IIAR Opens Facility In Springfield Illinois
Transcription
IIAR Opens Facility In Springfield Illinois
Illinois Institute for Addiction Recovery at Proctor Hospital Fall 2003 Vol. 8 No. 4 2002 Pinnacle Award Certificate of Merit & Healthcare Marketing Report Gold Award IIAR Opens Facility In Springfield Illinois PLUS: Obsessed with Lolita Too Much Empathy Should I Write a Prescription? NON PROFIT U.S. POSTAGE PAID PERMIT NO. 135 MIDLAND, MI 48640 SpotLight Table of Contents Fall 2003 The Illinois Institute for Addiction Recovery Vice President: Rick Zehr, M.S., C.S.A.D.C., C.C.G.C., P.C.G.C., MISA II announces the opening of their newest facility located in Springfield, Illinois Proctor Hospital opened a new addiction treatment facility in Springfield, Illinois. The new facility provides several levels of care including: partial hospitalization, intensive outpatient, aftercare, family and individual therapy. The Illinois Institute for Addiction Recovery at Springfield treats the following addictions: • • • • Chemical Gambling Spending Food • Sex • Internet • Chronic Pain with Addiction For additional information on the Illinois Institute for Addiction Recovery at Springfield and its treatment programs, call 1 (800) 522-3784 or visit the Web site www.addictionrecov.org. Administrative Director: Randee McGraw, C.S.A.D.C., N.C.G.C., C.E.A.P, C.A.D.P., MISA II Angie Moore provides a presentation on the IIAR’s award-winning quality improvement efforts during the NAATP annual conference. 14 2 Clerical Coordinator: Madge White F E Contributing Staff: Patricia Erickson, R.N., C.A.R.N. Bryan DeNure, M.A., C.A.D.C., MISA II Pamela Hillyard, L.C.P.C., C.A.D.C., P.C.G.C., I.C.G.C. Phil Scherer, C.S.A.D.C., C.C.G.C., MISA II Mary Murphy-Howard, R.N. Director of Communications: Steve Wilson 16 20 A T U R E 4 IIAR’s intervention services 6 Should I Write a Prescription? Pain patient’s with a history of addiction By Howard A. Heit, M.D., F.A.C.P., F.A.S.A.M. 12 Too Much Empathy? Neglecting your own wants and needs By Nina W. Brown, Ed.D., LPC, NCC 14 Girls Will Be Girls Raising confident, courageous daughters By JoAnn Deak, Ph.D. 20 Art Credits Obsessed with Lolita Cover Titled “Thanksgiving Harvest” by Ashlie Modeling on the internet The Children’s Art Project at The University of Texas M. D. Anderson Cancer Center began with one volunteer’s creative idea 30 years ago. Since then, thanks to the dedication of thousands of inspired volunteers, customers and community and corporate supporters, the Project has supported more than $17 million in patient-focused programs at M. D. Anderson. Today, the Project is one of the country’s largest and most well-known charitable card projects. By Dorn Checkley Art Courtesy of NARSAD page 10 Untitled by Richard Gallagher page 14 Titled “Little Mommy” by Larry Walker page 16 Untitled by Jeffery Guerin NARSAD Artworks products showcase the art of talented artists who happen to suffer from brain disorders called mental illness. All sale proceeds go to fund mental illness research. For information or a free color brochure call 1 (800) 607-2599. You may also visit the Web site www.narsadartworks.org. S Intervention ©2003 Targeted Publications Group, Inc. All rights reserved. PARADIGM magazine is published quarterly by the Illinois Institute for Addiction Recovery at Proctor Hospital with general offices at 5409 N. Knoxville Ave., Peoria, Ill. 61614. Bulk Rate postage is paid at Moline, Ill. and additional offices. PARADIGM is a registered trademark of Targeted Publications Group, Inc. and is licensed to the above publisher. No article in this issue and no part of this publication may be reproduced without the expressed written permission of the Publisher and Targeted Publications Group, Inc. SUBSCRIPTIONS: Subscriptions in the United States are $18.00 for one year and $36.00 elsewhere outside the United States. Back issue rate is $9.00. Send subscriptions to Eric Zehr, Proctor Hospital, 5409 N. Knoxville Ave., Peoria, Ill. 61614. Allow 6-8 weeks for new subscriptions. Allow 6-8 weeks for change of address. For more information, phone Eric Zehr at 1 (800) 522-3784. For a free catalogue of the Children’s Art Project holiday cards and gift items, featuring young cancer patients’ art, or to volunteer, call 1 (800) 231-1580 or visit the Web site www.childrensart.org. Ronald J. Hunsicker, D.Min., FACATA, President and CEO of NAATP presents the 2003 James W. West, M.D. Quality Improvement Award to Angie Moore, MS, MHSA, CMADC, CCGC, LCPC, Manager, Illinois Institute for Addiction Recovery. 