Private Practice Psychology

Definition
Attention-deficit/hyperactivity disorder is a neurobehavioral disorder characterized by a combination of inattentiveness, distractibility, hyperactivity, and impulsive behavior. AD/HD appears early in life. It is estimated that 3 percent to 7 percent of school-age children are diagnosed with AD/HD; boys are diagnosed more often than girls. Untreated AD/HD has been shown to have long-term adverse affects on academic performance, vocational success, and social-emotional development. AD/HD children have difficulty sitting still and paying attention in class and do not do well at school, even when they have normal or above-normal intelligence. They engage in a broad array of disruptive behaviors and experience peer rejection. As they grow older, children with untreated AD/HD are more prone to drug abuse, antisocial behavior, and injuries of all sorts. More than half the children diagnosed with AD/HD continue to have symptoms during their adolescent years and into adulthood.

Symptoms Diagnosing an adult with AD/HD is not easy. Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to understand some of the traits that have given him or her trouble for years—distractibility, impulsivity, restlessness. Other adults will seek professional help for depression or anxiety and will find out that the root cause of some of their emotional problems is AD/HD. They may have a history of school failures, problems at work, or frequent automobile accidents.

To be diagnosed with AD/HD, an adult must have childhood-onset, persistent, and current symptoms. The accuracy of the diagnosis of adult AD/HD is of utmost importance and should be made by a clinician with expertise in the area of attention dysfunction. For an accurate diagnosis, a history of the patient’s childhood behavior, together with an interview with his life partner, a parent, close friend, or other close associate, will be needed. A physical examination and psychological tests should also be given. Comorbidity with other conditions may exist such as specific learning disabilities, anxiety, or affective disorders.

A correct diagnosis of AD/HD can bring a sense of relief. The individual has brought into adulthood many negative perceptions of himself that may have led to low esteem. Now he can begin to understand why he has some of his problems and can begin to face them. This may mean, not only treatment for AD/HD but also psychotherapy that can help him cope with the anger he feels about the failure to diagnose the disorder when he was younger.

Causes Health professionals are still unsure about what causes AD/HD. It may be a genetically determined disorder, as attention disorders often run in families. Studies indicate that 25 percent of close relatives in the families of AD/HD children also have AD/HD, whereas the rate is about 5 percent in the general population. Many studies of twins now show that a strong genetic influence exists in the disorder.

Recent studies show that AD/HD is caused by neurobiological dysfunction. Scientists using neuroimaging and brain scanning tools for studying the brain have demonstrated a link between a person’s ability to maintain attention and the level of activity in the brain. For example, scientists have found differences between the frontal lobes of individuals who have AD/HD and those who do not.

Current research is exploring the structure of the brain to determine if there are differences that might indicate a physical basis for attention-deficit/hyperactivity disorder.

There is correlating evidence between the use of cigarettes and alcohol during pregnancy and the risk for developing AD/HD in the unborn child. These substances may endanger the fetus’ developing brain. It is best to refrain from smoking, alcohol use, and use of other drugs during pregnancy, as they may distort developing nerve cells and lead to AD/HD.

Toxins in the environment may also disrupt brain development or brain processes, which may lead to AD/HD. Lead is one such possible toxin. It is found in dust, soil, and flaking paint in areas where leaded gasoline or paint were once used. It is also present in some older water pipes.

There is, however, little compelling evidence that AD/HD stems from the home environment. Researchers report that not all children from unstable or dysfunctional homes have AD/HD, and not all children with AD/HD come from dysfunctional families. Scientists have also found no real evidence that head injury, undetectable damage to the brain, early infection, or complications at birth cause AD/HD.

Typically, adults with AD/HD are unaware that they have this disorder—they often just feel that it’s impossible to get organized, to stick to a job, to keep an appointment. The everyday tasks of getting up, getting dressed and ready for the day’s work, getting to work on time, and being productive on the job can be major challenges for the AD/HD adult.

Treatment When adults take a medication for AD/HD, they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for AD/HD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.

