Denis Boyd & Associates

Best Years of Their Lives?

Mon, 25 May 2009 10:29:29 -0800

Often times I hear people tell youth their teen years are going to be the 'best years of their lives'. Every time I hear this, I shake my head. Having worked with a teenage population for a couple years has opened my eyes to all the new challenges and difficulties that are being thrown into the lives of youth. It seems too often that young people are coming to me with overwhelming feelings of anxiety and worry. So let's take a minute to explore some the major sources of stress encountered by today's youth.

One of the major sources of stress is school. At the academic level, there are the tests and assignments paired with expectations to achieve good grades. When inquiring into where the expectations are coming from, youth feel they are from parents, teachers, and self. They fear disappointing their family with poor marks and are concerned for their futures. Youth appear in my office as young as 13 expressing concern over what career they should pick and fearful that anything less than a B grade on any exam during their entire highschool career will eliminate any opportunity to pursue a post secondary education and ultimately ruin their future. For some, perfectionism becomes an addiction.

Paired with academics are all the extracurricular activities in which youth feel required to partake. Extracurricular activities now serve a purpose of demonstrating to future employers and schools student's level of community involvement. Without them, some youth feel they will be at a disadvantage for getting into the post-secondary institute of their choice. Thus, making it appear even more imperative to load up their schedules with clubs and sports. Youth are also required to participate in work experience programs to assist them in exploring possible future occupations. During their work experience, the expectation to maintain their grades and extracurricular involvement remains.

On top of it all, youth are faced with their peers and comparing themselves to others. I am often amazed at the value of possessions the modern teen holds. Between the designer clothes, bags, phones, and other electronics, I have seen more than a handful teens that, in one outfit, could be valued more than my first car. When a youth does not hold these modern symbols of status, they get an earful of negative comments from peers. What makes it even more difficult is the impossibility to escape being bullied. Not only are youth getting bullied face to face, but they can be bombarded with text messages, voice mails on their cell phones, and wall posts on internet social networking sites.

After a lengthy day of juggling stress at school and after school activities, teens make the trek home. Strife in the home and even parent's expectations can be other sources of stress. In addition, youth encounter chores, part-time jobs, helping with younger siblings, catching up on school work, and finding time to relax and recharge. During these down times, youth may spend time focusing on self stress - stress that others are unaware of, such as self esteem, confidence, expectations, and body image. Self stress also includes the natural desire to discover one's own belief system, values, and identity. Self talk, or internal dialogue, often plays a role with self stress. When feeling overwhelmed, one's internal dialogue has a tendency to turn negative. Common self talk statements I hear include 'Nobody understands me', 'I'm so stupid', and 'I'm not good enough'. It's almost as if youth begin to bully themselves. It's important for youth to learn how to acknowledge and change these statements. They need to know that it is okay to not be perfect and how to appreciate their strengths.

The result of all this stress is a generation of tired and irritable youth who keep hearing that these are going to be the best years of their lives. Perhaps it's time to shift our focus to the potential for the wonderful and exciting futures these young people hold. We can do this by encouraging and supporting our youth by commenting on the things they are doing well. We can acknowledge life can be challenging and that stress can be managed. We can also model healthy coping strategies such as healthy communication, exercise, positive eating habits and time management. Parents, keep the lines of communication open and strong between yourself and your teen. Part of this communication will be to use your listening skills and maintaining a non-judgemental ear. To help build the relationship, plan more time together to chat and have fun. Perhaps start family movie or game nights. Also, include children in making a list of activities the family could do together. Lastly, let them know you are proud of them and that life only gets better.

Workplace Bullying

Mon, 25 May 2009 10:16:24 -0800

Over the past decade, bullying in the workplace has become recognized as an occupational health and safety issue. Most Canadian workers have seen it happen to someone or experienced it themselves.

Bullying is also referred to as harassment or psychological violence. This is any repeated mistreatment of a person that endangers their health or level of functioning. Individuals who are bullied may feel anxiety, humiliation, anger, frustration, de-motivation, stress and shame. They may lose their self-confidence.

Workplace bullying may include such things as verbal abuse; spreading of rumours; issuing threats; criticism; isolating the target; exclusion; humiliation; setting the target up for failure by setting unrealistic goals or deadlines; overloading the employee with work or responsibility and then often removing the authority necessary to get the job done.

Harassing acts of commission or omission are driven by the bully's need to control a person or situation that is perceived as a threat. Bullies are insecure individuals who usually target good employees who are competent, co-operative and efficient .Bullying tends to escalate over time. While the bully is very seldom held accountable, bullied individuals face a 70% chance of losing their jobs.