12 Manager: Angie Moore, L.C.P.C., C.M.A.D.C., C.C.G.C., MISA II POSTMASTER: Send address changes to: Eric Zehr Proctor Hospital 5409 N. Knoxville Avenue Peoria, Ill. 61614 IIAR Wins Prestigious West Award The Illinois Institute for Addiction Recovery at Proctor Hospital received the 2003 James W. West, M.D., Quality Improvement Award presented by the National Association of Addiction Treatment Providers at the 2003 annual conference in Indian Wells, California. Among the many distinguished guests were former President Gerald R. Ford and Mrs. Betty Ford who together received the 2003 Nelson J. Bradley Life Time Achievement Award. In addition, the IIAR was featured in the April 2003 Behavioral Healthcare Tomorrow magazine for its quality improvement efforts. Medical Directors: James Bowman, M.D. Steven Ingalsbe, M.D. Ameel Rashid, M.D. D E P A R T M E N T SpotLight • 2 New Facility Opens in Springfield, Illinois Profile • 4 The Christopher D. Smithers Foundation, Inc. By Mary Allen On Track • 10 The Hunt for Heroes, Heaven and Happiness By Pamela Teaney Thomas, M.Ed. Perspectives • 16 Seizing the Moment By Grace Jo P. O’Leary, C.A.D.C. Lighten Up • 19 Using Humor to Reduce Stress By Linda Hutchinson Calendar • 23 Training and Workshop Schedule for 2003 S Profile by Mary Allen immersed in being a farmer until World War II when he entered the Army. He was discharged in 1945 as a Major. T h e C h r i s t o p h e r D . S m i t h e r s Fo u n d a t i o n , I n c . Shortly after his father’s passing, Brink himself marked an important date — his sobriety. It was almost fifty years ago that Yvelin Gardner, Deputy Director of the National Council on Alcoholism, met with Brink and told him, “Brink, you have a disease and there is treatment for it.” These words changed the direction of Brink’s life and the shape of the mission of the Foundation. It signaled Brink’s recovery from alcoholism, his life’s dedication to the alcoholism cause and the start of the Foundation’s close working relationship with the National Council on Alcoholism. It was truly the beginning of the alcoholism movement in this country and ultimately the world. 4 R. Brinkley “Brink” Smithers founded the Christopher D. Smithers Foundation on October 21, 1952 in memory of his late father. Brink was born in 1907 to Christopher D. and Mabel Brinkley Smithers in New York. His father was a member of the IBM Executive and Finance Committees for many years and his contribution toward the growth of this leading business machines company spanned a period of 39 years. Educated at the Browning School in New York City and St. George’s School at Newport, Rhode Island, Brink entered Johns Hopkins University in Baltimore, Maryland in the fall of 1927. It was his intention to become a physician and Johns Hopkins had one of the prominent medical schools in this country. However, after his second year of “pre-med” study, Brink began evidencing the early signs of alcoholism. His father thought he was using school as a country club and withdrew him from Johns Hopkins. He began work in 1929 as a trainee at Brown Brothers & Co., investment bankers on Wall Street, just two weeks before the “Great Depression” of the 1930’s. After two years of training in investment banking, Brink joined the 1932 summer sales school, held by IBM in Endicott, New York. He remained with IBM until October 1936. Shortly thereafter, Brink found that his work was interfering with his drinking, and he resigned from the firm at the age of 30, much to his father’s disappointment. He bought a farm in Maryland and was Paradigm • Fall 2003 In January 1946 his sister, Mabel, died suddenly. Since she was the only other living child, his father and mother were in shock. Brink sold his farm and moved home to Locust Valley, Long Island, New York. There Brink established a Kaiser-Frazer auto franchise and took into partnership a boyhood friend. Both Smithers and his partner were heavy drinkers. After his friend died suddenly due to alcoholism, Brink finally realized that he had a drinking problem too. THE CHISTOPHER D. SMITHERS FOUNDATION, INC. After recovering from alcoholism in 1954, Brink dedicated his life to the creation of a better understanding of alcoholism. After attending the Yale Summer School of Alcohol Studies in 1956, Brink decided that the family charitable foundation should concentrate on this health problem. He also shared his personal resources to fight against this disease. The Smithers Foundation is neither “wet” nor “dry” and solely concerned with alcoholism as a disease. When the Foundation made its first alcoholism grant of $1,000 to the National Committee on Alcoholism (now NCADD) in 1955, there were few organizations or individuals interested in dealing with this serious, frequently fatal illness; because among the nation’s charitable foundations, any major interest in such a stigmatized illness was considered undignified. A strong advocate of grass roots involvement in the war against alcoholism, Brink and the Foundation provided seed grants to help establish the National Council on Alcoholism and Drug Dependence (NCADD) affiliates in 36 states and the District of Columbia. He served for 10 years in various volunteer leadership capacities within NCADD. Brink was Honorary President of NCADD and a member of the executive, nominating and awards committees. The Foundation celebrated 50 years in 2002. Over the past fifty plus years, the Foundation, under the leadership of the late R. Brinkley Smithers and Adele Smithers-Fornaci, worked tirelessly to remove the stigma attached to alcoholism, to