Antidepressants are considered a second choice for treatment of adults with AD/HD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of AD/HD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight, or at its regular dosage its effect may last longer in an adult. The adult may take other medications for physical problems, such as diabetes or high blood pressure; often the adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Although medication gives needed support, the individual must succeed on his own. To help in this struggle, both AD/HD education and individual psychotherapy can be helpful. The therapist can encourage the AD/HD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of AD/HD that are positive—boundless energy, warmth, and enthusiasm.

Treatment plans for adult AD/HD may include:

1. Consultation with appropriate medical professionals
2. Education about AD/HD
3. Medication
4. Support groups
5. Psychotherapy for help change a longstanding poor self-image
6. Coaching in organizational skills
7. Vocational/educational counseling
8. Appropriate accommodations for work and school (NIMH, 2006)

Sources:

• American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
• Barkley R.A. (2000). Taking Charge of AD/HD. New York: The Guilford Press, p. 21.
• Biederman J, Faraone SV, Keenan K, Knee D, Tsuang MF. (1990) Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29(4): 526-533.
• Consensus Development Panel (CDP) (1982). Defined Diets and Childhood Hyperactivity. National Institutes of Health Consensus Development Conference Summary, Volume 4(3).
• Faraone SV, Biederman J. (1998) Neurobiology of attention-deficit hyperactivity disorder. Biological Psychiatry, 44, 951-958.
• Harvard Mental Health Letter (2002). Attention Deficit Disorder in Adults. Vol. 19:5, 3-6.
• The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (AD/HD) (1999). Archives of General Psychiatry, 56:1073-1086.
• National Institute of Mental Health (2006). Attention-Deficit/Hyperactivity Disorder. Bethesda (MD): National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services. http://www.nimh.nih.gov/publicat/AD/HD.cfm#teen
• National Institutes of Health - National Library of Medicine - MedlinePlus, 2007. Attention deficit hyperactivity disorder (AD/HD). http://www.nlm.nih.gov/medlineplus/ency/article/001551.htm
• US Department of Justice (USDOJ) (2006). A Guide to Disability Rights Laws. Civil Rights Division: Disability Rights Section http://www.usdoj.gov/crt/ada/cguide.htm#anchor62335
• U.S. Department of Transportation, National Highway Traffic Safety Administration. State Legislative Fact Sheet, April 2002.
• Wilens TC, Faraone, SV, Biederman J, Gunawardene S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 111:1:179-185.
• Wilens TE, Biederman J, Spencer TJ. Attention (2002). deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53:113-131.

After many years of working with couples, I am a firm believer in the importance of nonsexual touch in marriage.

What is Nonsexual Touch?

Here are more examples of affection and nonsexual touch in marriage:

• Holding hands both privately and in public.
• Nonsexual massage of neck, shoulders, back.
• Hugs.
• Sitting close to one another both privately and in public.
• Kisses, especially unexpected kisses.
• Holding one another.
• Cuddling, snuggling.
• Walking arm in arm.
• Stroking.
• Reaching across the table to touch hands.
• Simple caring and tender gestures such as resting your hand on your spouse’s leg.
• Putting your hand on your spouse’s shoulder.
• Gentle caresses.

Why is Nonsexual Touch Important in Your Marriage?

Nonsexual touch and other signs of affection strengthens your marriage relationship, creates a comforting and calming atmosphere in your home, builds trust between the two of you, and deepens your intimacy with one another. Do not let nonsexual touch become a thing of the past in your marriage!

We all feel sad sometimes. Sadness is a normal emotion that can make life more interesting. Much art and poetry is inspired by sadness and melancholy. Sadness almost always accompanies loss. When we say goodbye to a loved one we usually feel sad. The sadness is even deeper if a close relationship has ended or a loved one has died.

Sadness also helps us appreciate happiness. When our mood eventually changes from sadness toward happiness the sense of contrast adds to the enjoyment of the mood.