Many surveys have been conducted in regard to this issue and their results are quite surprising. In a 2003 survey, the Workplace Bullying and Trauma Institute found the following results concerning individuals who had been bullied at work.

76% exhibited symptoms of stress and severe anxiety.

71% had disturbed sleep patterns.

39% had symptoms of post-traumatic stress disorder.

In 70% of the cases, the victims quit their jobs or were let go.

17% of the victims transferred to other departments within the same company.

Only 13% of the perpetrators ever suffered any consequences.

In 71% of the cases the bully had higher rank than the victim.

17% were bullied by peers.

12% of the victims were bullied by someone lower than them on the workplace ladder.

What can you do if you find yourself the target of a bully? The Canada Safety council has some advice. They recommend that the first step you take is talking to the bully face to face. Explain why you think you are being targeted and how you feel. Be calm and never retaliate with disrespect or threats as these may be used against you.

Check the company policy. Many companies have procedures to follow. Avoid being alone with the bully. Discuss the problem with your manager, Human Resources personnel or a trade union representative. You may want to talk to your co-workers to see if anyone else has been subjected to the same treatment.

Document all incidents. Record the date, what happened, any witnesses that were present, how it affected your feelings and your work, and any medical help you sought. With the exception of Quebec, unless harassment involves sexual harassment or discrimination along the lines of sex, race, age, or religion, Canadian labour laws do not address bullying. You may decide to bring the issue to the attention of the Human Rights Commission.

Educate yourself about this issue. There is a wealth of information on this topic in self-help books and on-line. If possible, be active in your workplace. Try to influence company policy and guidelines regarding harassment, bullying and psychological violence. Repeatedly remind yourself that you are not the problem. The bully is the problem. The bully's view and opinion of you is incorrect and intrue. Encourage yourself to be strong.

Medically, psychologically and socially, society pays a high cost for bullying. Employers and employees suffer because bullying can lead to illness, resignation, high staff turn over, severance packages and costly litigation. A workplace atmosphere can become poisoned with low morale, high absenteeism, loss of efficiency, fear, anger and depression. A target's marriage, family and friendships may suffer. Bullying costs the health care system in terms of visits to doctors, prescription medicine and long term counselling.

Many individuals have had to leave the work they love because of bullying. This is very unfair and most unfortunate. However, in the long run, it is not worth allowing bullying to permanently damage your health and your future. If there is no solution within a reasonable time, consider moving on to a new work environment. Move on but don't go quietly. Make sure that the highest ranking person in your company or trade union is aware of your situation. If you have difficulty letting go and moving on, you may need to seek help from a counsellor.

Communicating With Teens

Mon, 25 May 2009 09:48:37 -0800

Is it possible to communicate with a teenager? Yes... we are always communicating with our teens. However, the issue has more to do with quality than quantity and often the quality is not that great.

Effective communication with teens can be enhanced by focusing on a few ground rules:

Keep it short: Most teens dislike "lectures." Keep to the point with brevity and you will be more likely to have an impact. Your teen may not acknowledge this impact though, so don't be surprised if their response to your short life lesson is the word "whatever."
Influence over direction: When our children are young we are the "boss" and make all the decisions related to their care. As they become older they take over more and more control of their lives; there are only a few areas of life in which we still have "control" as parents. For instance we do not have control over who their friends are; this is an area in which we "influence" decisions. Giving an opinion in a brief manner carries more weight than trying to tell a teen who his friends should be. Some parents, however, pull back from being the boss to saying nothing at all. Teens, though, are open to influence and might question our commitment and love if we do not offer our opinions from time to time.
Review your own life as a teen: It can be useful to think back on our lives as teens and remember how we got along with our own parents. There was a father who was very strict with his sixteen year old daughter. He had been a rebel as a teen and much more adventurous than his daughter. He was worried that his daughter would go down the path he had followed and she was beginning to do so as a response to his controlling style of parenting. In another instance a mother had clashed with her own mother who had been very directive towards her. As a parent of a teen she was using the same approach her mother had used on her and it was working just as poorly. It was as if these two parents had forgotten what it was like to be a teenager.
Be aware of the "tasks of adolescence": Teenagers are in the process of making the transition from childhood to adulthood and in this journey there are themes which tend to surface. Most teens will experiment with ideas and lifestyle decisions, including friendships. Sometimes these choices are very different than those they would have made in the past. You will have a young person who has always gone to church with his family; now he no longer wishes to attend or if he does, he sits off by himself. You will have another teen whose family rarely if ever attended a church service and she will begin to go to a church with a friend. Teens are very peer conscious and will seem to make friends their major priority; they are also hypersensitive to authority and being "bossed around."
It becomes important to teens to be unique. The teen is in the process of "individuating" or of becoming an independent adult. Once the transition is made, many of the decisions about lifestyle are similar to those embraced as a child and yet the young adult is living this lifestyle because it is her choice to do so, not that of her parents.

