A schema is a cognitive structure that serves as a framework for one’s knowledge about people, places, objects, and events. Schemas help people organize their knowledge of the world and understand new information. While these mental shortcuts are useful in helping us make sense of the large amount of information we encounter on a daily basis, they can also narrow our thinking and result in stereotypes.
Key Takeaways: Schema
A schema is a mental representation that enables us to organize our knowledge into categories.
Our schemas help us simplify our interactions with the world. They are mental shortcuts that can both help us and hurt us.
We use our schemas to learn and think more quickly. However, some of our schemas may also be stereotypes that cause us to misinterpret or incorrectly recall information.
There are many types of schemas, including object, person, social, event, role, and self schemas.
Schemas are modified as we gain more information. This process can occur through assimilation or accommodation.
Schema: Definition and Origins
The term schema was first introduced in 1923 by developmental psychologist Jean Piaget. Piaget proposed a stage theory of cognitive development that utilized schemas as one of its key components. Piaget defined schemas as basic units of knowledge that related to all aspects of the world. He suggested that different schemas are mentally applied in appropriate situations to help people both comprehend and interpret information. To Piaget, cognitive development hinges on an individual acquiring more schemas and increasing the nuance and complexity of existing schemas.
The concept of schema was later described by psychologist Frederic Bartlett in 1932. Bartlett conducted experiments that tested how schemas factored into people’s memory of events. He said that people organize concepts into mental constructs he dubbed schemas. He suggested that schemas help people process and remember information. So when an individual is confronted with information that fits their existing schema, they will interpret it based on that cognitive framework. However, information that doesn’t fit into an existing schema will be forgotten.
Examples of Schemas
For example, when a child is young, they may develop a schema for a dog. They know a dog walks on four legs, is hairy, and has a tail. When the child goes to the zoo for the first time and sees a tiger, they may initially think the tiger is a dog as well. From the child’s perspective, the tiger fits their schema for a dog.
The child’s parents may explain that this is a tiger, a wild animal. It is not a dog because it doesn’t bark, it doesn’t live in people’s houses, and it hunts for its food. After learning the differences between a tiger and a dog, the child will modify their existing dog schema and create a new tiger schema.
As the child grows older and learns more about animals, they will develop more animal schemas. At the same time, their existing schemas for animals like dogs, birds, and cats will be modified to accommodate any new information they learn about animals. This is a process that continues into adulthood for all kinds of knowledge.
Types of Schemas
There are many kinds of schemas that assist us in understanding the world around us, the people we interact with, and even ourselves. Types of schemas include:
Object schemas, which help us understand and interpret inanimate objects, including what different objects are and how they work. For example, we have a schema for what a door is and how to use it. Our door schema may also include subcategories like sliding doors, screen doors, and revolving doors.
Person schemas, which are created to help us understand specific people. For instance, one’s schema for their significant other will include the way the individual looks, the way they act, what they like and don’t like, and their personality traits.
Social schemas, which help us understand how to behave in different social situations. For example, if an individual plans to see a movie, their movie schema provides them with a general understanding of the type of social situation to expect when they go to the movie theater.
Event schemas, also called scripts, which encompass the sequence of actions and behaviors one expects during a given event. For example, when an individual goes to see a movie, they anticipate going to the theater, buying their ticket, selecting a seat, silencing their mobile phone, watching the movie, and then exiting the theater.
Self-schemas, which help us understand ourselves. They focus on what we know about who we are now, who we were in the past, and who we could be in the future.
Role schemas, which encompass our expectations of how a person in a specific social role will behave. For example, we expect a waiter to be warm and welcoming. While not all waiters will act that way, our schema sets our expectations of each waiter we interact with.
Modification of Schema
As our example of the child changing their dog schema after encountering a tiger illustrates, schemas can be modified. Piaget suggested that we grow intellectually by adjusting our schemas when new information comes from the world around us. Schemas can be adjusted through:
Assimilation, the process of applying the schemas we already possess to understand something new.
Accommodation, the process of changing an existing schema or creating a new one because new information doesn’t fit the schemas one already has.
Impact on Learning and Memory
Schemas help us interact with the world efficiently. They help us categorize incoming information so we can learn and think more quickly. As a result, if we encounter new information that fits an existing schema, we can efficiently understand and interpret it with minimal cognitive effort.
However, schemas can also impact what we pay attention to and how we interpret new information. New information that fits an existing schema is more likely to attract an individual’s attention. In fact, people will occasionally change or distort new information so it will more comfortably fit into their existing schemas.
In addition, our schemas impact what we remember. Scholars William F. Brewer and James C. Treyens demonstrated this in a 1981 study. They individually brought 30 participants into a room and told them that the space was the office of the principal investigator. They waited in the office and after 35 seconds were taken to a different room. There, they were instructed to list everything they remembered about the room they had just been waiting in. Participants’ recall of the room was much better for objects that fit into their schema of an office, but they were less successful at remembering objects that didn’t fit their schema. For example, most participants remembered that the office had a desk and a chair, but only eight recalled the skull or bulletin board in the room. In addition, nine participants claimed that they saw books in the office when in reality there weren’t any there.
How Our Schemas Get Us Into Trouble
The study by Brewer and Trevens demonstrates that we notice and remember things that fit into our schemas but overlook and forget things that don’t. In addition, when we recall a memory that activates a certain schema, we may adjust that memory to better fit that schema.
So while schemas can help us efficiently learn and understand new information, at times they may also derail that process. For instance, schemas can lead to prejudice. Some of our schemas will be stereotypes, generalized ideas about whole groups of people. Whenever we encounter an individual from a certain group that we have a stereotype about, we will expect their behavior to fit into our schema. This can cause us to misinterpret the actions and intentions of others.
For example, we may believe anyone who is elderly is mentally compromised. If we meet an older individual who is sharp and perceptive and engage in an intellectually stimulating conversation with them, that would challenge our stereotype. However, instead of changing our schema, we might simply believe the individual was having a good day. Or we might recall the one time during our conversation that the individual seemed to have trouble remembering a fact and forget about the rest of the discussion when they were able to recall information perfectly. Our dependence on our schemas to simplify our interactions with the world may cause us to maintain incorrect and damaging stereotypes.
The Faster EFT Tapping Basic Recipe is easy, quick, efficient, effective and a fun healing tool.
It is used to change the references held in the subconscious that result in problems in all areas of life.
It is this procedure that is used for every round of tapping.
This Faster EFT Tapping Basic Recipe method can be used to solve any issue — financial, personal, professional, emotional, psychological, physiological, health related.
This Faster EFT Tapping Basic Recipe has provided relief to thousands of people around the world with impressive results.
We encourage you to try and test this out for yourself.
But first, you will need to know the basics of Faster EFT Tapping, so let’s start!
With just SIX easy steps to learn, it is the Fastest EFT tapping technique out there.
The Faster EFT Tapping Basic Recipe has only FIVE steps, that takes only 30 seconds to do.
Anyone of any age can learn this simple technique and use it whenever they want, wherever they are with lasting results.
It may seem a little strange at first, but after a couple of round of using the Faster EFT Tapping Basic Recipe, you’ll feel more comfortable.
Just like with anything new you learn, it takes practice and persistence.
This will be a tool that can be used throughout your life, like brushing your teeth or taking a shower.
It’ll always be on hand for you to use, no matter the circumstances.
Why Faster EFT Works
In order for a problem to exist, there must be proof (the memory or record of an experience) and feelings.
Feelings are what make a problem a problem.
It is how you feel about something that determines whether it’s a problem or not.
If you feel good, that means you like something.
Conversely, if you feel bad, it means you don’t like something.
It’s that simple.
It is the feelings that make the problem real.
For example, Tom feels angry when he hears loud music in a parked car.
Another person, Tina, may enjoy the music.
She hears the same loud music, but she feels good.
In each of those cases, the subconscious is referencing a record that connects loud music in parked cars with either a negative meaning or a positive meaning; and then the brain signals the organs to produce the matching chemicals for those emotions.
How Faster EFT Tapping Basic Recipe works
FasterEFT is an energy based system as well, founded on Neurology and Biology.
Emotions affect both our physical and mental wellbeing.
So it follows that once your turbulent emotions are healed and cleaned up, you’ll have overall wellbeing.
The foundation belief in Faster EFT is that there is no disruption of energy, unlike traditional EFT.
In fact everything in your life and body is functioning as it should.
According to the way the brain has developed in order to survive in the environment, depending on your life’s experiences.
In Faster EFT, the tapping is used to disrupt the signal between the brain and the major organs of the body that trigger the fight or flight response while changing neural pathways in the neocortex of the brain.
