself discounting the process as “stupid,” “worthless,” “a waste of time,” or “sophomoric,” then take a moment to recognize that’s the voice of the imposter syndrome speaking. The part of you that’s been diminished, ignored, and mistreated in the past is trying to get in the way because a part of you feels that you’re not worthy of success. Instead of listening, push through. While the work is time consuming and can at times bring up painful memories, it’s worth it. Through it, you’ll be able to identify and banish the most pernicious and self-defeating messages holding you back, and you’ll be able to build a foundation upon which your success can flourish.

“All he’s concerned about is his f*kin’ hair! My sister can’t pay her rent, and all he talks about is how his inability to get a haircut has made him even more handsome. I’m done…Do you know a good divorce attorney?”

According to a recent story by ABC News, family attorneys around the country are being flooded with requests for advice from stressed-out clients who want to file for divorce as soon as the dust of the pandemic settles.  Many spouses feel unable to tolerate being “trapped” in their homes with a person they suddenly realize is a real-life Narcissus.

Long-standing toxic relationship patterns, amplified  

Over the past 15 years of working in relational therapy as a licensed marriage and family therapist (LMFT), I’ve found that in nearly 90% of the cases where I’m called in to help navigate relationships that appear to be falling apart, one of the partners suffers from a narcissistic personality disorder (NPD). While it’s common in our modern lexicon to talk about people as narcissistic, and to label them as narcissists, it’s important to remember that personality disorders including Narcissistic Personality Disorder (NPD) are empirically based clinical terms that have clearly articulated diagnostic criterion.

Narcissism, defined.

Narcissism is a nexus of traits characterized by self-absorption, a need for constant validation, a sense of superiority, and an extraordinary capacity for manipulating others. It’s a consequence of overcompensating for a deficiency that a person endured early in their developmental path.

Historically, when we think of narcissists, we think of men. Data from 2008 indicates that the prevalence rate among men was nearly twice that of women (7.7% for men and 4.2% for women), but as I discuss in my book, Fragile Power, published just last year, women are catching up to their male counterparts in the rate at which they are displaying and being diagnosed as narcissistic.

While there’s nothing new about relationships being negatively affected by partners with NPD, the sheltering-in-place and quarantine orders that confine us with our loved ones have made many people feel they are stuck in purgatory with Narcissus himself.

There’s no cure, but there is healing and hope

There’s no “cure” for NPD, because it is not the type of disorder that can be entirely eliminated from a person’s psychic makeup; however, through ongoing therapy, a narcissist’s personality can be softened. Still, most people with NPD resist treatment and therapy—both individual and couples therapy. To a narcissist, the problem is always external to themselves. They are masters in the art of deflection, so any problem or conflict is not due to them, but rather to the people, places, and things around them.

Living with a narcissist is challenging—even in the best of times. When things get rough, narcissists provide little support to soften the hard edges of life. When the top blows off the world, as it has in the COVID-19 pandemic, narcissists drain the life force from everything around them. As is evidenced by the client who I quoted at the start of this blog, a narcissist’s inability to consider anything or anyone other than themselves is exhausting and infuriating. In addition to being masters of deflection, they are masters in what is known as the narcissistic cycle of abuse.

When people who suffer from NPD do make it into treatment, it’s usually from the threat of a significant loss, a loss that will entail a momentous injury to their grandiose and fragile ego. Once in the therapeutic process, however, they come to see how deeper, more intimate, and trusting relationships can add significant value to their lives. In seeing this value proposition, they become willing to stick with the long, reparative process that therapy provides. This ongoing therapeutic process helps them gain insight into significant issues of their past that impact how they see themselves and the world around them.

But as I mentioned above, this is a long-term process, which typically spans up to two years of consistent work. So, what’s a person to do when they need immediate and short-term help to figure out how to cope with a narcissist in the immediacy of sheltering in place? For starters, we need to be familiar with the official diagnostic criteria for NPD.