Reach out regularly: When relationships become tense, it can be easy to ignore each other and to not initiate contact. We used to go on Sunday outings as a family and our 16 year old daughter would stay behind. One day we made our plans and did not invite her to join us and she was upset. My excuse was that she always said no to the invitations and she responded that "she wanted to be invited anyway." It was important to her that we still thought about her and wanted her to be part of our excursion. When she still said no to the invitation we suggested that she bring a friend and this pleased her; she came along with a friend in tow. Her friends would usually exclaim to us how great it was that we "did things as a family."

It is also important to be friendly. This can be challenging if things are tense between a parent and teen and yet it can be a simple way, over time, to warm things up. Teens can be reactionary and will play "tit for tat." If we are negative they will respond in kind. If we are nice they may do the same, but not right away necessarily.

Choices and consequences work: Being influential rather than directive is fine but there are some aspects of life which require direction; it is important however to avoid "power struggles." Let's say that you as a parent want help with chores around the home. You can create a list of five items and ask your teen to choose three. One of the items may not be negotiable, such as cleaning his room once a week. When the decisions have been made, deadlines are given which allow the teen freedom to complete the task at his convenience but by a deadline so that you as the parent have some assurance the job will eventually get done. If the deadline is met, all is well and it's business as usual. If the deadline is not met there is a consequence which would have been spelled out before hand. If the room is not clean by five o'clock on Friday, no use of "media" (i.e. computer and phone) will be allowed until the job is done. If the agreement was that the teen be in by a certain time and she is late, the consequence might be a loss of media for 24 hours. If there is debate or argument about the consequence, this can be discouraged by offering a further consequence which is a doubling of the 24 to 48 hours. This second consequence often shortens the argument. Many teens prefer this approach to the hassling which can result from chores being ignored. They dislike "nagging" as much as they dislike "lectures."

Feelings first: When talking with a teen, or anyone for that matter, it can be useful to tune into his or her feelings. Keep in mind that when people say rude or outrageous things, the challenge for you is to focus on the feelings before reacting to the way they were shared. "You must be tired to be saying that" or "You sound really angry right now. Why don't we talk later."

Collaborate with your spouse: Parents usually have very different parenting strategies and can easily become locked in a debate as to whose approach is the best. One person is usually strict and the other more easy going. The truth lies somewhere between the two approaches and can be best accessed by the parents listening to each other's feelings and then trying to move to a collaborative position. Collaborative or "team parenting" can be very effective and can enhance the marital relationship at the same time.

Brooke Lewis

Tue, 28 Apr 2009 18:52:29 -0800

Brooke Lewis, MA
Registered Clinical Counsellor, 3332

Brooke, a registered clinical counsellor, offers counselling to individuals thirteen years and older who are experiencing a variety of concerns, including depression, anxiety, self-esteem, transition, stress management, personal growth, and substance abuse.

Brooke incorporates a range of therapy orientations into her practice. She provides a safe, supportive environment in which clients can explore their personal challenges and difficulties.

Brooke has worked in high school settings in addition to day and residential addiction programs. Brooke has also provided workshops on a variety of topics including stress management, addiction, suicide, and sexual exploitation. She received her M.A. degree from the Adler School of Professional Psychology and is registered with the BC Association of Clinical Counsellors.

Living With a Chronic Illness: Why You Should Maintain Hope

Tue, 17 Feb 2009 16:10:14 -0800

Part 1 - What to expect

Kathy vividly remembers her "life turning upside down" after her car accident ten years ago. She has struggled with chronic pain ever since. Despite being a "high achiever," she has not been able to work since this time and has had difficulty accomplishing her usual household tasks. Martin has had multiple sclerosis for eight years and had to leave an upper management position, after 20 years with the company. Both Kathy and Martin experience ongoing low mood, feelings of uselessness, and an overall decrease in their self esteem. Both feel isolated from others, as they are no longer able to participate in activities with friends or family to the same degree. They frequently feel that significant people in their lives don't understand what they are going through and at times feel rejected or blamed for their illnesses. Both feel defined by their respective illnesses and are no longer the "Kathy" and "Martin" that they previously were.