The Faster EFT Tapping Basic Recipe doesn’t just deal with energy disruptions, which only fixes the outer issue of the problem.
It deals with the root cause of the problems, eliminating them completely.
Faster EFT recognizes that experiences are recorded in the subconscious for future reference.
This is how we learn to walk, drive, take a shower, eat, wash the dishes, type etc. without needing to consciously concentrate on every movement and decision.
Regular EFT specifically believes that negative emotions have nothing to do with memories, and are caused only by a disruption in the body’s energy system.
The Faster EFT Tapping Basic Recipe interrupts that signal between the brain and the organs by focusing on the meridian points connected to those organs.
This rewrites the reference or memory associated with that trigger.
For example, if Tom feels angered by the loud music and wanted to change that automatic response, he could use the Faster EFT Tapping Basic Recipe to disrupt the production of the chemicals that cause the feeling of anger when he hears the loud music.
And change the meaning of the loud music in his subconscious from “rude” or “disruptive” (or whatever they learned it means) to fun and enjoyment.
This will then result in an automatic feeling of enjoyment and fun when Tom hears that loud music in the future.
The Faster EFT Tapping Points
The following illustration is pretty straightforward and we’ll give a brief explanation with it as well.
For now, just identify each of these Faster EFT Tapping points on your body and follow along!
Step #1: Aim
Notice how you know you have the problem.
You don’t need to know what the emotions or feelings are, just notice how you know they’re there.
What do you feel?
Where in your body do you feel it?
What do you see or hear?
How do you know it’s a problem?
Step #2: Tap
Use two fingers to tap the following points, while focusing on the feeling of your fingers on your skin:
between your eyebrows
beside your eye
under your eye
just below your collarbone
While you are tapping, say “Let it go”. You can also add “It’s safe to let it go”.
Note: It doesn’t matter which side you tap — you can do either side, or both if you like.
Step #3: Peace
Grab your wrist, take a deep breath, blow it out, and say “peace” — and go to a peaceful memory for a moment.
Step #4: Check
Go back to your problem and take notice of how it’s changed.
Do you feel different?
Is the intensity of the feeling different?
Does the memory look or sound different?
Step #5: Repeat
Repeat steps two to four until the feeling or memory has “flipped” — in other words, the negative memory has been replaced by a positive memory.
Gaslighting is a form of psychological or emotional abuse — a series of manipulative techniques designed to gain control of another person. By blatantly and repeatedly lying or challenging reality, the gaslighters keep their victims off-kilter and make them question themselves. Many times, a person’s diagnosis of ADHD is used against him or her by the gaslighter. I have been a therapist for 20 years, and lately I have seen more and more clients with ADHD reporting being gaslighted in their relationships and at their jobs.
One of the best defenses against gaslighting is to educate yourself about this kind of emotional abuse. Adults with ADHD may be more vulnerable to gaslighting due to issues with self-esteem, difficulty with past relationships, and feelings of guilt and shame. Know that there is hope, and you can rebuild your life after living with gaslighting for months or even years.
Gaslighters sometimes hide their partners’ belongings and blame their partners for being “irresponsible,” “lazy,” or “so ADHD” when they can’t find the items. A gaslighter may also tell their partner that they don’t need to take medication for ADHD because “I know what you need better than some doctor does.”
Gaslighting behaviors include:
Telling you that you didn’t see or hear something
Cheating often, but obsessively accusing you of cheating
Saying that other people think you are crazy
Pitting you against people (this is known as “triangulating”)
Idealizing you, then devaluing you, and finally discarding the relationship
Gaslighters sense vulnerabilities in a person. They specifically target people who are grieving a loss or who feel inadequate or isolated. If you have ADHD, you probably grew up with the feeling that you were “less than.” You may have had difficulties maintaining friendships or relationships. You may have been dismissed by others who said you were “difficult.”
When you meet a gaslighter for the first time, he or she will do something called “love bombing.” They will tell you everything you have wanted to hear from someone, especially after a lifetime of rejection. The purpose of the behavior is to hook you. Once you are committed to the relationship, the gaslighter begins abusive behavior.
Early on, the gaslighter asks you about your fears and inadequacies. It feels good to have someone listening to you and caring about what you have to say. However, the gaslighter is gathering data to be used as ammunition against you later. You may eventually hear, “No wonder your sister doesn’t talk to you anymore. She knows you’re crazy, too.”
If you leave the relationship, the gaslighter will “hoover” — drawing you back. They will send messages through friends and family that they miss you. They will promise you the world, but will never apologize. They don’t think they did anything wrong. The threat of losing their ability to manipulate you motivates a gaslighter to get you back in their clutches. But once you return, everything promised to you disappears, and your relationship becomes more abusive than before.
How to Escape Gaslighting In a Relationship
For most people, leaving a gaslighting relationship means “no contact — at all.” Block phone numbers and email addresses. Tell friends and family that you will not listen to any messages sent through them. You should also meet with a licensed mental health professional; having ADHD makes you vulnerable to anxiety and mood disorders. Set up and follow through with an ADHD treatment plan, and re-establish connections with the healthy people in your life. If you have children with a gaslighter, meet with an attorney to establish a detailed parenting plan.
Gaslighting at the Workplace
Sometimes bosses and coworkers take advantage of the fact that someone has ADHD. They will accuse you of being forgetful or not caring about your work.
Chronic insomnia is defined as at least three restless nights per week for at least three months. (Alyssa L. Miller, Flickr cc)
While the American College of Physicians (ACP) can’t say cognitive behavioural therapy (CBT) outperforms medications for chronic insomnia, the group does say psychotherapy is less risky than drugs.
“Sometimes we forget that sleep medications have the potential for serious side-effects in some patients, while cognitive behavioural therapy is very low [risk] to patients,” said Dr. Wayne J. Riley, ACP president.
“The evidence is clear that CBT and sleep hygiene can be long lasting, life long, durable and delivered at a lower cost,” said Riley, who is also affiliated with Vanderbilt University in Nashville.
About 6 to 10 per cent of people in the U.S. have insomnia. Through loss of productivity, the condition is estimated to have cost the country about $63 billion US in 2009, according to the ACP committee that wrote the new guideline, which is published in the Annals of Internal Medicine.
Chronic insomnia is defined as at least three restless nights per week for at least three months.
“We wanted to take a deep dive into the literature for what makes a big difference with insomnia,” Riley told Reuters Health.
The ACP commissioned two reviews of insomnia treatments. One focused on medications, and the second focused on psychological and behavioural treatments.
Medication and ‘sleep driving’
Overall, the first review found that some medications may improve sleep over a short period of time, but those come with the potential for changes in thinking and behaviour. Additionally, there is a risk for infrequent but serious harms.
The U.S. Food and Drug Administration says medications for insomnia should only be used for short periods. The agency warns those drugs may impair people during the daytime, lead to “sleep driving,” behavioural changes and worsening depression.
The review of psychological and behavioural treatments found that CBT for insomnia improved overall sleep with a low risk of harms, the researchers report.
Evidence collected separately for the two reviews found that “side-effects can be quite severe with the use of insomnia medications in contrast to CBT, where there are minimal side-effects,” said Riley.
CBT for insomnia is typically delivered in four to six one-hour weekly sessions. People are taught behavioural techniques such as sleep restriction and stimulus control, and they are also taught sleep hygiene.
When chronic insomnia isn’t helped by CBT alone, the ACP advises patients and doctors to consider a short course of medication. That discussion should touch on the potential benefits, harms and costs of medication, the ACP says.
Doctors should encourage patients with insomnia to engage in CBT, according two researchers whose editorial was published with the reviews and the guideline.
‘Prescription not the best solution in the long term’
But, they admit, CBT for insomnia might not be covered by insurance and is likely not available at doctors’ offices, write Dr. Roger Kathol, of the University of Minnesota in Minneapolis, and J. Todd Arnedt, of the University of Michigan Medical School in Ann Arbor.
“Unless access to and unencumbered payment for value-based behavioural interventions, such as CBT (for insomnia), in medical settings become a reality, patients with chronic insomnia will continue to receive suboptimal treatment and experience suboptimal outcomes,” they write.
Alternatives to in-person CBT for insomnia include group therapy session, telephone counseling, online lessons and self-help books, Riley said.
The ACP recommendations are similar to that of the American Academy of Sleep Medicine (AASM), said Dr. Alcibiades Rodriguez, who is medical director of NYU Langone Medical Center’s Comprehensive Epilepsy Center-Sleep Center in New York City.