Here are some ways to experience normal sadness in a healthy way and to allow this emotion to enrich your life:

• Allow yourself to be sad. Denying such feelings may force them underground, where they can do more damage with time. Cry if you feel like it. Notice if you feel relief after the tears stop.

• If you are feeling sad, plan a sadness day. Plan a day or evening just to be alone, listen to melancholy music, and to observe your thoughts and feelings.
  Planning time to be unhappy can be actually feel good. It can help you ultimately move into a more happy mood.

• Think about the context of the sad feelings. Are they related to a loss or an unhappy event? It is usually not as simple as discovering the “cause” of the sadness, but it may be possible to understand factors involved.

• Sadness can result from a change that you did not expect, or it can signal the need for a change in your life. Change is usually stressful, but it is necessary for growth.

• Know when sadness turns into depression. Get help if this happens rather than getting stuck in it.

Get help if you experience more than a couple of the following symptoms of depression:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain.

It is the end of our fourth session and Ming gets up and walks to the door. After the customary “see you next week,” she adds:”Thank you so much for these sessions. I really feel a lot better afterward.”

Uh oh.

A common misunderstanding about therapy is that its function is to help us “feel better” each week. Many equate psychotherapy with the day spa where we enter with tension and leave feeling relaxed and refreshed. Sometimes this is the case. But much of the time we leave with a greater understanding of the gravity, severity and prevalence of our issues. We think we have one problem but realize we have five. This does not always feel better; it can feel much worse.

That is why my response to Ming’s comment is “uh oh.” If she is expecting to always feel good after her sessions, she may be setting herself up for disappointment.

In the first few sessions the therapist and client are getting to know one another and explore the issues. If there is a good connection between them, clients often feel relieved, supported and hopeful. The issue they have held inside is finally being addressed, the therapist seems to care and understand without judgment, and there is a real sense that progress can be made. This feels good.

As the work continues, things often get worse before they get better. In his book The Heart of Psychotherapy, psychologist George Weinberg writes:

“In the course of psychotherapy, we help the person see the generality of his problem…As patients see, ‘This problem is more pervasive than I thought,’ they are occasionally disheartened somewhat…And to the extent that the problem was broader than they thought, the gain is greater when it is resolved.” (p. 18)

Ming entered therapy to better understand her difficulty with dating. She describes herself as a “serial monogamist” who dates men until her suspicions lead her to believe he is untrustworthy. In these first three sessions, she has been able to tell her story, vent a bit about her lousy relationships, and feel that I am working to understand and assist her. She truly feels better after the session because she was heard and supported. But our future sessions may go into uncomfortable territory.

We might discover that her suspicions have cost her many friendships as well. We could find that painful events in her childhood made trust very difficult to maintain. We might even find that her issues extend to herself - that she has a hard time trusting her own thoughts and feelings, and she projects this onto other people. These harsh realisations will not leave her with a spring in her step. This is the “disheartened” feeling Weinberg mentions.

I have seen many clients get to this point in therapy and decide to stop. We have opened several cans of worms and they simply feel overwhelmed. I do not blame them for feeling this way, but encourage them to stick with it. This is the pain we endure to achieve the gain. I equate this process with a person organizing a long-forgotten basement or closet - when you start pulling stuff out it is easy to feel overwhelmed by the clutter and sheer volume of material.

Leave it now, and you are stuck with a big mess on your hands. But push through and you will see gradual progress and eventually a more organised space.

I believe the goal of psychotherapy is to help each client grow in awareness, understanding, responsibility and acceptance. Rather than helping her “feel better” an hour a week, I hope therapy helps Ming know who she is, why she does what she does and feels how she feels. I hope it helps her realistically appraise her strengths and limitations, giving her the freedom to choose relationships, jobs and activities that bring her joy, accomplishment and contentment.

A funny thing happens when you don’t make a practice of listening to people. They find others who will. Anytime employees, spouses, colleagues, children, or friends no longer believe they are being listened to, they seek out people who will give them what they want. Sometimes the consequences can be disastrous: the end of a friendship, lack of authority at work, lessened parental infleunce, or the breakdown of a marriage.