encourage others to join in the fight against it and were instrumental in helping in every area of this monumental task. In 1971 his $10 million grant to New York City’s Roosevelt Hospital in Manhattan established the Smithers Alcoholism Treatment and Training Center. The center was first program of its type in the world to be an integral part of a major hospital, providing detoxification, rehabilitation and professional training. This was the largest grant ever made by any individual or organization (including the federal government) to the fight against alcoholism. He wanted the rehab program run in a separate facility and personally selected a grand $1 million mansion to house it. In 1994 Brink passed away. Only a year after his death, St. Luke’sRoosevelt Hospital Center decided to sell off the mansion and move the center to a hospital ward. Brink’s widow, Adele Smithers-Fornaci, is suing St. Luke’s for the sale and for its administration of a $10 million endowment left by Brink. She had discovered that the hospital had used some of the endowment, which was restricted to financing alcoholism treatment, for other expenses. “If money is given for a certain cause or to be spent in a certain way, then I think it should be used for that cause or spent in that way,” she said. Currently, the case is pending in the New York State Supreme Court. A trial date has not been scheduled. Adele C. Smithers-Fornaci continues the mission of the Foundation established by her late husband — “to create a better understanding of this baffling, complex disease and to have alcoholism recognized as a respectable, treatable disease from which people can and do recover.” For the past 43 years, Adele Smithers-Fornaci has devoted herself to the field of alcoholism. She is an activist for creating greater understanding of alcoholism, the recipient of countless awards and honors over the years, and remains active in many community and charitable organizations today.M For additional information call (516) 676-0067, email: info@smithersfoundation.org or visit the Web site www.smithersfoundation.org. The Foundation Celebrates 50 Years For example, in 1952: • There were practically no treatment facilities for alcoholics. Today, alcoholics and their families may receive help and referral in just about every community in the country. Brink’ $10 million gift to the Roosevelt Hospital in New York City in 1971 established the Smithers Alcoholism Treatment and Training Center. This was the first facility for alcoholism to be included as an integral part of a leading hospital’s program and became the model for similar units throughout the country and the world. • The federal government had little concern with the disease of alcoholism. In 1970 Congress passed legislation recognizing alcohol abuse and alcoholism as major public health problems and created the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Today NIAAA has excellent programs, mostly in research. • Companies and unions regarded alcoholics as “drunks” and fired them. Today, most large corporations have Employee Assistance Programs where such employees are referred to treatment and restored to productive lives. • Few physicians would treat alcoholism. Today, the American Society of Addiction Medicine boasts thousands of members — all involved in treating alcoholics. • Colleges and universities ignored alcoholism. Today, few campuses are without a program to conduct alcoholism research and educate students to facts that they can have fun in an alcoholfree environment. • The stigma attached to alcoholism was so strong that public figures with alcoholism never identified themselves. Today, celebrities speak about their alcoholism recoveries openly, and thus encourage active alcoholics to seek help. • Media coverage of alcoholism was scarce or “sensational” in nature. Today, all forms of the mass media give thoughtful coverage to the subject. Medical journals carry technical articles about it to keep professionals abreast of developments in the field. Paradigm • Fall 2003 5 Should I Write a Prescription for a Pain Patient with ? a History of Addiction by Howard A. Heit, M.D., F.A.C.P., F.A.S.A.M. When a clinician is evaluating a patient for treatment of moderate to severe pain with opioids, it is very important to be able to differentiate between a patient who is seeking pain relief and a patient who is drug seeking. 