The scenarios described above are indicative of what someone with a chronic illness might experience. Unlike more acute illnesses, chronic illnesses are often poorly understood, both by the patient, their family members, and, at times, even by the physicians involved in their care. Well meaning friends or family members may tell them that "it is all in their head," "they are using their illness as an excuse" or that they just need to "pull up their bootstraps and get on with their lives." And "getting on with their lives" is essential; however, it is often a long and difficult struggle, with little clarity regarding how to do this.

So what does "getting on with one's life" mean? Getting on with one's life involves finding a way to slowly adjust to and cope with the illness, and to ultimately regain a sense of meaning and value in one's life. However, people need to actively go through a number of stages of dealing with their illness before they can get to this point. The typical stages are as follows:

Initially, the person experiences challenging symptoms that are new to them. They may feel confused, overwhelmed, and fearful about their symptoms. They may begin to experience a sense of loss regarding the impact of their symptoms on their lives and the consequent limitations that they are facing. Some experience a sense of denial and even try to ignore their symptoms. In this stage, the person may see a number of health care professionals, who offer conflicting diagnoses and treatment methods.

During the second stage, a diagnosis may be provided. This can provide relief in explaining what has been happening to them. However, there may be increased uncertainty about their future and how much improvement can be hoped for. The reality of having a chronic illness has sunk in and is very difficult to accept. Many will not accept it and will push themselves past their physical limits, resulting in increased symptom severity. Others may experience an increased sense of despair regarding their illness. Typically, there are ongoing attempts to find the "magic cure." Many wind up isolating from others who don't appear supportive, although they may desperately yearn for their support and understanding.

In the third stage, the person has accepted the fact that they have a chronic illness. At this point, they may experience deep grief about the loss of their former "self" and other illness-related losses. They may question why this has happened to them. Consequently, they may question their religious or spiritual beliefs, as well.

During the fourth stage, the person has found a way to integrate the illness into their life. They understand their symptom patterns (i.e., from relapse to plateau) and have learned how to structure their lives accordingly. At this stage, the person has developed new interests that are compatible with their physical challenges. Although some relationships may have been lost, others have been strengthened and new relationships are likely to have been developed. The person has developed a sense of meaning and purpose to their life, despite the physical challenges that they continue to endure. They are no longer defined by their illness; rather, the illness is viewed as one aspect of who they are.

Part 2 - How to move forward

The following psychological strategies can help you move through the four stages, so that, ultimately, you can "get on with your life."

It is essential to let go of blaming yourself - your illness is truly not your fault. It could happen to anyone. It is important to slowly develop compassion for yourself with what you are facing. It takes enormous strength to deal with a chronic illness and being able to validate this can be extremely helpful.

It is necessary that you slowly modify your expectations for what you need to accomplish each day. Unfortunately, compared with your earlier days, having a chronic condition necessitates using a different "yard stick" to evaluate your accomplishments. This can be hard to face. However, it is very important to learn to give yourself credit for the "small accomplishments" of each day. Pacing yourself, so that you do small chunks at a time, with breaks in between, is essential, so that you do not "crash" the next day.

In the initial stages of the illness, you may experience various emotional changes (e.g. outbursts of sadness or anger) in response to your illness. This is not unusual as you are dealing with significant changes in your life.

You may have to slowly learn when you need to ask others for help. Significant people in your life may truly not know how to support you. You may need to educate them with what you need. Finding helpful supports, through friends, family, or a therapist is essential for navigating through these phases. Seeking a support group of others who are facing a chronic condition can also be helpful.

At some point, it will be essential to go through a grief stage. This entails actively mourning the losses/changes in your life and the loss of your former self. Taking time in your day to allow feelings of sadness and anger, as well as journaling about your feelings is very important.

Writing a narrative about your "journey" with your illness can be valuable. This can assist you with developing new insights about yourself, others, and life. In this process, you can discover your true values and what is truly important and meaningful to you. Surprisingly, you will find a number of qualities that still remain true of you, even with the illness (e.g. empathy, creative side, sense of humor, keen interest in learning new things, etc.)

It will be essential to find new interests/hobbies that fit with the limitations imposed by your illness. Reading, writing, creating art work, playing a musical instrument, attending classical music performances in small venues, and having meaningful conversations with others are examples of the many possibilities.

You may also have to examine some tough existential questions regarding the unfairness of why the illness happened to you. Reconnecting with a religious faith or a spiritual belief system is enormously helpful in this regard. In the process of answering these questions, you can actually discover a greater sense of meaning from what you have experienced. Ironically, your life may take on a greater sense of depth and purpose, despite your illness.