What are the reasons why people fail to listen???

1. Lacking Focus

For some people, especially those with high energy, slowing down enough to listen can be challenging. Most people tend to speak about 180 words a minute, but they can listen at 300 to 500 words a minute. This disparity can create tension and cause a listener to lose focus. Most people try to fill up that communication gap by finding other things to do, such as day dreaming, think about their daily schedule or mentally review their to-do list, or watch other people.

2. Experiencing Mental Fatigue

Former president Ronald Reagan told an amusing story about two psychiatrists, one older and one younger. Each day they showed up at work immaculately dressed and alert. But at the end of the day, the younger doctor was frazzled and disheveled while the older man was as fresh as ever.

“How do you do it?” the younger psychiatrist finally asked his colleague. “You always stay so fresh after hearing patients all day.”

The older doctor replied, “It’s easy. I never listen.”

An eighty-nine year old woman with hearing problems visiting her doctor was told, “We now have a procedure that can correct your hearing problem. When would you like to schedule the operation?”

“There won’t be any operation because I don’t want my hearing corrected. I’m eighty-nine years old, and I’ve heard enough!”

So if you’re tired or facing difficult circumstances, remember that to remain an effective listening, you have to dig up more energy, concentrate and stay focused.

3. Selective Hearing

You have already stereotyped the people whom you are communicating with and this can be a huge barrier to listening.

“She’s just another woman. All she has to say revolves around shoes, handbags and clothes. Nothing will interest me.”

“She’s talking about her trip to Europe…oh yeah, been there done that. I won’t get anything new from listening to what she has to say.”

It tends to make us hear what we expect rather than what the person is actually saying. Most of us think that we don’t fall into this trap, but we all do to some degree.

4. Carrying Emotional Baggage

Nearly everyone has emotional filters that prevent him or her from hearing certain things that other people say. Your past experiences, both positive and negative, colour the way you look at life and shape your expectations. and particularly strong experiences, such as traumas or incidents from childhood, can make you tend to react strongly whenever you perceive you are in a similar situation. As Mark Tawin once said, “A cat who sits on a hot stove will never sit on a hot stove again. He’ll never sit on a cold stove either. From then on, that cat just won’t like stoves.”

If you’ve never worked enough through strong past emotional experiences, you may be filtering what others say through those experiences. If you’re preoccupied with certain topics, if a particular subject makes you defensive, or if you frequently project your point of view onto others, you may need to work through your issues before you can become an effective listener.

5. Being Preoccuped with Self

Simply said, if you don’t care about anyone but yourself, you are not going to listen to others. But the ironic thing is that when you don’t listen, the damage you do to yourself is ultimately even greater than what you do to other people.

Recent research has linked lack of sleep to a wide range of ailments, including memory problems and obesity. Learn more about some of the top reasons why you should get a good night’s sleep.

Sleep May Help You Learn More Effectively

Researchers have long believed that sleep plays an important role in memory, but recent evidence suggests that getting a good night’s sleep can improve learning. In one study, researchers found that depriving students of sleep after learning a new skill significantly decreased memory of that skill up to three days later (Winerman, 2006). Known as the memory consolidation theory of sleep, this notion proposes that sleep serves to process and retain information learned earlier while awake. While there is research both for and against the theory, many studies have shown that sleep can play an important role in certain types of memory.

Research Suggests Sleep Deprivation May Contribute to Obesity

In addition to affecting memory and learning, lack of sleep has been linked to body weight. In one 2005 study published in the Archives of Internal Medicine, overweight participants were found to sleep less than participants of a normal weight (Vorona et al., 2005). Brandon Peters, About.com’s Guide to Sleep Disorders, reports that poor sleep at age 30 months can predict obesity at age seven. While researchers do not yet understand exactly how sleep disruption impacts appetite and metabolism, getting a good night’s sleep certainly can’t hurt your weight loss or weight maintenance efforts.