6 Introduction Assessment The clinician should know that chronic pain is pain that 1 has outlived its usefulness. Acute pain is an adapted beneficial response necessary for the preservation of tissue integrity. There is no positive physiological reason for the existence of chronic pain, and therefore it should be treated appropriately with medicine approved by the Food and Drug Administration consistent with state and federal regulations for prescribing a scheduled controlled substance. When a clinician is evaluating a patient for treatment of moderate to severe pain with opioids, it is very important to be able to differentiate between a patient who is seeking pain relief and a patient who is drug seeking. If a patient is drug seeking, the patient will declare him or herself by not following the agreed-upon medical regimen. This article will discuss what a clinician should consider when deciding whether to prescribe opioids to a pain patient with a history of addiction. Proper pain assessment and comfort of the clinician treating the patient remains the cornerstone of pain management regardless of substance-abuse history. It must be emphasized that there is no legal or regulatory obligation to prescribe opioids on demand or at the first visit. The treatment plan is discussed and agreed upon based on mutual trust and honesty. The therapeutic relationship is a team approach based on what the clinician will do for the patient and what the patient will do for the clinician. The following is a list of what the clinician should do and what the patient should do before the first prescription is written: The prevalence of addiction in the general population is 2 approximately 10 percent. At the present time, there are no good prospective studies determining what the relapse rate is in this patient population treated with opioids. Therefore, patients in recovery are often discriminated against in regard to the treatment of their pain. It just makes sense that, if someone with moderate to severe pain who is in recovery is not treated with appropriate medications, his or her chance of relapse will increase, whether it is with a legal drug such as alcohol or an illicit drug, in an attempt to anesthetize the pain. John N. Chappel, M.D., states that 12-step programs such as AA and NA are compatible with the treatment of all medical and mental disorders. (American Society of Addiction Medicine review courses) The clinician should: • Take a complete history and physical examination, including review of pertinent past medical records and treatment successes and failures, including patient disclosure of substance abuse history and medications currently prescribed • Perform an assessment to determine any underlying psychiatric diagnoses such as anxiety, depression, bipolar disorder, or eating disorders. Non-restorative sleep, sexuality, and social, economic, or environmental factors that affect the patient’s holistic well being must also be part of the evaluation • Provide informed consent on all opioid risk including a statement that risk of relapse may be greater in patients with a history of substance abuse • Know the pharmacology of the drugs used • Know how to taper the patient off any prescribed medications • Plan to document all of his or her thoughts in the chart • Explain that he or she will work with the patient’s significant others It is imperative that clinicians understand the difference between addiction, physical dependence, and tolerance when considering opioid analgesics for patients with a history of substance abuse (Table 1). A recovering alcoholic or drug addict may become physically dependent during a therapeutic trial of opioids, but this normal physiological response to the drug must not be confused with addiction, in which patients seek substances despite deleterious effects on quality of life. For example, a patient could become physically dependent on corticosteroids to treat asthma or physically dependent on insulin to treat diabetes, but certainly in the latter instance, we do not call it insulin-addictive diabetes. The patient should: • Sign a waiver of privacy so that the clinician can contact appropriate sources to obtain or provide information about the patient’s care or actions or obtain additional consultations deemed necessary • Agree in writing upon a treatment plan based on mutual trust and honesty. Consent to random urine drug tests or pill counts at the clinician’s request • Agree to start or continue recovery programs such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) if there is a history of substance abuse • Agree to the need for complete, honest self-report of pain relief, side effects and function at each medical visit Paradigm • Fall 2003 The clinician and patient should: • Agree that the prescribing of opioids is a therapeutic trial to decrease pain and increase function with continuation of opioids based on a positive clinical response • Agree on regular medical visits for evaluation of the agreed-upon treatment plan and medication refills; the patient should bring the original bottles of prescribed medication to each visit • Agree on prescription renewal only during regular office hours • Agree that one physician and one pharmacy will be responsible for opioid prescribing/dispensing • Agree that any evidence of drug hoarding and/or use of any illegal drug may cause termination of the physician-patient relationship. Use the word “may” instead of “will” in the agreement so clinical judgment can be used in each situation. • Agree that if the patient violates the agreement, patient and physician should talk and decide if opioids are still appropriate, adjusting the boundaries of the treatment plan accordingly. boundary setting