Reading true stories about others who have used adversity to transform their lives in a meaningful way can also assist in developing greater meaning and purpose.

Reframing some of your losses and seeing them from a more positive perspective is also essential. For example, perhaps, you are no longer able to do weekly walks/hikes with your closest friend; however, you can attend monthly lectures on art history; or, you can engage in deep conversations about life, over coffee. In fact, despite your losses, your newly developed insights may, in turn be a "gift," You may have developed a compassion for the struggles of others, as well as a certain "wisdom" about life. Your insights might even inspire others or help them, in turn, create more meaningful lives.

Note: During all these stages, it is essential to continue to see your physician for ongoing monitoring of your condition. Additionally, the strategies described above take time and effort to implement. If you feel that you are not able to move forward through these stages, it is essential to get counseling from a licensed psychologist or counselor.

When Partners Start Forgetting

Tue, 17 Feb 2009 16:07:03 -0800

Allison is rushing to get ready for a theatre engagement with her sister. Frank notices the commotion and asks what's going on. "What are you talking about?" says Allison angrily, "I told you yesterday that I was going to the theatre with Marion. Don't you ever listen?" "You never told me that" says Frank. Allison now thinks that Frank is either playing games or he didn't care enough to listen to her in the first place.

Occasionally, one of us will forget something that the other has told us recently.

As couples age there may come a time when one or both partners has an occasional lapse in memory or maybe even more regular and noticable memory difficulties. This can be both irritating and concerning for the partner of the one who has become memory challenged.

Allison is definitely frustrated and annoyed but since this has happened before she is also getting worried. She wonders if their relationship is weakening or if Frank is becoming depressed or worse. Her frustrated response is just her knee-jerk reaction but she has noticed that since Frank retired they have more time and interactions together which might explain the greater number of incidents like this occurring.

Getting into a "Yes I did - No you didn't" type of argument only deteriorates into fault finding and harms the relationship. Allison has to admit that she occasionally forgets details that Frank tells her as well. Allison realizes she could have chosen to give Frank the benefit of the doubt and she vows that if this happens again she will clearly and kindly (and not condescendingly) repeat the forgotten detail. She wishes now that she had responded more caringly; something like "Sorry Frank, I meant to remind you that I'm going out to the theatre tonight with my sister. I know you wanted to stay home and watch the game anyway".

At other times, one of us will forget that we have already told a story or some non-critically important detail to the other.

"Frank, wait until I tell you about the piece of property that Marion and Stan bought" says Allison. "You already told me that three times" retorts Frank as he shakes his head. "What on earth is wrong with you?" Allison looks shocked and hurt and a bit frightened. "Did I really?" she asks softly. "Maybe there really is something wrong with me."

If Allison honestly doesn't remember having told the story before, how loving is it to blurt out a bruising statement like, "What's wrong with you?" or "You tell that same joke every Christmas."

When someone repeats the same story a second, third, or fourth time within a matter of days or weeks or even months, consider it a gift that they want to include you in their life! Rather than abruptly stopping the story, a wise and more loving choice may be to value the presence of the story-teller in your life and listen patiently and kindly. There are times when we all forget that we told a particular person a certain story or joke. Frank could have asked himself the question: "Has it really been helpful for Allison's memory functioning to remind her that she's already told me this story before?" And he can remind himself that Allison is simply sharing her excitement and in doing so is making a loving connection.

Young children often like to be told the same story over and over again, and they often like to repeat the same story. Rather than cut them off, most adults are very patient with their young children and grandchildren at these times. Maybe we can apply the same adult wisdom to our relationship with adults as well. And we should remember that we are all children in many ways and still learning.

Recent memory for non-life-threatening details should become less important than patience and wisdom in strengthening the relationship of a loving, aging couple.

My Midlife Crisis

Tue, 17 Feb 2009 15:23:46 -0800

I recently bought a high-powered sports car. It has an engine the size of a 747 and can go from zero to 100 in about one second. I tell people I wanted something that was sexy and racy with a hint of sophistication much like my own personality. This usually elicits those sad looks reserved for balding old men who fancy themselves as chick-magnets. This purchase was a spontaneous act, not in keeping with my down-to-earth, reserved and supposedly practical image. I even tried balancing a pair of dark designer sunglasses on top of my head like those really cool guys. Unfortunately I discovered that tri-focal sunglasses are extra heavy and keep falling into my lap. Did I mention the wicked Bose stereo system in the dashboard that can rattle the windows of houses three blocks away? My wife and grown children are still shaking their heads.