Sleep is Important for Managing Stress

According to many experts, most people need between seven and eight hours of sleep each night. What happens when you don’t get enough sleep? Symptoms such as moodiness, anxiety, aggression and increased stress levels can result. About.com’s Guide to Stress Management, Elizabeth Scott, suggests taking “power naps” to combat drowsiness, reduce stress and increase productivity. While sleeping more certainly won’t eliminate all stress, it can help increase your readiness to cope with the stress of day-to-day life.

Sleep Can Help You Make Better Decisions

Have you ever found yourself struggling to make relatively simple decisions after a night of poor sleep? In addition to reducing such things as response time and accuracy, lack of sleep has also been linked to difficulty making good decisions. In one study published in the journal Sleep, researchers found that sleepiness has a serious impact on the ability to make effective decisions (Roehrs, 2004). Another study suggested that sleep impairs decision-making when gambling by increasing expectations of potential gains while minimizing losses. If you’re facing a challenging decision, make sure that you are well rested so that you will be at your best.

References

_{American Academy of Sleep Medicine (2007, May 5). Sleep Deprivation Can Threaten Competent Decision-making. ScienceDaily. National Sleep Foundation. (2008). Longer Work Days Leave Americans Nodding Off On the Job.}

_{Peters, B. (2008). Why so fat and tired?}

_{Roehrs, T., Greenwald, M., Roth T. (2004). Risk-taking behavior: effects of ethanol, caffeine, and basal sleepiness. Sleep, 27(5), 887-93.}

_{Vorona, R. et al. (2005, Jan. 10). Overweight and Obese Patients in a Primary Care Population Report Less Sleep Than Patients With a Normal Body Mass Index. Archives of Internal Medicine, 165, 25-30.}

_{Winerman, L. (2006). Let’s sleep on it: A good night’s sleep may be the key to effective learning, says recent research. Monitor on Psychology.}

If you and your spouse wind down at a different time the day, your sleep preference differences could hurt your marriage.

Changing your body clocks isn’t all that easy and actually may be impossible. So what can you do to keep these differences from having a negative impact on your marriage? Here are some suggestions.

Solutions for Married Night Owls and Early Birds

• Talk about it. Brainstorm solutions together.
• If you are an early bird don’t insist that your spouse go to bed when you go to bed. As your night owl spouse lies there unable to sleep, resentment will grow. Additionally, night owls can’t expect their early bird spouses to stay up way past their bedtime without being grouchy the next day.
• Consider having a few minutes each evening to share your day, your thoughts, and your feelings with one another.
• Agree to keep your bedroom free from television or computer usage.
• Avoid stressful conversations at the end of the day.
• Accept your early bird spouse’s need to have quiet time before going to bed.
• Find out if you can snuggle with your sleeping spouse. Some folks don’t want to have their sleep disturbed while others would love a snuggle.
• If you are an early bird believe and accept that staying up late doesn’t mean your night owl spouse loves you any less.
• Make the most of your “overlapping” hours together.

Please Note:
Seek help from your doctor if your inability to get a full night’s sleep lasts for more than a month. You could have chronic insomnia or other health issues.

Seek help from a marriage counselor if one of you is feigning sleep or staying late up to avoid sex or to avoid talking and/or connecting with one another.

All animals, including humans, use emotional displays to interact with one another. Aggression is the most dramatic example. Dogs growl, cats arch their backs, snakes hiss, horses stand up and wave their front legs menacingly, bulls kick sand, apes beat their chests, and humans puff up their muscles. (Early humans use to roar, which is why you talk in a more menacing voice when angry and want to scream in traffic.) There are just as obvious though less dramatic gestures of courtship, affiliation, playfulness, and interest in humans and other social animals.