must be part of any opioid treatment plan with all patients, with or without an addictive disorder. Through education of clinicians and patient and with honest and open communication, pain management in patients with or without addiction being present can improve. This is consistent with the Hippocratic oath: “I will prescribe a regimen for the good of my patient according to my ability and my judgment and never do harm to anyone.”M Table 1 Addiction: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Treatment Certainly not all patients with chronic or acute pain should be treated with opioids. However, if it is determined that opioids are needed, it is very important to choose the correct agent to treat pain in a patient with the disease of addiction. The clinician can choose immediate-release (IR) opioids such as codeine or oxycodone with or without aspirin or acetaminophen; a long-acting opioid such as methadone; or a controlled-release (CR) opioid, in which an IR opioid, such as morphine, oxycodone, or fentanyl, is delivered via a controlled-release delivery system. While all opioids may cause physical dependence and tolerance, evidence suggests that long-acting or CR opioids are less likely to 3,4 induce tolerance and abuse than IR opioids. This clearly would favor use of a long-acting or CR opioid for moderate to severe pain in patients with an addiction history. Physical Dependence: Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Tolerance: Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time. American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine. Definitions Related to the Use of Opioids for the Treatment of Pain, Glenview, IL, American Academy of Pain Medicine, 2001 Morphine should not be the opioid of choice for patients with a history of heroin addiction, since heroin is 5 metabolized to morphine. Results of random urine drug tests, which should be part of the treatment plan, will be positive for morphine. The clinician will not know if the positive result was because of the prescribed morphine or a relapse with the use of heroin. Therefore, in this particular clinical situation, one should choose an opioid such as methadone, which has also been shown to have a 4 lower abuse potential than morphine. Dr. Howard A. Heit, is board certified in internal medicine and gastroenterology. He is also certified in addiction medicine by the American Society of Addiction Medicine (ASAM). Dr. Heit was an author, section coordinator and an editor on the section “Pain Management and Addiction Medicine” for ASAM’s textbook Principles of Addiction Medicine. Dr. Heit is an assistant clinical professor of medicine at Georgetown University School of Medicine in Fairfax, Virginia. Conclusion References Moderate to severe pain is undertreated across the world, especially in the population of patients with the disease of addiction. For these patients who have moderate to severe pain, the treatment regimen can include opioids. When deciding whether to prescribe opioids to this population, the clinician should BET on his or her patient; i.e., Believe, Evaluate, and Treat as indicated with a mutually agreed-upon treatment plan, keeping in mind that “I will prescribe a regimen for the good of my patient according to my ability and my judgment and never do harm to anyone.” 1. Oaklander, A.L. The pathology of pain. Neuroscientist; 5:302-310, (1999). 2. Savage, S.R. Long-term opioid therapy: assessment of consequences and risks. J Pain Symptom Manage; 11:274-286, (1996). 3. Brookoff, D. Abuse potential of various opioid medications. J Gen Intern Med; 8:688690, (1993). 4. Garrido, M.J.,Troconiz, I,F. Methadone: a review of its pharmacokinetic/pharmacodynamic properties. Journal of Pharmacological and Toxicological Methods; 42:61-66, (1999). 5. Braithwaite, R.A., Jarvie, D.R., Minty, P.S.B., Simpson, D. and Widdop, B. Screening for drugs of abuse. Annals of Clinical Biochemistry; 32:123-53, (1995). Paradigm • Fall 2003 7 INTERVENTION Services at the Illinois Institute for Addiction Recovery Why Use Intervention? It was once believed that an individual struggling with addiction or resisting to change unhealthy behaviors had to sincerely want help in order to get help. The individual had to “hit bottom” before being motivated to change. This, of course, is not always true. No person can easily survive without support from someone close to him/her. Interventions are based on this fact. A person will continue to live his/her life of active addiction or unhealthy behavior when friends and family offer inappropriate support. This type of support typically allows the addiction or behavior to continue. In most cases, family and friends feel they are protecting the individual, but in fact, are creating an unhealthy support system for the person. The intervention process addresses the unhealthy support system that allows the addiction to progress. Addiction breeds secrecy and isolation for both the individual and those who care about him/her. The intervention process brings together family, friends and other