I've only had my vehicle for a few weeks but have already overheard several people mumble the words "midlife crisis" under their breath. That couldn't be me, not really. I'm just trying to have a little fun during my long daily commute to and from work. It's not like I traded my wife in for a younger model, bought a luxury yacht, chucked my career, and headed off into the sunset. Or is it?

Although the experts disagree on whether a midlife crisis actually exists there appears to be a time in our lives when we sense the passing of youth and the rapid advancement of old age. We begin to measure our age, not in years spent, but in years remaining. It's a time when we reflect back on our goals and accomplishments, if any, and take special note of our bad decisions and wasted opportunities. Did I really make my work a higher priority than my wife and kids and did I make money and status the holy grail of my existence? Did I allow my health to suffer at the same time by ignoring stress, good eating habits, and proper exercise? And that period of years between 40 and 60 is often when long-term marriages begin to deteriorate. Some even turn to alcohol or other drugs in a misguided attempt to relieve their painful realizations.

Many feel a need for adventure and change. I have friends in the over 50 crowd who have either retired early or work part-time. Some have taken on major challenges like walking across England from sea to sea, peddling their bikes on long journeys, building a log cabin, travelling around the world, and writing a book. Some simply savour the joy of babysitting their grandkids, volunteering at the Red Cross, or turning their backyard into the garden of their dreams.

The journey from youth to middle age and on into old age may seem frightening and discouraging but you can also choose to see it as an opportunity to re-evaluate and perhaps change the direction of your life. Rather than believing that aging is simply about having to give things up, try to think about what you'd like to start. When you reach 60 you could still be only two-thirds of the way through your life. That leaves a great deal of time to broaden your interests, travel, take courses, learn new skills, and take up new hobbies and sports. Or why not embark on some new challenging adventure? There is still a whole world of opportunity around us. Do what your health and interests allow so that in another few years you aren't looking back with even greater discouragement.

Those struggling with their current stage of life may want to consider contacting a counsellor or a lifestyle coach. Don't waste your time in regret. You may not be interested in buying a flashy new car but ... VROOM VROOM ... it works for me.

Winning Your Private Battles

Mon, 10 Nov 2008 11:31:30 -0800

He got the gold. Forty year old Eric Lamaze won an Olympic Gold medal for the individual show jumping competition in the 2008 Beijing Olympics, the first one for Canada in Olympic Equestrian show jumping since 1976. This happened years after being banned from competing on the world stage for a positive drug test. In an interview with CBC Sports he stated "when you give people chances and allow them to come back from their mistakes, great things happen and I'm a perfect example that you shouldn't give up on people". Mr. Lamaze is most definitively winning his private battle with cocaine abuse.

How does he do this? Or more importantly, how do any of us fight our private battles and win? Some of us may have a battle with our temper and have difficulty managing our anger in the face of frustrating circumstances or people. We may have difficulty managing our impulses and overspend or overeat. Others are controlled by addictions to substances or gambling, pornography or other unhealthy internet habits. And all of us struggle to some extent with the intensely private battles not evident to others - which come in the form of our own thoughts - criticizing, blaming or shaming ourselves and others. Because the struggles are so intense, we may presume defeat before the fight even begins.

There are two important phases to winning these private battles. In the first phase we need to grow in awareness and understanding of the behaviours that entrap us again and again. In the second phase we need to enact simple changes that move us out of self--defeating habits. Small, consistent changes lead to long term results.

There are three common self-defeating behaviours:
Short term comfort brings long term pain: When Sally gets frustrated with her boss's unreasonable expectations at work, she complies without comment, but is inwardly seething. Instead of discussing the problem constructively, she eats an extra donut or two at coffee break, which makes her feel better in the short term, but is causing her to gain weight and feel poorly about herself in the longer term.
The remedy: Replace self-defeating behaviors with alternative ones. Eating is not a helpful way for Sally to handle her emotions. It would be better for her to become aware of this pattern and instead, do something else. Writing her thoughts or taking a walk might be better alternatives. Better yet, she needs to consider how to carefully confront the situation at work, in order to make her workload more manageable and lessen her frustration with her boss.

Waiting to be in the right mood: Often we wait for the 'right mood" to hit us before we tackle something that needs to be done. While we're waiting, we engage in all sorts of activities to avoid what we know needs doing: we procrastinate, watch TV, surf the net, worry, sleep... the possibilities are endless.
The remedy: Avoid avoidance. None of the "waiting tactics" are as effective as actually getting to the task at hand. Often when we engage in doing what needs to be done, we even feel more motivated to do it. Once complete, we have a sense of accomplishment and confidence. Feelings not only cause behavior, they flow from behavior.