More recent observations suggest that all social animals, including humans, put out much more subtle emotional signals as well — most of which are outside conscious awareness — and that these, too, affect how we interact with one another. Like all social animals, we can pretty much feel when someone is putting out positive or negative emotional energy, even if he or she makes no overt behavioral indication. Although we can’t tell what they’re thinking, we can read the emotional tone of most people — whether they are quiet or whether they are shouting — with a fair degree of accuracy. Of course, the accuracy declines as we move further from loved ones, friends, neighbors, and members of our own culture.

How many times have you asked someone you know, “Is anything wrong?”

“No, nothing’s wrong,” is the abrupt response. You don’t buy it because you know there is something wrong.

Even when we consciously try to shut out our unconscious perceptions of one another, we retain our natural sensitivity to each other’s emotions. That’s why you feel different when you ignore your spouse, compared to the way you feel when he or she is not in the room with you. It’s why you feel different when you’re the only one walking down your side of the street, compared to how you feel when the sidewalk is crowded with other people, whom you try to ignore.

This innate sensitivity to one another’s emotional states derives from the social nature of our central nervous systems. From the beginning of our time on this planet, humans lived in groups and tribes. We are very much social animals, hard-wired to interact emotionally, in subtle yet profound ways, with everyone we encounter. On a deep, visceral level, we continually draw energy from and contribute energy to a dynamic web of emotion that consists of everyone we interact with and everyone with whom they interact. Each person you pass on the street subtly reacts to you and vice versa. Each person you pass in turn subtly influences each person he or she passes. In the web of emotion, you never react to just one person but to everyone that person has recently encountered.

Whether we like it or not, we are emotionally connected to virtually everyone we encounter. Our only choice is to make the connection positive or negative, to put out compassion or download resentment, to clean up emotional pollution, or contribute to it.

Destructive behavior takes various forms: from subtle self-sabotage and self-defeating patterns to passive hostility to severe self-destructive symptoms, violent aggression and, sometimes, evil deeds.

Commonly, destructive behavior in adults bears the impetuous, impulsive quality of childish petulance or narcissistic temper tantrums. Or an infantile neediness, dependency, and dread of abandonment. Or an irresponsibility and angry refusal to be an adult: the “Peter Pan syndrome,” or what Jungians refer to as a puer or puella complex. The archetypal Jungian notion of the puer aeternus (male) or (female) puella aeterna–the eternal child–provides the basis for what has come in pop psychology and self-help movements (see, for example, the writings of Dr. Eric Berne, Dr. Alice Miller, or John Bradshaw) to be known as the “inner child.” What exactly is this so-called inner child? Does it truly exist? And why should we care?

To begin with, the inner child is real. Not literally. Nor physically. But figuratively, metaphorically real. It is–like complexes in general–a psychological or phenomenological reality, and an extraordinarily powerful one at that. Indeed, most mental disorders and destructive behavior patterns are, as Freud first intimated, more or less related to this unconscious part of ourselves. We were all once children, and still have that child dwelling within us. But most adults are quite unaware of this. And this lack of conscious relatedness to our own inner child is precisely where so many behavioral, emotional and relationship difficulties stem from.

The fact is that the majority of so-called adults are not truly adults at all. We all get older. Anyone, with a little luck, can do that. But, psychologically speaking, this is not adulthood. True adulthood hinges on acknowledging, accepting, and taking responsibility for loving and parenting one’s own inner child. For most adults, this never happens. Instead, their inner child has been denied, neglected, disparaged, abandoned or rejected. We are told by society to “grow up,” putting childish things aside.

To become adults, we have been taught that our inner child - representing our child-like capacity for innocence, wonder, awe, joy, sensitivity and playfulness - must be stifled, quarantined or even killed. The inner child comprises and potentiates these positive qualities. But it also holds our accumulated childhood hurts, traumas, fears and angers. “Grown-ups” are convinced they have successfully outgrown, jettisoned, and left this child - and its emotional baggage - long behind. But this is far from the truth.