concerned persons and creates a support network for each member. The support network in turn engages and empowers the individual to grow and change in a positive way. How do you Conduct an Intervention? In the ARISE method (A Relational Intervention Sequence for Engagement), a three stage approach is utilized to match the level of effort used by the intervention network to the resistance of the individual in order to motivate a start in treatment. A network of support is formed which will be used to advocate for the person to change his/her behavior. A trained professional works closely with members of the network and facilitates each stage of the intervention. What Occurs in an Intervention? An intervention is the action taken by family, friends an employer and/or concerned others to actively assist someone to change unacceptable behavior. The problem areas that an intervention typically addresses are addiction to: alcohol and/or other drugs, nicotine, food, the Internet, sex, spending/shopping, and gambling as well as a need for a nursing home, medical assistance, domestic violence protection, and chronic pain with addiction. 8 In Stage III, family and friends set limits and consequences for the individual in a loving and supportive way. By the time the intervention network gets to this point, the individual has been given and has refused many opportunities to enter treatment. Because the individual has been invited to each of these meetings, this final limit setting approach is a natural consequence and does not come as a surprise. The ARISE process is designed to protect and enhance the long-term nature of the family relationships, while at the same time removing the addiction or behavior from controlling the family. When Can an Intervention Occur? A call placed to the Illinois Institute for Addiction Recovery by a concerned person starts the intervention process. A professional and the concerned person will plan the date and time of the first meeting. Who Can Be Involved in an Intervention? The support network for an intervention is comprised of family, friends and others with a caring, significant relationship to the individual. All members of the support network must agree to empower the individual to make change, not shame or humiliate him/her because of past behavior.M All members of the support network must agree to empower the individual to make change, not shame or humiliate him/her because of past behavior. For more information about Intervention or other services offered through the Illinois Institute for Addiction Recovery or to speak with the Business Manager about program cost, please call 1 (800) 522-DRUG (3784) or visit the Web site www.addictionrecov.org. The Illinois Institute for Addiction Recovery has centers at the following three locations: Each stage of the intervention has its own goals. What is an Intervention? strategies to reach the individual with the goal of treatment engagement. Stage I uses motivational techniques designed specifically for telephone coaching. Professionals help you establish a basis of hope, identify whom to invite to the intervention meeting, design a strategy to mobilize the group and teach techniques to successfully invite the individual to the first meeting. Stage II follows if starting treatment does not occur from the initial efforts. Typically, between two to five face-to-face sessions are held, with or without the individual present, to mobilize the intervention network in developing motivational Proctor Hospital 5409 N. Knoxville Avenue Peoria, IL 61614 BroMenn Regional Medical Center Virginia at Franklin Normal, IL 61761 Illinois Institute for Addiction Recovery at Springfield 3050 Montvale Drive Springfield, IL 62704 Paradigm • Fall 2003 9 On Track The Hunt for HEROES, HEAVEN and HAPPINESS by Pamela Teaney Thomas, M.Ed. “The secret of happiness is not doing what one likes but in liking what one has to do.” —Unknown A little boy quietly came to answer the door. In America the number of books on happiness has quadrupled in recent years. The therapy industry has tripled, and anti-depressant prescriptions have increased five fold. Cosmetic surgeries are rocketing each year. Half of all Americans dream of becoming rich. Baby boomers (born between 1946-64) assume they should be happy and are four times more likely to say they are not satisfied with their lives than their parents’ generation. Incidence of psychological depression is ten times what it was pre World War II. Following in their parents’ footsteps, a recent survey in our community revealed that over 42 percent of our high school students felt sad or depressed most of the time. Why, when we are the wealthiest, healthiest, most educated generation in our nation’s history? Outside stood a salesman, “Is your mother here?” President Abraham Lincoln stated, “People are about as happy as they make up their minds to be.” “Yes,” whispered back the little boy. “May I talk to her?” inquired the man. Still in a whisper, the boy answered, “She’s busy.” “How about your father, is he here?” “He’s busy too.” “Well, is there anyone else here?” I am Here to Say That Happiness is Over Rated! “Yes, a fireman and a policeman.” Frustrated the salesman asked, “What are they all doing?” Quietly the boy answered back, “They are all looking for me!” In 1979 as a young high school teacher, I had hopes of inspiring young people to look for success in their lives. I soon discovered many of our youth walking into the dead end trap of violence, drug and alcohol abuse — destroying their dreams. Reaching out to help them, I began wondering what factors would lead some people to use and abuse and others not. Why were these young people searching for happiness in physical beauty, money, fame, power or drugs? 