The AASM’s 2008 practice guidelines for treating chronic insomnia endorse psychotherapy as a first-line treatment and suggests it be used when medications are prescribed.
“The recommendations made by the ACP will appeal to a broader group of physicians to make them aware of this,” said Rodriguez, who was not involved with the new recommendations. “Then the doctors know just giving patients who come to their office with sleep problems a prescription is not the best solution in the long term.”
With that expert’s list of ways to manage anxiety, the latest trendy mental health app and that “magical cure for depression” your aunt heard about on TV, it seems like everyone’s full of mental health advice these days.
So, we asked our mental health community to share pieces of advice they’ve actually found helpful. These little nuggets of wisdom aren’t FDA-approved, but when used correctly side effects may include: self-care, acceptance and a little more patience with yourself.
Here’s some advice that’s actually helped people with mental illness:
1. “On a particularly difficult day, I was trying to fight through an anxiety attack and finish all the child-related tasks I needed to complete. My husband kept offering help, and I kept refusing. He pulled me aside in the laundry room as I was frantically folding another load and said, “Just let me help you.” It doesn’t immediately make the anxiety go away, but it’s helped me learn to let go.” — Maria Heldreth
2. “Don’t wait. See a doctor. Don’t be afraid to ask for help. Don’t be embarrassed. Chances are, someone knows exactly what you’re going through.” — Kristin Salber
3. “I have depression and anxiety (as well as other chronic medical conditions), and after the worst week I’ve had in a while, my doctor said,“Find something you enjoy, and if you can’t find that, find the joy in something.” This really had an impact on me and still reminds me to look for a silver lining.” — Faith Merryn
4. “I have generalized anxiety disorder, and I made friends with someone who’s extremely similar to me. She told me to always be myself and the people who truly care will stick around. It truly did help.” — Julia Ann Lange
5.“Words can hurt to say, but they need to come out. Write all those words down on paper.” — Melissa Cote
6. “A friend recently told me that no matter if I get a job one day or not,your life matters as long as you can make people smile. When I think of it that way, it’s easier to see my life as something of worth.” — Emma Wozny
7. “A great therapist I had told me to focus on ‘harm-reduction, not perfection.’ I felt like I was expected to magically ‘get better,’ and she helped me learn that starting with baby steps was totally OK.” — Jen Decker
After I Was Diagnosed With Bipolar Disorder, I Decided to Move Forward
When I was 17 years old, I was diagnosed with Bipolar Disorder, something that came as no surprise, as my life prior to my diagnosis was fraught with behavioral challenges. At 21 years old, after years of battling uncontrollable moods, fits of rage, a myriad of body image issues, addiction and frustration with finding adequate medication I found myself in my first psychotic episode. This was no way to live, I knew I was capable of so much more as an articulate young woman with big dreams. At 5 o’clock in the morning on July 7, 2011, after driving through the night with a head full of racing thoughts in a mind that possessed zero ability to cope, I found myself collapsed on the porch of my father’s home manic, enraged and inconsolable. I was surrendering, I could no longer fight the battle my life prior to that summer had felt so unrelenting and inhibiting. After a brief rest early that morning, the first few hours of sleep I had experienced in days, is when made my decision to thrive. For years prior to that hazy morning, I had been urged by loved ones to receive intensive clinical psychological treatment in a formal setting, but I believe part of me was always resisting in denial and arrogance. It was at the end of my rope where I found my desire to change the trajectory of my life. On July 11, 2011, I made the first imprints in the path toward my new way of being in the world. I spent 90 days in intensive psychological care and healing treatment where I acquired invaluable “tools” that allowed me to move forward in the world, the woman I was on my father’s porch that July morning became a shadow of my former self and an unwelcome stranger in my future.
Almost three years later not a day goes by where I don’t draw on the lessons learned through my decision to thrive. I am currently finishing my Bachelor’s degree in clinical psychology and work as a peer counselor to youth experiencing their first onset of mental illness in Los Angeles, California. Everything I do comes from a place of gratitude for my demons and experiences that catalyzed my decision to forge the path I am on today. For I would be nothing without them just as I would be nothing without the boundless compassion, patience and support of the loved ones in my life who have championed all of my efforts.
I used to think the notion that people could change was a farce … until I did it myself. I am changing everyday, creating a more authentic self with every opportunity to do so, and within the beautiful chaos of it all — I am thriving.
SUMMARY (repeated from Introduction) Listen first and acknowledge what you hear, even if you don’t agree with it, before expressing your experience or point of view . In order to get more of your conversation partner’s attention in tense situations, pay attention first: listen and give a brief restatement of what you have heard (especially feelings) before you express your own needs or position. The kind of listening recommended here separates acknowledging from approving or agreeing . Acknowledging another person’s thoughts and feelings does not have to mean that youapprove of or agree with that person’s actions or way of experiencing, or that you will do whatever someone asks.
By listening and then repeating back in your own words the essence and feeling of what you have just heard, from the speaker’s point of view, you allow the speaker to feel the satisfaction of being understood, (a major human need). Listening responsively is always worthwhile as a way of letting people know that you care about them. Our conversation partners do not automatically know how well we have understood them, and they may not be very good at asking for confirmation. When a conversation is tense or difficult it is even more important to listen first and acknowledge what you hear . Otherwise, your chances of being heard by the other person may be very poor.
Listening to others helps others to listen. In learning to better coordinate our life activities with the life activities of others, we would do well to resist two very popular (but terrible) models of communication: arguing a case in court and debating. In courts and debates, each side tries to make its own points and listens to the other side only to tear down the other side’s points. Since the debaters and attorneys rarely have to reach agreement or get anything done together, it doesn’t seem to matter how much ill will their conversational style generates. But most of us are in a very different situation . We probably spend most of our lives trying to arrange agreement and cooperative action, so we need to be concerned about engaging people, not defeating them. In business (and in family life, too) the person we defeat today will probably be the person whose cooperation we need tomorrow!
As Marshall Rosenberg reported in his book, Nonviolent Communication , “studies in labor-management negotiations demonstrate that the time required to reach conflict resolution is cut in half when each negotiator agrees, before responding, to repeat what the previous speaker had said.” (my emphasis)
When people are upset about something and want to talk about it their capacity to listen is greatly diminished. Trying to get your point across to a person who is trying to express a strong feeling will usually cause the other person to try even harder to get that emotion recognized. On the other hand, once people feel that their messages and feelings have been heard, they start to relax and they have more attention available for listening. For example, in a hospital a nurse might say, after listening to a patient: “I hear that you are very uncomfortable right now, Susan, and you would really like to get out of that bed and move around. But your doctor says your bones won’t heal unless you stay put for another week.” The patient in this example is much more likely to listen to the nurse than if the nurse simply said: “I’m really sorry, Susan, but you have to stay in bed. Your doctor says your bones won’t heal unless you stay put for another week.” What is missing in this second version is any acknowledgment of the patient’s present experience.
The power of simple acknowledging. The practice of responsive listening described here separates acknowledging the thoughts and feelings that a person expresses from approving, agreeing, advising, or persuading. Acknowledging another person’s thoughts and feelings…
…still leaves you the option of agreeing or disagreeing with that person’s point of view, actions or way of experiencing.
…still leaves you with the option of saying yes or no to a request.
…still leaves you with the option of saying more about the matter being discussed.
One recurring problem in conflict situations is that many people don’tseparate acknowledging from agreeing. They are joined together in people’s minds, somewhat like a two-boxes-of-soap “package deal” in a supermarket. The effect of this is, let us say, that John feels that any acknowledgment of Fred’s experience implies agreement and approval, therefore John will not acknowledge any of Fred’s experience. Fred tries harder to be heard and John tries harder not to hear. Of course, this is a recipe for stalemate (if not disaster).
People want both: to be understood and acknowledged on the one hand, and to be approved and agreed with, on the other. With practice, you can learn to respond first with a simple acknowledgment. As you do this, you may find that, figuratively speaking, you can give your conversation partners half of what they want, even if you can’t give them all of what they want. In many conflict situations that will be a giant step forward. Your conversation partners will also be more likely to acknowledge your position and experience, even if they don’t sympathize with you. This mutual acknowledgment can create an emotional atmosphere in which it is easier to work toward agreement or more gracefully accommodate disagreements. Here are three examples of acknowledgments that do not imply agreement:
Counselor to a drug abuse client: “I hear that you are feeling terrible right now and that you really want some drugs. And I want you to know that I’m still concerned this stuff you’re taking is going to kill you.”
Mother to seven-year-old: “I know that you want some more cake and ice cream, Jimmy, because it tastes so good, but you’ve already had three pieces and I’m really worried that you’ll get an upset tummy. That’s why I don’t want you to have any more.”