Rumination: This is one of the common activities repeatedly linked to depression. This is the act of dredging up and turning over repeated negative thoughts of past failures, resentments, comparisons with others or painful feelings and worries that perpetuate anxiety. Ruminating can be a way to avoid problem solving, and leads you to focus solely on yourself. It distorts perspective.
The Remedy: Become aware of your ruminating patterns and switch tracks. If you realize you have ruminated for more than two minutes and have not understood more about the problem, resolved it or felt better about yourself, move on. Just because a negative thought enters your mind does not mean you have to entertain it for any length of time. Recognize it for what it is - "here's that critical thinking again -- I need to move on." Don't argue with your negative thoughts, just move on to another topic.

When you are ready to making changes:

Decide and write out your commitment to change.
Become aware of your self-defeating habits. List them. When are you most susceptible to them?
Set achievable objectives. Change small simple things first.
Monitor your progress. Don't be discouraged with relapses. Perseverance brings success.
Practice wellness habits. Get enough sleep, exercise frequently, plan something positive for yourself each day, practice gratefulness and kindness. These are daily habits that can change your life.
Get help. Find people who believe in you and support you as you change. If changing negative patterns was easy, you would have done it by now.

I Just Can't Stop It

Mon, 10 Nov 2008 10:52:26 -0800

Eight year old Matthew, a handsome youngster in a Canucks jersey, appeared alert and polite, albeit a little anxious, when I greeted him in my waiting room. After settling Matthew into a drawing activity, I interviewed his parents regarding their son. They described Matthew, the eldest of three children, as succeeding in almost all aspects of his life- at school, with his peers, and in the hockey arena alongside his teammates.

Over the last several months, Matt had become increasingly worried about his health. That anxiety began shortly after Matt suffered a bout with the flu. Although he recovered within a few days, Matt continued to worry that he might be getting sick again. This anxiety had escalated to the point where Matt was now seeking repeated reassurance from his parents that he was in fact healthy. Bedtime had become especially difficult because Matt worried that he may become ill or even die during his sleep. Matt was also describing concerns about germs and he was avoiding specific foods that he feared might make him sick. His chaffed hands were evidence of excessive handwashing, an apparent attempt to avoid contamination.

His parents were becoming increasingly worried about how Matt's fears were impacting his younger brothers as well as complicating Matt's own life. They saw him investing time supervising his parents as they prepared his school lunch. He was also becoming reluctant to attend regular social events, most recently a team gathering and then a birthday party, because he was worried about what foods might be served or how others might react to his new concerns around foods. His parents felt confused and helpless in their efforts to support their previously happy and confident son.

When I interviewed Matt, he presented as attentive and capable. He described largely positive relationships with his siblings, parents and friends as well as typical interests- hockey and video games- and activities. Matt also described his worries in detail, and he became tearful when estimating how much time those anxious and unwelcomed thoughts cost him. He described feeling isolated in his worries- he didn't know anyone else who suffered such thoughts.

Matt was pleased to be at my office and he hoped for a solution to his problem. He was further interested to learn that there were in fact names for the unwelcomed thoughts that distressed him as well as for the repetitive actions- asking his parents to confirm he was okay, refusing suspect foods, and washing his hands repeatedly- that in the end only briefly alleviated his worries. Matt was relieved to hear that other children also suffered persistent and disruptive thoughts, called obsessions, and related behavioral urges, called compulsions. He was visibly disappointed to learn that there was no straightforward solution or easy cure for obsessions and compulsions, but he again became encouraged when he heard that there were strategies he could learn to more effectively manage those behaviors.

Over the next few months Matt and his parents worked together to learn about obsessive- compulsive disorder and how that could be treated. They learned that obsessive- compulsive behavior is understood to be a type of anxiety disorder caused by a combination of biological, psychological and social factors, and that it is diagnosed in approximately 1% of all children. Matt and his parents also learned that the primary treatment for obsessive- compulsive behavior is a combination of behavioural and cognitive behavioral therapy. They were informed that in severe cases psychological treatment works best in combination with medication to alleviate obsessive- compulisve symptoms.