Narcissistic traits

From a clinical standpoint, narcissists suffer from key personality traits; it’s possible to think of these traits as signs of narcissism or the traits of a narcissist:

• They are what they have. Narcissists define themselves from the outside in. Their sense of self is derived from their appearance, as well as the things and people they possess.
• They’re an emotional hand grenade. As long as their ego is being fed, narcissists are happy and even a pleasure to be around, but the minute they are challenged or things don’t go their way, they explode.
• They don’t care about you or what is important to you. Narcissists lack empathy and compassion. The only time they care about you is when you can help them get something they can’t get on their own.
• They’re master manipulators. They know when to charm and when to threaten. They will say or do anything to manipulate and exploit others for their personal gain.
• They’re grandiose. A narcissist believes they are unique and special. They are condescending and hyper critical of others.
• They’re entitled. They feel they are deserving of special treatment and admiration from others even though they have done nothing to deserve it.
• They need constant attention. They compulsively strive to be the center of attention and will say or do anything to be in the spotlight.

Stress amplifies narcissistic traits    

While we are all living in a state of uncertainty and a lack of control, most of us have the tools to manage the stress. Narcissists don’t.  As a result, their narcissistic traits have become amplified. The reasons for this are several. First, while a person who suffers from narcissism presents to the world as confident and full of bravado, at the core of their being they are insecure and fearful. This pandemic has brought with it a personal threat that chastises even the most grandiose individuals. Second, narcissists lack the tools to constructively deal with the challenges of life. These tools include learning to tolerate frustration, appreciating the value of humility, and—perhaps most importantly—a strong social support system to which they can turn for comfort and guidance. Not in the bailiwick of most narcissists are the tools that are highly effective in managing the challenges presented by this pandemic: cultivating gratitude for the little things in life, strategically sharing vulnerabilities with trustworthy others, and the capacity to transcend one’s self to connect with a higher spiritual or universal order.

A treatment strategy, pivoted

Traditionally, helping couples transcend the destructive force of narcissism would involve my working with them in person, over a specifically defined period of time. Today, however, neither one of these treatment protocols are practical. Instead, my longer-term therapeutic work has been replaced by short-term coaching sessions with a client who needs specific “tips and tricks” to help them get “to the other side” of this pandemic. That is, instead of focusing on how the narcissist’s development of vulnerability, humility, and empathy will enhance the quality of a relationship over time, the work must be narrowly focused on enabling a narcissist’s partner to integrate short-term strategies of individual self-care into their daily routine during quarantine. The top-three strategies that I recommend to these clients are:

• Make the time to recharge. Everything about COVID-19 is exhausting. Therefore, it’s important to make time every single day to temporarily shut down your mind and your body. The best way to do this is to get out of the house, even for 10 minutes. By changing your physical environment, you’ll be able to calm yourself down and find relief from the toxicity of your relationship.
• Avoid conflict. Narcissists compulsively crave attention. It doesn’t matter if the attention is found through conflict or concord. Try, as best you can, to avoid conflict. When the narcissist in your life tries to hook you into conflict, simple statements such as, “I’m sorry you feel angry, but I just don’t have the energy to engage,” will enable the narcissist to feel validated and help you avoid their drama.
• Think long term, but act short term. It’s healthy to plan for the future, but to do it wisely, you’ll need to have short-term strategies to implement the plan. Unless you are truly experiencing a life-threatening crisis, it might be best to leave definitive decisions for a later date. Remember that a pandemic is not the best time for reactive decisions or actions. Instead, spend your time thinking through your options and discussing them with a trustworthy confidante.

Even though we don’t know exactly when or what our world will like when COVID-19 passes, it will pass. Yes, in its fury and wake we’ll have sustained enormous losses. Institutions we counted on will have become extinct or will be radically transformed. We will grieve loved ones lost and be unsure of our financial future. The externals of our lives will be altered and perhaps not for the better. For these reasons, we need to make sure we are doing everything within our power to ground ourselves rather than allow ourselves to be drained by the narcissistic people in our lives.

#FinancialStress

The COVID-19 pandemic has made it difficult being human. Millions of Americans have been laid off, furloughed or, had their livelihoods decimated. In addition to financial stresses, our most primitive needs for safety, security, and stability have evaporated overnight.  Several of my patients have mentioned they feel they’re at war, in the trenches fighting for their lives. Everyone speaks in terms of how “frightening,” “dangerous,” and “hostile,” the world we live in has become.

#Fear

During the past several weeks, my clients and I have spent hours processing the fear and anxiety produced by experiences that were once commonplace and nurturing. One patient of mine, a mother of three, couldn’t help but focus on how excursions to her local market fill her with panic. “My grocery store has become enemy territory. How do I know that the carton of milk that I bring back isn’t going to infect my family with coronavirus?” Another spoke of the unseen dangers lurking in her home. “I look at my kitchen counter like it’s a ticking bomb that will explode with corona any second.”  Everyone’s experiencing a level of exhaustion, stretched to their emotional and physical limits trying to contain the fear and chaos of the pandemic; and as bad as it is now, we are told that it’s going to get worse before it gets better.