Union representative to company owner’s representative: “I understand from your presentation that you see XYZ Company as short of cash, threatened by foreign competition, and not in a position to agree to any wage increases. Now I would like us to explore contract arrangements that would allow my union members to get a wage increase and XYZ Company to advance its organizational goals.”
In each case a person’s listening to and acknowledgment of his or her conversation partner’s experience or position increases the chance that the conversation partner will be willing to listen in turn. The examples given above are all a bit long and include a declaration of the listener’s position or decision. In many conversations you may simply want to reassure your conversation partner with a word or two that you have heard and understood whatever they are experiencing. For example, saying, “You sound really happy [or sad] about that,” etc.
As you listen to the important people in your life, give very brief summaries of the experiences they are talking about and name the want or feeling that appears to be at the heart of the experience. For example:
“So you were really happy about that…”
“So you drove all the way over there and they didn’t have the part they promised you on the phone. What a let-down…
“Sounds like you wanted a big change in that situation…”
“Wow. Your dog got run over. You must be feeling really terrible…”
The point here is to empathize, not to advise. If you added to that last statement, “That total SLOB!!! You should sue that person who ran over your dog. People need to pay for their mistakes, etc.”, you would be taking over the conversation and also leading the person away from her or his feelings and toward your own.
Other suggestions about listening more responsively:
As a general rule, do not just repeat another person’s exact words.Summarize their experience in your own words . But in cases where people actually scream or shout something, sometimes you may want to repeat a few of their exact words in a quiet tone of voice to let them know that you have heard it just as they said it.
If the emotion is unclear, make a tentative guess, as in “So it sounds like maybe you were a little unhappy about all that…” The speaker will usually correct your guess if it needs correcting.
Listening is an art and there are very few fixed rules. Pay attention to whether the person speaking accepts your summary by saying things such as “yeah!”, “you got it,” “that’s right,” and similar responses.
If you can identify with what the other person is experiencing, then in your tone of voice (as you summarize what another person is going through), express a little of the feeling that your conversation partner is expressing. (Emotionally flat summaries feel strange and distant.)
Such compassionate listening is a powerful resource for navigating through life, and it also makes significant demands on us as listeners. We may need to learn how to hold our own ground while we restate someone else’s position. That takes practice. We also have to be able to listen to people’s criticisms or complaints without becoming disoriented or totally losing our sense of self worth. That requires cultivating a deeper sense of self worth, which is no small project. In spite of these difficulties, the results of compassion-ate, responsive listening have been so rewarding in my life that I have found it to be worth all the effort required.
Real life examples. Here are two brief, true stories about listening. The first is about listening going well and the second is about the heavy price people sometimes pay for not listening in an empathic way.
John Gottman describes his discovery that listening really works: “I remember the day I first discovered how Emotion Coaching [the author’s approach to empathic listening] might work with my own daughter, Moriah. She was two at the time and we were on a cross-country flight home after visiting with relatives. Bored, tired, and cranky, Moriah asked me for Zebra, her favorite stuffed animal and comfort object. Unfortunately, we had absentmindedly packed the well-worn critter in a suitcase that was checked at the baggage counter.
“I’m sorry, honey, but we can’t get Zebra right now. He’s in the big suitcase in another part of the airplane,” I explained.”I want Zebra,” she whined pitifully.
“I know, sweetheart. But Zebra isn’t here. He’s in the baggage compartment under-neath the plane and Daddy can’t get him until we get off the plane. I’m sorry.”
“I want Zebra! I want Zebra!” she moaned again. Then she started to cry, twisting in her safety seat and reaching futilely toward a bag on the floor where she’d seen me go for snacks.
“I know you want Zebra,” I said, feeling my blood pressure rise. “But he’s not in that bag. He’s not here and I can’t do anything about it. Look, why don’t we read about Ernie,” I said, fumbling for one of her favorite picture books.
“Not Ernie!” she wailed, angry now. “I want Zebra. I want him NOW!”
By now, I was getting “do something” looks from the passengers, from the airline attendants, from my wife, seated across the aisle. I looked at Moriah’s face, red with anger, and imagined how frustrated she must feel. After all, wasn’t I the guy who could whip up a peanut butter sandwich on demand? Make huge purple dinosaurs appear with the flip of a TV switch? Why was I withholding her favorite toy from her? Didn’t I understand how much she wanted it?
I felt bad. Then it dawned on me: I couldn’t get Zebra, but I could offer her the next best thing — a father’s comfort. “You wish you had Zebra now,” I said to her. “Yeah,” she said sadly.
“And you’re angry because we can’t get him for you.”
“You wish you could have Zebra right now,” I repeated, as she stared at me, looking rather curious, almost surprised. “Yeah,” she muttered. “I want him now.”
“You’re tired now, and smelling Zebra and cuddling with him would feel real good. I wish we had Zebra here so you could hold him. Even better, I wish we could get out of these seats and find a big, soft bed full of all your animals and pillows where we could just lie down.” “Yeah,” she agreed.
“We can’t get Zebra because he’s in another part of the airplane,” I said. “That makes you feel frustrated.” “Yeah,” she said with a sigh.
“I’m so sorry,” I said, watching the tension leave her face. She rested her head against the back of her safety seat. She continued to complain softly a few more times, but she was growing calmer. Within a few minutes, she was asleep.
Although Moriah was just two years old, she clearly knew what she wanted — her Zebra. Once she began to realize that getting it wasn’t possible, she wasn’t interested in my excuses, my arguments, or my diversions. My validation, however, was another matter. Finding out that I understood how she felt seemed to make her feel better. For me, it was a memorable testament to the power of empathy.”
Sam Keen describes a friend’s lament about the consequences of not listening deeply: “Long ago and far away, I expected love to be light and easy and without failure.
“Before we moved in together, we negotiated a prenuptial agreement. Neither of us had been married before, and we were both involved in our separate careers. So our agreement not to have children suited us both. Until… on the night she announced that her period was late and she was probably pregnant, we both treated the matter as an embarrassing accident with which we would have to deal. Why us? Why now? Without much discussion, we assumed we would do the rational thing — get an abortion. As the time approached, she began to play with hypothetical alternatives, to ask in a plaintive voice with half misty eyes: `Maybe we should keep the baby. Maybe we could get a live-in helper, and it wouldn’t interrupt our lives too much. Maybe I could even quit my job and be a full-time mother for a few years.` ”
“Maybe . . .“ To each maybe I answered: “Be realistic. Neither of us is willing to make the sacrifices to raise a child.“ She allowed herself to be convinced, silenced the voice of her irrational hopes and dreams, and terminated the pregnancy.
“It has been many years now since our `decision,` and we are still together and busy with our careers and our relationship. Still no children, even though we have recently been trying to get pregnant. I can’t help noticing that she suffers from spells of regret and guilt, and a certain mood of sadness settles over her. At times I know she longs for her missing child and imagines what he or she would be doing now. I reassure her that we did the right thing. But when I see her lingering guilt and pain and her worry that she missed her one chance to become a mother, I feel that I failed an important test of love. Because my mind had been closed to anything that would interrupt my plans for the future, I had listened to her without deep empathy or compassion. I’m no longer sure we made the right decision. I am sure that in refusing to enter into her agony, to share the pain of her ambivalence, I betrayed her.”
“I have asked for and, I think, received forgiveness, but there remains a scar that was caused by my insensitivity and self-absorption.”
[ Workbook editor’s note: I have not included this real life excerpt to make a point for or against abortion. The lesson I draw from this story is thatwhatever decision this couple made, they would have been able to live with that decision better if the husband had listened in a way that acknowledged all his wife’s feelings rather than listening only to argue her out of her feelings. What lesson do you draw from this story? ]
First exercise for Challenge 1: Active Listening. Find a practice partner. Take turns telling events from your lives. As you listen to your practice partner, sum up your practice partner’s overall experience and feelings in brief responses during the telling:
Your notes on this exercise:
Second exercise for Challenge 1: Learning from the past with the tools of the present. Think of one or more conversations in your life that went badly. Imagine how the conversations might have gone better with more responsive listening. Write down your alternative version of the conversation.
Suggestions for reading on the topic of listening.
The Power of Listening – An Ancient Practice for Our Future: Leon Berg
Free Article: Tell Me More an essay by Brenda Ueland, explores the transformative power of listening to friends and familiy members:
“I want to write about the great and powerful thing that listening is. And how we forget it. And how we don’t listen to our children, or those we love. And least of all — which is so important too — to those we do not love. But we should. Because listening is a magnetic and strange thing, a creative force. Think how the friends that really listen to us are the ones we move toward, and we want to sit in their radius as though it did us good, like ultraviolet rays.”