In therapy Matt learned to identify and address anxiety through physical relaxation and by addressing anxiety provoking thoughts. Matt was treated with exposure/ response prevention therapy that supported him as he faced his fears while using strategies to resist the compulsive behaviors that he had employed in the past to reduce his anxieties. Through counselling, Matt's parents learned how to best support Matt in managing his obsessive- compulsive tendancies by helping him monitor his overall level of stress, by encouraging his use of new strategies and skills, and by being careful not to inadvertently enable his compulsive behaviors.

Four months after therapy began, Matt and his parents were reporting a marked decrease in his obsessive and compulsive behavior. Matt was feeling successful and increasingly confident in his ability to recognize and address intrusive thoughts and compulsive urges. Later on that year Matt's worry did escalate in anticipation of a grade 3 Science unit on the human body but he was ultimately able to address his distress and complete that unit of study with his class. Today Matt is effectively managing his obsessive- compulsive tendencies.

It is not unlikely that Matt will be again challenged by disruptive thoughts and/ or compulsive urges in the future. However, should that occur, Matt will undoubtedly respond to that experience with improved understanding and skill.

The Storm Within

Mon, 10 Nov 2008 10:25:15 -0800

Mary has suffered for years in her personal relationships and in her private world. Her behaviour, thoughts, and emotions were often described as though she was in the middle of a whirlwind.

When meeting men she would put them on a pedestal, idealizing them to the point where they appeared to reach near sainthood in her eyes. Shortly after, she would seek out their flaws and vulnerabilities and go on the attack. She said it was like "I'm fire or ice, hot and cold, I can lose control at the drop of dime, I say the most terrible things, ripping people to shreds. Once it's out of my system, I feel a calm return and expect people to carry on as though nothing happened. One partner said I had no idea of the devastation that I left during my rampages". Her emotional outbursts usually didn't last long, but for those around her it was described as "walking on eggshells", never quite knowing what might ignite her fuse. At times she is aware she is sabotaging these relationships but feels uncertain how to change her behaviour.

Mary also described intense fears of abandonment. It could be her partner going on a business trip, out for a hockey game, or leaving for work. She described her experience as "It becomes absolutely terrifying, it's difficult to put into words. Like I cease to exist or maybe he ceases to exist when he leaves. There is a strange emptiness inside me. I feel empty most of the time, but when someone I care about leaves, emotionally I feel they are gone forever and will never return. I've done crazy things to stop people leaving me. I can get really frantic, I've threatened to harm myself, tried to instil guilt, been manipulative. It's like I become a child, abandoned and helpless. Just isolated and alone".
Whether feeling abandoned or in her own private hell Mary has also engaged in numerous impulsive acts. When boyfriends left for business trips she may go and have affairs. At other times she would abuse drugs or alcohol; engage in out of control spending, bulimia, reckless driving, and the list goes on.

Over the years Mary has also engaged in recurrent suicidal behaviour. Cutting herself, threats of self harm or going to the edge of consuming excessive alcohol and overdoses of pills or drugs. At times this behaviour was used to manipulate others, at other times it was a manifestation of intense loneliness and pain. She has now come to realize that her intent was not to die, but rather the belief that she wanted to things to be different. How she could make this happen was a mystery to her. Stress could bring on the feeling of paranoia. Suspicions would abound and create thoughts that the world was out to get her. There was no love, no loyalty. She felt alone. During these times she could experience a floating sensation, as though she wasn't really here, didn't exist. Everything would appear foreign and strange.

The people closest to Mary were confused and devastated by her behaviour. One family member said "It's like she is saying 'I hate you, don't leave me' or 'I love you but get out of my life'. Things seem so dramatic, so over the top. We know she is hurting but are getting frustrated with her attempts to self destruct. We are caught in her vortex and feel helpless".

Mary and her family are not alone. The intensity, impulsivity, and extent of Mary's behaviour is indicative of someone who has traits of Borderline Personality Disorder.

Unfortunately, the person afflicted with these traits often feels like a leper. Mary said "It's like the very thing I fear the most, abandonment and the emptiness in my soul, becomes more intense as my behaviour pushes people away from me. I need to understand my emotions and control them, learn to communicate my needs in an unharmful way. I need to find out who I am, what I believe in, and learn to be a part of the world.

The above description of Mary's life is dramatic and intense. She has experienced the majority of traits that could be classified as borderline. However, in her quiet moments (yes she does have them) there is a warm, compassionate woman. She holds down a responsible job, volunteers, and is an accomplished musician. She would help anyone who needed her assistance. She takes care of two ailing parents.

She needs to learn how to take care of herself and develop the skills to nurture emotional intimacy.

If the above description seems familiar to yourself or someone close to you it may be helpful for you to seek therapy.