#RelationalConflict

This time we’re living through might feel unendurable, which is straining many relationships to what seems like a breaking point. During a recent virtual check-in with a client, I kicked off the session as I frequently do—asking how she was doing. The reply was fast and furious. “The first thing I’m doing once this [pandemic] recedes is contacting my divorce attorney and filing. He actually complained that I made him the same dinner twice in a row. He’s lucky he’s eating anything at all.” Uncomfortable patterns in relationships that have been overlooked for years have suddenly become unbearable, amplified by COVID-19’s wattage. Personality traits that were mildly annoying in better times have become excruciating in this crisis.

#RelationalHealing

As a licensed marriage and family therapist (LMFT) I have the privilege of helping families and couples navigate challenging times. My brand of relational therapy provides strategies that enable couples and families to do more than just survive difficult moments—whatever the cause or trigger of the difficulty. Right now, we’re living in a time of external challenges that are putting consistent stress on our internal lives and relationships. The tactics clients and I regularly practice in sessions are highly relevant in navigating the heightened levels of stress, fear, and uncertainty that define our conditions at this moment.  Such tactics and strategies move us beyond managing and surviving; they help us find a higher level of functioning and relational satisfaction.

#StrategiesThatHeal

During this period of “sheltering in place,” I find myself coming back to the following tactics with all of my clients—and in my own life:

1. Practice Strategic Vulnerability: Even in the best of times, we should embrace and expose our vulnerabilities strategically, bringing intentionality and awareness to the process of revealing our vulnerabilities in specific situations. This is especially true for people who have experienced any type of trauma in their developmental path. Yes, vulnerability can provide opportunities to enhance our individual and relational well-being, but only if it’s utilized in situations that make us feel safe, secure, and cared for. Relative security is crucially important for vulnerability to lead to breakthroughs. That means we should be vulnerable with the people worthy of holding our vulnerability. Otherwise, vulnerability should be strategically called on in situations where we want to intentionally take risks to test the integrity of the relationship and challenge ourselves to grow. Strategic vulnerability is the process of determining when it is safe to be vulnerable and have clearly defined goals for allowing the vulnerability to occur. In this time of fear and uncertainty, we must be extra cautious with how and with whom we share our vulnerabilities.
2. Create Shared Meaning: The most successful couples have developed a shared resiliency that helps them transcend stress in their relationship. At the heart of resiliency is meaning. Purpose and meaning protect us from the destructive forces that threaten us and our relationships. When couples come together to find the shared meaning of their relationship, in the midst of any type of stress they are always able to return to that sense of shared meaning. While we are living in an unprecedented time, couples need to actively search for shared meaning in the trials and tribulations that the pandemic has brought into relationships and families.
3. Accept That Some Things Cannot Be Changed: We are living in exhausting times. Just getting out of bed and trying to navigate the day is arduous and stressful. Rather than fighting the reality around us, we can accept it. Acceptance changes our perspective and focus. By becoming a bit more myopic or narrowing our focus, we choose to look at what’s significant in our lives. We focus on what and who matters, and tune out or turn down the volume on what really doesn’t matter. That has to include the little things our loved ones do or say that sometimes annoy us. Now is not the time to prove a point or try to change a loved one’s perspective or habits. Now is the time for caring for ourselves and our loved ones. That is, rather than bemoaning the present state of our lives, we need to accept that things are rough, that they will continue to be rough for the near future, and that we can channel our energies into protecting ourselves and those we love from harm. In this process, we can reset our lens and focus, and our feelings of stress retreat.

#PostCOVID19

History shows us that in times of challenge, it is possible to do more than survive. It’s possible to emerge from periods of stress, change, and fear with a stronger sense of self, a deeply committed relationship, and a stronger family dynamic. To accomplish these objectives, families must move intentionally through their fears, into their vulnerabilities, and to a place of trust with themselves and their loved ones. Don’t let this period of historical significance pass by underutilized. Take the stresses, fears, and challenges that have become a temporary part of our new day-to-day experience and use them to propel you and your family into a higher, more compassionate and evolved level of functioning.