Free Article: Positive Deviant is a magazine article about the transformative power of deep listening, as it occurred in a program to reduce child malnutrition in Vietnam. It is one of the clearest examples I have ever read of what is now called “appreciative inquiry,” which advocates that helpers pay disciplined and systematic attention to the strengths, capacities and past successes of those people they wish to help.
[from the editor] Forms of compassionate listening have been practiced among Quakers and Buddhists for centuries, and among psychotherapists for decades. The late Gene Knudsen Hoffman (1919 – 2010) was both a Quaker peace activist and a pastoral counselor, and in my view she achieved two great things over the course of her life. First, she took the practice of compassionate listening out of the quiet environs of the Quaker meeting house, out from behind the closed doors of therapy session, and on to the stage of the world’s greatest conflicts. Her many trips to Russia and the Middle East have made her a legend in the peacemaking community. Second, she popularized compassionate listening in a generous way that invites and encourages other people to take up this practice, develop it and apply it in new areas. This small book is an expression of that generosity. Available for free around the world as an e-book, it includes both her lesson plans for Compassionate Listening Workshops and reports from Leah Green and Cynthia Monroe, two of her co-pioneers and creative colleagues.
Books: The following books can be found around the world, new and used, via the links below provided by the Global Find-A-Book service of Human Development Books, the publsher of this Seven Challenges Workbook. Click on the book titles below to bring up a Global Find-A-Book page for each title.
Listening is an essential skill worth every effort to learn and to master. Listening takes us out of our tendency toward self-absorption and self-protection. It opens us to the world around us and to the persons who matter most to us. When we listen, we learn, we grow, and we are nourished.
Why do we often feel cut off when speaking to the people closest to us? What is it that keeps so many of us from really listening? Practicing psychotherapists, Donoghue and Siegel answer these questions and more in this thoughtful, witty, and helpful look at the reasons why people don’t listen. Filled with vivid examples that clearly demonstrate easy-to-learn listening techniques, Are You Really Listening? is a guide to the secrets and joys of listening and being listened to. [From the publisher, Sorin Books] List price new, appx. $16. ISBN: 1893732886.
What do family members, coworkers, and friends want most but seldom get? Your undivided attention. Poor listening can be a cause of divorce, depression, customer dissatisfaction, low grades, and other ills. This Zen-based, practical guide will help you build relationships, sharpen concentration, create loyal clients, strengthen negotiating skills, hear what others miss, and get them to hear.[From the publisher, Quest Books] List price new, appx. $16. ISBN: 0835608263.
In this thoughtful anthology, eighteen contemporary spiritual teachers explore the transformative effects, and the difficulties, of skillful listening and suggest ways in which becoming a ‘listening warrior’ — someone who listens mindfully with focused attention — can improve relationships. Free of religious dogma and self-help clichés, the essays are inspiring, intelligent and accessible. [from the back cover] List price new, appx $17. ISBN: 0861713559.
Permission to Make Copies: Much of the material on this web site is available to be copied under the
terms of a Creative Commons license. Please look for the reproduction permissions at the bottom of
each page, and please check our Copyrights and Permissions page.
The following are criteria for Aspergers that have been excerpted from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV):
Qualitative impairment in social interaction, as manifested by at least two of the following:
Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
lack of social or emotional reciprocity
Restricted repetitive & stereotyped patterns of behavior, interests and activities
The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
There is no clinically significant general delay in language
There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction) and curiosity about the environment inchildhood.
They are often physically awkward and socially tactless.
You’ve probably known quite a few. Maybe they are even in your family. There’s that brilliant professor you had in college who looked at his desk the entire time he was talking to you and whose office was so overflowing with stuff there was nowhere for a visitor to sit. How about your brother-in-law the mechanic, whose work is superb but who insists on describing in minute detail exactly what he did to fix your car — and doesn’t seem to notice all your hints that you’re trying to leave already! What about your uncle or cousin or the sister of your best friend who is so socially awkward that you squirm with discomfort whenever they show up at an event, wondering what they’ll do next to embarrass themselves?
They are often physically awkward and socially tactless. They seem to be perfectionists but often live in chaos. They know more about some obscure or highly technical subject than seems possible — and go on and on about it. They may seem to lack empathy, and are often accused of being stubborn, selfish, or even mean. They can also be extremely loyal, sometimes painfully honest, highly disciplined and productive in their chosen field, and expert at whatever they decide to be expert at. They are the Aspies, adults with Asperger’s Syndrome.
The number of adults with Aspergers is still difficult to determine. The syndrome wasn’t even officially acknowledged in the DSM until 1994, even though it was described by Hans Asperger in 1944. The result? Many older adults weren’t diagnosed — or helped — as children. Teachers found them exasperating because they were so disorganized and uneven in their academic performance despite often being clearly bright. Other kids considered them weird and either bullied them or ignored them. As adults, they are only now discovering that there is a reason they’ve had difficulties with relationships their entire lives.
For many, having a diagnosis is a relief.
“I never could figure out what other people want,” says Jerome, one of my Aspie clients. “People seem to have some kind of code for getting along that is a mystery to me.”
Jerome is a brilliant chemist. He has the respect of his colleagues but he knows that he’s not well-liked. The finely tuned intuition he uses to do research breaks down completely in relationships.
“I know I’m well-regarded in my work. As long as we’re talking about a research problem, everything is fine. But as soon as people start doing that small talk stuff, I’m lost. It’s good to have a name for it. At least I know there’s a reason.”
Jerome is now starting to put the same intelligence he uses in his lab to learning better social skills. For him, it’s an academic problem to solve. Like many other Aspies, he wants to get along and have friends. He’s highly motivated to learn the “rules” most people take for granted. He just never understood what those rules were. Having the diagnosis has given him new energy for the project.
The press coverage of the syndrome of the last several years has been very helpful as well.
“I was working on a highly technical engineering project with a new guy last week. In the middle the morning, he put down his pencil, looked at me and said, “You have Aspergers, don’t you.”
Ted was explaining a recent encounter to me. “I got real nervous, thinking he was going to leave.”
“What did you say?” I asked.
“Well. I know now that’s my problem so I just said he was right. And you know what he said? He said, ‘I thought so’ and told me I could relax because he works with another guy who has the same thing. We had a great morning solving the problem. That wouldn’t have happened even a few years ago. I would have upset him somehow without understanding why. He would have gone back to his company thinking I was some kind of jerk. Things are just better now that there’s some understanding out there.”
Having the diagnosis has also saved more than a few marriages. Now that the kids are grown, Judy was ready to separate from her husband of 27 years when she first came to therapy.
“If Al and Tipper Gore could do it after 40 years of marriage, I figured I could manage it too. I don’t know what their problems were but I was just exhausted. I felt like I’d been single-parentingour two kids forever. Actually, I felt like I had three kids. Most of my friends couldn’t figure out what I saw in a guy who could only talk about one thing and who would rudely disappear in the middle of a social evening. He never seemed to be able to understand any of our feelings. Our finances were always a mess because he would lose track of bills. Yes, he was really sweet to me in our private life and he’s always been great about doing things like building the kids a tree house — that was really, really cool. But it became harder and harder to see that as a fair exchange for all the times I had to smooth things over because of something he did or didn’t do that bothered someone.
Then my daughter emailed me an article about Aspergers. It changed everything. I realized he wasn’t deliberately making life so hard. He couldn’t help it. As soon as he took an Aspie quiz online, he saw it was true. He does love us. He didn’t want the family to fall apart. He went right out and found a therapist who works with adults with Aspergers. He’s far from perfect but he’s honestly trying. He’s even apologized to the kids for not being more involved while they were growing up. I can’t ask for more than that.”
A diagnosis is primarily used to drive treatment decisions and to make it easier for clinical people to communicate with each other. But in cases like these, it can also be an enormous comfort to the individual and their families. As long as someone with Aspergers feels like they are being blamed or criticized for something they don’t even understand, they can only be defensive or bewildered. When the people around them feel offended or disrespected, they can only get exasperated, argue, or write them off. But when the thing that makes a relationship difficult is named and understood, it becomes a problem that can be worked on together. That shift can change everything.
All the employees of school districts on a witch hunt to expel and otherwise permanently punish young boys for shooting toy guns or forming their fists into the shape of a gun need to read Back to Normal.