In fact, these so-called grown-ups or adults are unwittingly being constantly influenced or covertly controlled by this unconscious inner child. For many, it is not an adult self directing their lives, but rather an emotionally wounded inner child inhabiting an adult body. A five-year-old running around in a forty-year-old frame.

It is a hurt, angry, fearful little boy or girl calling the shots, making adult decisions. A boy or girl being sent out into the world to do a man’s or woman’s job. A five or ten-year old (or two of them!) trying to engage in grown-up relationships. Can a child have a mature relationship? A career? An independent life?

Yet this is precisely what’s happening with us all everyday to some degree or another. And then we wonder why our relationships fall apart. Why we feel so anxious. Afraid. Insecure. Inferior. Small. Lost. Lonely. But think about it: How else would any child feel having to fend for themselves in an apparently adult world? Without proper parental supervision, protection, structure or support?

This is the confusing state of affairs we so frequently see in seekers of psychotherapy. It is not dissociative identity disorder (multiple personality), but rather a far more common, pervasive and insidious sort of socially sanctioned dissociation. But if we can recognize this problem for what it is, we can begin dealing with it, by choosing to become psychological - not just chronological - adults. How is this accomplished?

First, one becomes conscious of his or her own inner child. Remaining unconscious is what empowers the dissociated inner child to take possession of the personality at times, to overpower the will of the adult.

Next, we learn to take our inner child seriously, and to consciously communicate with that little girl or boy within: to listen to how he or she feels and what he or she needs from us here and now.

The often frustrated primal needs of that perennial inner child - for love, acceptance, protection, nurturance, understanding - remain the same today as when we were children. As pseudo-adults, we futilely attempt to force others into fulfilling these infantile needs for us. But this is doomed to failure. What we did not sufficiently receive in the past from our parents as children must be confronted in the present, painful though it may be. The past traumas, sadness, disappointments and depression cannot be changed and must be accepted.

Becoming an adult means swallowing this “bitter pill,” as I call it: that, unfortunately for most of us, certain infantile needs were, maliciously or not, unmet by our imperfect parents or caretakers. And they never will be, no matter how good or smart or attractive or spiritual or loving we become. Those days are over. What was done cannot be undone. We should not as adults now expect others to meet all of these unfulfilled childhood needs. They cannot.

Authentic adulthood requires both accepting the painful past and the primary responsibility for taking care of that inner child’s needs, for being a “good enough” parent to him or her now - and in the future.

At least in the sort of psychotherapy I practice, the adult part of the personality learns (and this, like much of therapy, is a learning process) to relate to the inner child exactly as a good parent relates to a flesh-and-blood child, providing discipline, limits, boundaries and structure.

These are all - along with support, nurturance, and acceptance - indispensable elements of loving and living with any child, whether metaphorical or actual. By initiating and maintaining an ongoing dialogue between the two, a reconciliation between inner child and mature adult can be reached. A new, mutually beneficial, cooperative, symbiotic relationship can be created in which the sometimes conflicting needs of both the adult self and inner child can be creatively satisfied.

Has your adult self spent time with your inner child today?

Red Flags in a Marriage

If you think your marriage is in trouble, it probably is. Every marriage relationship is unique, but there are common warning signs and red flags that indicate problems in the marriage.

Here are some of the more common warning signs of a troubled marriage.

• The two of you bicker a great deal.
• You are withdrawing from one another.
• You don’t fight fair.
• You no longer have fun together.
• You have nothing nice to say to one another.
• You don’t talk with one another about your problems.
• You don’t respect one another.
• You can’t agree on goals and values.
• You don’t trust one another and feel suspicious.
• The level of sexual intimacy in your marriage is low.
• One of you, or both, has been unfaithful.
• Teasing has become hurtful.
• Your spouse tries to isolate you from your family and friends.
• You are happier when your spouse is away from home for an afternoon, a meeting, or for a business trip.
• You realize that there is emotional and/or physical abuse in your marriage.

Don’t Wait to Seek Professional Help

To receive the most from marriage counseling, don’t wait until your marriage is beyond repair to get professional help.