The purpose of psychologist Enrico Gnaulati’s 2013 book is to argue how ordinary childhood behavior is often misdiagnosed as ADD, ADHD, depression and autism — frequently with life-long, disturbing consequences. But along the way he raises the taboo question of whether we “label boys as mentally unstable, behaviorally unmanageable, academically underachieving, in need of special-education services, or displaying behavior warranting school suspension just because their behavior deviates noticeably from that of the average girl?”
He adds, “In a sense, girl behavior has become the standard by which we judge all kids.”
He cites numerous studies showing that typical boy behavior – wrestling, rough games of tag, good guy/bad guy imaginative play that involves “shooting” — are condemned by preschool and elementary school teachers, the vast majority of whom are women, without the behavior being redirected appropriately to release boys’ “natural aggression.” Boys who play in the way noted above are not on a path to mass murder, contrary to what zero tolerance school policies suggest. For the vast majority of them, they are simply on the path to manhood. I wonder how many of us who recognize that truth still stifle our boys’ rough play or cowboy shoot outs out of fear of the new rules – reinforcing the capriciousness of regulations in young minds who will one day asked to make them.
Without changes to rigid policies and attitudes about what constitutes good behavior, we will be on a path as a society to generating mass confusion and depression in boys whose natural tendencies are being relabeled as criminal traits or medical problems that need to be treated.
This is not just an existential threat. As unorthodox feminist Camille Paglia said recently in remarks at American University:
Extravaganzas of gender experimentation sometimes precede cultural collapse, as they certainly did in Weimar Germany. Like late Rome, America too is an empire distracted by games and leisure pursuits. Now as then, there are forces aligning outside the borders, scattered fanatical hordes where the cult of heroic masculinity still has tremendous force. I close with this question: is a nation whose elite education is increasingly predicated on the neutralization of gender prepared to defend itself against that growing challenge?
If that sounds crazy, is it wrong to worry how the massive increase in the number of children taking anti-depressants and other drugs as a result of skyrocketing diagnoses of ADHD, bipolar disorder and autism spectrum disorder will impact their lives?
Many drugs used to treat the above disorders cause serious problems, including mood swings, sleeplessness, weight gain, weight loss and slower growth. And then there is the long-term impact of a mental health diagnosis, which can create a sense that the child is not in control of his actions because it is purely a chemical imbalance in the brain.
As Gnaulati writes, however, in many cases it’s “causes — plural, not singular — that explain why a child behaves the way he or she does.”
“On any number of occasions in my practice over the years,” he writes, “I have seen how a mildly depressed or ADHD-like kid can be transformed by a change of teacher, a change of school, signing up for a sport, a reduced homework load, a summer abroad, a front-of-the-class seating arrangement, a month living away from home with an even-tempered aunt, or any of a host of other everyday steps.”
Many forces conspire to push a mental health diagnosis, from rules on health insurance to schools achieving certain goals under federal No Child Left Behind law. Gnaulati’s book should give parents struggling with a difficult child hope that their child may not be permanently mentally ill, but going through a difficult stage that can be treated without medication. And it should give school administrators perspective on how best to handle unruly boys and channel their energy without condemning their nature. At the very least, we don’t need any more boys suspended for chewing a Pop-Tart into a gun.
If you’ve had time away from work, or have been long term unemployed due to mental or emotional health problems, you’re not alone. Almost 50% of long-term absences from work are due to mental health issues, including depression, anxiety and bipolar disorder.
People who have had a mental health problem and been out of work often worry about going back. Common concerns include facing discrimination or bullying, and going back too soon and feeling unwell again.
According to a recent report by the Royal College of Psychiatrists on mental health and work, “…many people with mental health problems fear that, no matter how good a recovery they have made, their symptoms will be made worse by going back to work.”
However, although work can cause stress to some people in some situations, recent research shows that for most people:
Work is beneficial to health and wellbeing.
Not being in work is detrimental to health and wellbeing.
Re-employment after a period of being out of work leads to an improvement in health and wellbeing.
The benefits of being in work can include:
a greater sense of identity and purpose
an opportunity to build new friendships
an improved financial situation and security
a feeling that you’re playing an active part in society
Going back to work after a period of ill health is usually a positive experience. This applies to people who have had severe mental health problems, such as bipolar disorder, as well as people coping with more common issues such as anxiety.
Returning to your job after taking sick leave
You don’t have to be 100% better or well to do your job, or at least some of it, and the benefits of returning to work generally outweigh the downsides.
If you already have a job that is still open for you, talk to your GP about going back to work. They can give you advice as part of your fit note. The fit note includes space for your GP to give you general advice about the impact of your illness, and to suggest ways in which your employer could support your return to work.
You may then like to arrange a meeting with your employer and/or your occupational health advisor. You can discuss anything that concerns you about returning to work, including your GP’s recommendations, and ask for some adjustments to make the transition back into work easier. Under the Disability Discrimination Act (1995) and the Equality Act (2010), your employer has a legal duty to make “reasonable adjustments” to your work. Depending on your particular circumstances, you might like to ask about:
Flexible hours, for instance you might like to return part-time, or start later in the day if you’re sleepy from medication in the mornings.
Support from a colleague, in the short or long term.
A place you can go to for a break when needed.
Access to Work
The Government provides support to help people with mental health problems continue to work, or find a new job.
You can find out more about the Access to Work scheme on the GOV.UK website. An Access to Work grant helps pay for practical support so that you can continue to do your job.
Looking for a new job
If you’re unemployed and want to get back into work, staff at your local Job Centre, your GP or your mental health worker can all give you advice about getting back into work.
If you have ongoing mental health issues, you can speak to the Disability Employment Advisor at your local Job Centre. They can tell you about the opportunities that are available to help people with mental health problems get back to work.
There are a number of different issues to consider and research when you’re thinking about getting back to work, including:
where you would like to work
what kind of work you’d like to do
what type of support you may need
your current financial situation, including any benefits you’re receiving related to your health
Full-time paid employment is not the only option available to you. There are a number of possibilities that may suit you, such as part-time work, or volunteering.
Volunteering is a popular way of getting back into working life. Helping other people in need is great for your self-esteem and can help take your mind off your own concerns. Plus, volunteer work can improve your chances of getting a paid job when you’re ready, and until then you can continue to claim your benefits. Find out more about how to volunteer.
Your rights and the law
Some people worry that when they apply for a job, they’ll be discriminated against if they admit that they have, or have had, mental or emotional health problems.
However, new provisions in the Equality Act 2010 make it illegal for employers to ask health or health-related questions before making a conditional offer of employment. Furthermore, it is illegal under the Equalities Act to discriminate against any kind of disability, including mental health issues.
Jane Nelsen and Lynn Lott have completed a DVD training that includes 6 1/2 hours filmed at a live training and requires about 5 1/2 hours of homework to practice the skills in order to receive a certificate as a Certified Positive Discipline Parent Educator. At the end of this training, you will be ready to lead parenting classes and/or improve your skills as a parent educator regardless of the setting in which you work. Click Here for More Details and Sample Video Clips.
When parents ask, “How do I motivate my teen?” they usually mean, “How do I get my teen to do what I want? How do I get her to have some balance in her life? How do I get him off the computer, get outside, or do just about anything except sitting around doing nothing?” Read More
Eighteen Ways to Avoid Power Struggles By Jane Nelsen
Power struggles create distance and hostility instead of closeness and trust. Distance and hostility create resentment, resistance, rebellion (or compliance with lowered self-esteem). Closeness and trust create a safe learning environment. You have a positive influence only in an atmosphere of closeness and trust where there is no fear of blame, shame or pain.” Read More
Mental illness is the leading cause of global disability, accounting for one-third of disability worldwide, according to 2008 data from the World Health Organization. In the United States, costs of mental illness are 7 percent of total health care expenditures, with the indirect costs substantially higher at 2 percent of U.S. GDP. Over a lifetime, 50 percent of the population will suffer from at least one psychiatric disorder, and each year, nearly 30 percent of adults have a diagnosable psychiatric disorder. Of patients treated, only 32.7 percent receive minimally adequate treatment, the greatest likelihood of receiving it being highest in the mental health service sector and lowest in the general medical sector, which treats the majority of psychiatric patients. Most U.S. psychiatric patients remain untreated or poorly treated.
Psychotherapy is often unrecognized as a low-cost, effective lever to decrease many kinds of costs caused by mental illness. Psychotherapy is defined broadly as treatment of one or more patients with psychological processes, primarily through talking, and includes a therapeutic relationship and a trained therapist. It can include individual, family, and group treatment from several theoretical orientations. Its effectiveness has been established for many conditions, and a growing body of evidence indicates that psychotherapy is cost-effective; reduces disability, morbidity, and mortality; and at times leads to a reduction of medical and surgical services.
Psychotherapy is especially cost-effective for severe disorders, including schizophrenia, bipolar affective disorder, and borderline personality disorder, by leading to improved work functioning and decreased use of hospitalization.
To contain costs, many managed care programs employ as psychotherapists mental health workers with no graduate training. Mojtabai and Olfson reported in 2008 that in U.S. office-based psychiatry practices from 1996 through 2005, psychiatrists provided increasingly more pharmacotherapy and less psychotherapy. Managed care has stressed short-term treatment and biological approaches for mental illness, leaving at risk patients who require a more intensive course of psychotherapy, either alone or in conjunction with psychotropic medication.
Cost-effective analyses determine the relationship between the value of an intervention and its economic impact. Benefits, often difficult to measure economically, include increased earnings of the individual affected, improved role functioning in terms of family and economic behavior, and improved physical and mental health.
“Cost-effective” does not mean “cheap.” It refers to the value returned per dollar spent (as opposed to cost reduction or dollars saved) and indicates a measure of efficiency that can at times be improved by spending more and at times less. Focusing solely on cost reduction may actually result in increased inefficiency. In fact, the need to demonstrate that psychotherapy provides cost savings in medical and surgical services, or “cost-offset,” is a double standard for psychotherapy compared with other medical treatments.
Three percent of the population has been in outpatient therapy, with the poor and near-poor using long-term treatment in proportion to their numbers in the population, disconfirming the stereotype of psychotherapy as an unnecessary self-indulgence for the affluent. Just as sicker people consume more services for most chronic medical conditions, patients in long-term psychotherapy (over 20 sessions) comprise 16 percent of therapy patients, account for 63 percent of psychotherapy costs, are more distressed and in poorer general health, have higher general medical costs and more functional impairment, are more likely to need psychotropic medication, and more likely to have a psychiatric hospitalization than patients in short-term therapy. Despite fear that readily available outpatient psychotherapy would be overused, a Rand Corporation study demonstrated that when weekly outpatient psychotherapy is fully covered, only 4.3 percent of the insured population uses it for an average of 11 sessions.
In an update of their 1994 study published in the November 2002 American Journal of Psychiatry, Olfson, Marcus, and Druss found no change in the overall rate of use of psychotherapy from 1987 to 1997, but the number of visits per patient was significantly lower, with a marked decline in the proportion of patients in longer-term psychotherapy from 15.7 percent to 10.3 percent. In 1987 a much larger percentage of psychotherapy patients (61.5 percent) were also receiving medication. One-third of psychotherapy patients received only one or two sessions, indicating that there is a decreased emphasis on a psychotherapeutic approach and that much of the psychotherapy in the United States is shallow and of limited benefit.
For years insurance companies have limited coverage for psychotherapy with higher copayments, stricter yearly limits, and lower lifetime limits than for other medical care. Despite the widespread assumption that psychotherapy benefits will be overused and inflate health care expenditures more than other medical benefits, studies document that higher copayments for mental health services reduce both initial access to and treatment intensity of mental health care and impact patients at all levels of clinical need. Very ill psychiatric patients are equally affected by discriminatory copayments, and managed care has caused a generalized reduction of psychiatric care.
In reality, there is a very low additional expense for providing parity for all appropriate treatments for mental illness, and a 2005 study found that parity increased costs by a few percentage points at most, reduced out-of-pocket costs for patients, and should be affordable on a national level.
In October 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act mandating insurance coverage for mental health treatment equal to that for other medical care was signed into law. The mandate applies to insurance plans that already cover mental health care in plans covering 50 or more, does not preempt stronger state laws, and took effect in 2010.
The volume Psychotherapy Is Worth It: A Comprehensive Review of Its Cost-Effectivenessexamines the literature on the cost-effectiveness of psychotherapy for the years 1994 through 2007. For some illnesses (anxiety disorders, posttraumatic stress disorder, and substance abuse), cost-effectiveness can be demonstrated indirectly by comparing the high costs of the untreated illness with the known efficacy of specific psychotherapeutic treatments. The majority of the studies document the cost-effectiveness of the psychotherapeutic treatments for schizophrenia, borderline personality disorder, depression, and psychiatric illness in medical patients and for chronic anxiety, depression, and personality disorders requiring extended and intensive psychotherapy.
Susan G. Lazar, M.D., is a clinical professor of psychiatry at Georgetown University School of Medicine, George Washington University School of Medicine, and the Uniformed Services University of the Health Sciences. She is a supervising and training analyst at the Washington Psychoanalytic Institute. She is the coauthor and editor of Psychotherapy Is Worth It: A Comprehensive Review of Its Cost-Effectiveness from American Psychiatric Publishing. APA members can order the book at a discount at www.appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=7215.
Because of a few high-profile individuals, anger management and aggressive outbursts have been in the public spotlight recently. They’ve spurred conversations about what anger is, what it means to lose control, and how to deal with anger. In some cases, people are also beginning to talk about the fact that anger, in and of itself, is not always a bad thing. What is anger? Mayo Clinic describes it as “a feeling of displeasure or hostility.” It functions as an alert that something is not right. People may become angry when they feel threatened. The problem with anger is not that it arises, but rather how it is handled.
The fact that anger arises at all is not the issue: but often, when a person is in a place of anger or hurt, they react with generalized accusations (“You never do what I ask!”) or aggression (slamming doors, yelling, antagonizing). Losing control to anger can change the way you think and how you feel, both physically and emotionally. This can be difficult because it takes an already volatile reaction and moves it farther away from a place of calm and control. When a person becomes angry, they can then become upset at this lack of control, which only makes them angrier.
How a person handles anger is exactly what anger management therapy is about. Reactions to anger can generally be broken into two categories: expression and suppression. Suppression is generally unhealthy, as it just bottles up the energy; it’s likely to come out later in a worse form for not having been dealt with. Expression can be done in a healthy way (calmly addressing the problem) or an unhealthy way (yelling and losing control). In anger management counseling, clients work not to avoid anger, but to understand where it comes from, why certain situations are so personally upsetting, and how to better respond without losing control.
Anger is a natural part of the human condition, but it isn’t always easy to handle. And when people don’t handle it well, the harm they do can be both visible and invisible.
Some people mask their anger. Others explode with rage. For still others, anger is a chronic condition, a habit of resentment that surfaces over and over again.
There are Ten Anger Styles:
Anger Avoidance: These people don’t like anger much. Some are afraid of their anger, or the anger of others. It can be scary and they are afraid to lose control if they get mad. Some think it’s bad to become angry. Anger avoiders gain the sense that being good or nice helps them feel safe and calm.
They have problems, though. Anger can help you to survive when something is wrong. Avoiders can’t be assertive, because they feel too guilty when they say what they want. Too often the result is that they are walked over by others.
Sneaky Anger: Anger Sneaks never let others know they are angry. Sometimes, they don’t even know how angry they are. But the anger comes out in other forms, such as forgetting things a lot, or saying they’ll do something, but never intending to follow through. Or, they sit around and frustrate everybody and their families. Anger Sneaks can look hurt and innocent and often ask, “Why are you gettting mad at me?” They gain a sense of control over their lives when they frustrate others. By doing little or nothing, or putting things off, they thwart other people’s plans. However, Anger Sneaks lose track of their own wants and needs. They don’t know what to do with their own lives and that leads to boredom, frustration, and unsatisfying relationships.
Paranoid Anger: This type of anger occurs when someone feels irrationally threatened by others. They seek aggression everywhere. They believe people want to take what is theirs. They expect others will attack them physically or verbally. Because of this belief, they spend much time jealously guarding and defending what they think is theirs – the love of a partner (real or imangined), their money, or their valuables. People with Paranoid anger give their anger away. They think everybody else is angry instead of acknowledging their own rage. They have found a way to get angry without guilt. Their anger is disguised as self-protection. It is expesive, though. They are insecure and trust nobody. They have poor judgment because they confuse their own feelings with those of others. They see their own anger in the eyes and words of their friends, mates, and co-workers. This leaves them (and everyone around them) confused.
Sudden Anger: People with sudden anger are like thunderstorms on a summer day. They zoom in from nowhere, blast everything in sight, and then vanish. Sometimes it’s only lightning and thunder, a big show that soon blows away. But often people get hurt, homes are broken up, and things are damaged that will take a long time to repair. Sudden Anger people gain a surge of power. They release all their feelings, so they feel good or relieved. Loss of control is a major problem with sudden anger. They can be a danger to themselves and others. They may get violent. They say and do things they later regret, but by then it’s too late to take them back.
Shame-Based Anger: People who need a lot of attention or are very sensitive to criticism often develop this style of anger. The slightest criticism sets off their own shame. Unfortunately, they don’t like themselves very much. They feel worthless, not good enough, broken, unloveable. So, when someone ignores them or says something negative, they take it as proof that the other person dislikes them as much as they dislike themselves. But that makes them really angry, so they lash out. They think, “You made me feel awful, so I’m going to hurt you back.” They get rid of their shame by blaming, criticizing, and ridiculing others. Their anger helps them get revenge against anybody they think shamed them. They avoid their own feelings of inadequacy by shaming others.
Raging against others to hide shame doesn’t work very well. They usually end up attacking the people they love. They continue to be oversensitive to insults because of their poor self-image. Their anger and loss of control only makes them feel worse about themselves.
Deliberate Anger:This anger is planned. People who use this anger usually know what they are doing. They aren’t really emotional about their anger, at least not at first. They like controlling others, and the best way they’ve discovered to do that is with anger and, sometimes, violence. Power and control are what people gain from deliberate anger. Their goal is to get what they want by threatening or overpowering others. This may work for a while, but this usually breaks down in the long run. People don’t like to be bullied and eventually they figure out ways to escape or get back at the bully.
Addictive Anger: Some people want or need the strong feelings that come with anger. They like the intensity even if they don’t like the trouble their anger causes them. Their anger is much more than a bad habit – it provides emotional excitement. It isn’t fun, but it’s powerful. These people look forward to the anger “rush,” and the emotional “high.” Anger addicts gain a sense of intensity and emotional power when they explode. They feel alive and full of energy. Addictions are inevitably painful and damaging. This addiction is no exception. They don’t learn other ways to feel good, so they become dependent upon their anger. They pick fights just to get high on anger. And, since they need intensity, their anger takes on an all-or-nothing pattern that creates more problems than it solves.
Habitual Anger: Anger can become a bad habit. Habitually angry people find themselves getting angry often, usually about small things that don’t bother others. They wake up grumpy. They go through the day looking for fights. They look for the worst in everything and everybody. They usually go to bed angry about something. They might even have angry dreams. Their angry thoughts set them up for more and more arguments. They can’t seem to quit being angry, even though they are unhappy. Habitually angry people gain predictibility. They always know what they feel. Life may be lousy but it is known, safe, and steady. However, they get trapped in their anger and it runs their lives. They can’t get close to the people they love because their anger keeps them away.
Moral Anger: Some people think they have a right to be angry when others have broken a rule. That makes the offenders bad, evil, wicked, sinful. They have to be scolded, maybe punished. People with this anger style feel outraged about what bad people are doing. They say they have a right to defend their “beliefs.” They claim moral superiority. They gain the sense that anger is for a good cause. They don’t feel guilty when they get angry because of this. They often feel superior to others even in their anger. These people suffer from black-and-white thinking, which means they see the world too simply. They fail to understand people who are different from themselves. They often have rigid ways of thinking and doing things. Another problem with this anger style is crusading – attacking every problem or difference of opinion with moral anger when compromise or understanding might be better.
Hate: Hate is a hardened anger. It is a nasty anger style that happens when someone decides that at least one other person is totally evil or bad. Forgiving the other person seems impossible. Instead, the hater vows to despise the offender. Hate starts as anger that doesn’t get resovled. Then it becomes resentment, and then a true hatred that can go on indefinitely. Haters often think about the ways they can punish the offender and they sometimes act on those ideas. These people feel they are innocent victims. They create a world of enemies to fight, and they attack them with great vigor and enthusiasm. However, this hatred causes serious damage over time. Haters can’t let go or get on with life. They become bitter and frustrated and their lives become mean, small and narrow.
Anger is a tricky emotion, difficult to use well until you learn how. It is a real help though, as long as you don’t get trapped in any of the anger styles aforementioned. People who use anger well have a healthy or “normal” relationship with their anger. They think of anger in the following characteristic ways:
Anger is a normal part of life
Anger is an accurate signal of real problems in a person’s life
Angry actions are screened carefully; you needn’t automatically get angry just because you could
Anger is expressed in moderation so there is no loss of control
The goal is to solve the problems, not just to express anger
Anger is clearly stated in ways that others can understand
Anger is temporary. It can be relinquished once an issue is resolved
When you practice good anger skills, you never need to use your anger as an excuse. You can take responsibility for what you say and do, even when you are mad.
The more you know about your personal anger style(s), the more control you will have over your life. You can learn to let go of excessive anger and resentment.
by Jerry Lopper, Personal Growth Coach on June 13, 2011 »
Image By Colin Brough
The influence of our parents is on my mind right now. Even as we become fully functioning adults and parents ourselves, it’s intriguing to consider how much of who we are is directly attributable to beliefs and experiences we encountered as children of our parents.
I’m reminded of this in reading Into My Father’s Wake, by journalist and author Eric Best. Best leaves his job, buys a sailboat, and sails solo from San Francisco to Hawaii and return in an attempt to resolve his relationship with his parents, especially his father.
A respected journalist, Best’s marriage is failing, he feels dead-ended in his job, and he struggles with alcohol and anger. The 50 day, 5,000 mile solo journey is his attempt to find himself and correct the path of his life.
Adult Children of Abusive Parents
Interspersed with fascinating descriptions of his sailing adventures, Best shares pleasant childhood memories of long sailing voyages with his father and disturbing memories of brutal beatings with a rubber hose at his father’s hands. He recalls his mother’s silent support of her husbands discipline, and struggles to come to terms with both parents’ treatments.
Most children are raised without the abusive behaviors demonstrated in Best’s book, yet don’t we all grow up carrying mixed images of our parents’ behaviors?
Psychologists offer an explanation that makes sense. Carl Pickhardt Ph.D. is a psychologist in private counseling practice who has authored several parenting books exploring the various phases of parent/child relationships as a child moves from childhood to adolescence to adulthood.
Pickhardt explains that the child idolizes and worships her parents, the adolescent criticizes and blames her parents as she begins the process of independence, and the adult rationalizes parental behaviors as she begins to understand the complexities of parental behavior.
The children of abusive parents experience conflicting and inconsistent adult behavior, at times nurturing and caring, at other times abusive and hurtful. Given the child’s total dependence and natural tendency to look up to her parents, the abused child is confused, ceases to trust, and may even assume she’s part of the problem. Best demonstrates how these conflicts carry into adulthood.
Children of non-abusive parents also experience conflicts. We see behaviors that are loving and caring as well as darker behaviors such as anger. We see our parents’ faults, tend to focus on those in adolescence, and may even carry their faults into adulthood as the reasons for our own failures.
Life Purpose and Our Parents
Looking at more positive aspects of parental influence, in The Celestine Prophecy, author James Redfield suggests that each person’s life purpose evolves from and extends the life purpose of their parents. Intrigued by this, I followed the suggested process of examining what each of my parents stood for (their strong beliefs and values) and where they fell short (weaknesses and limitations).
Sure enough, I could clearly see how my own life extended what each of my parent’s stood for and how I’ve developed interests and strengths which they lacked.
Since this analysis was valuable and informational to me, I added the process to my Purpose in Life Workshop content, expecting that others would also find valuable insights.
I was surprised by the responses of workshop participants. Though some found the process positive and helpful, a majority reacted strongly against the hypothesis, even resisting my encouragement to keep an open mind and explore the possibilities. It seemed a large number of people attribute their life’s problems directly to their parents.
Coming to Terms with Parents
What does this all mean? To me it simply means that parents are human beings, with the full range of human strengths and weaknesses. Parenting is tough work. Our parents made some mistakes along the way, as we have in our parenting roles.
On the road to adulthood, we’re exposed to many examples of behaviors, including the very influential examples of our parents. Whether they were outstanding parents or lacking in many ways, as adults our behaviors are ours alone. We can chose whether to copy behaviors of our parents or discard them. We can chose whether to cherish their parental talents or denounce them.
Personal growth involves insightful—sometimes painful—self-reflection. Personal growth also involves accepting the accountability and responsibility of personal choice for our behaviors.
Eric Best reaches this conclusion near the end of his solitary 50 day voyage, deciding to cherish the love and care his father displayed in teaching him to sail, while forgiving his brutal discipline as a terrible weakness of his father’s own personal struggles.
Into My Father’s Wake is a good story of a man’s journey of self-discovery. Those without sailing knowledge may struggle a bit with the sailor’s terminology, but all will appreciate the vivid imagery Best conveys as he describes the beauty and danger of solo-oceanic travel. I found that sharing Best’s struggles with the human frailties of his parents stimulated useful self-reflection on the influence of my own parents on my adult life.