10 When our expectations (what we think we deserve) are higher than what we have, we become unhappy. For example, when we see gorgeous women or brawny muscular men, we compare ourselves to them and become unhappy. We play the game. “I’ll be happy when I lose 50 pounds, when I win the lottery or when I get a car.” Even when we get the car, we are only happy momentarily. Then we desire one with mag wheels, or with this or that. The list gets longer. Never being happy or content with what we have. We need to put on different glasses in order to truly see ourselves; glasses that help us view our world in a Paradigm • Fall 2003 Happiness is about the process, not the end. We cannot just arrive at it. Too many people are waiting to “arrive at happiness” before they can enjoy life. The essence of happiness is pausing to savor the gift of the present moment. We find it not in the big things, but really in the small events along the way. For example, we can find happiness while at lunch with a close friend, reading a bedtime story with your child, on an evening walk with your spouse, or curling up by the fire with a good book. The old adage, “Take time to smell the roses” is still viable. President Abraham Lincoln stated, “People are about as happy as they make up their minds to be.” The hunt for heroes has taken a similar voyage with the help of Hollywood. In John Wayne’s day one needed friends to help get the job done and be a hero. Then along came Rambo and the Terminator showing us that we only need ourselves, a dose of anger and revenge to be a hero. Action figures like the Power Rangers do not even have a mouth to speak with, yet they were heroes through acts of power. More recently many young people looked to movie and rock stars as their heroes since they had the ultimate goals of fame, fortune, and power at their fingertips. On September 11, 2001, our country had a paradigm shift in thinking regarding what a true hero was. For the first time in decades, people saw the common person — firemen, policemen and common citizens — doing their job well, putting others before themselves and showing the power the “will” has over their thoughts and emotions. These true heroes were serving and saving others. These people were elevated back to being the true heroes through their actions of being unselfish, caring, and giving. Even at Halloween, many children were excited about fireman and policeman costumes. We can look in our own lives for the everyday heroes who are caring, giving, unselfish and are serving as mentors to us. A mentor is like a hero — only better. You can idolize and admire a hero from a distance. On the other hand, a mentor is part of your life offering new ideas; changing the way we look at the world and ourselves, and helping us discover latent abilities and talents. Take time to thank the mentors in your life and strive to become a mentor yourself. If we, in the helping profession, can use the national experience of 9/11 to help people understand the power of the mental shift in thinking that took place, we can help them to see the power the “will” has over our thoughts and emotions when stuck in a destructive thought process. The “will” can override any emotions or thoughts we have. A simple example of the “power of the will” is experienced each morning when the alarm goes off and we think we are still too tired and do not feel like getting up. Nevertheless, the will takes over and we get up! This same “power of the will” can be used in choosing to see our self and the world through positive glasses. The “will” can be used to change the mental talk in our brain, thereby, changing the feelings. (Even though we did not feel like getting up, once the “will” changes and we get up; the feeling changes with the action). Life is a series of problems that can be seen as obstacles or opportunities. We can use the glasses to see the world as Heaven or as Hell. Humans have three levels of being — physical, mental and spiritual. Americans have put too much emphasis on the development of the physical and mental over the years. Spirituality and good character have been sadly missed leaving a void in our lives. This void within has led many people to try filling it with drugs and alcohol in pursuit of heaven and happiness. The new 9/11 heroes have also brought back to mind the importance of good character and spirituality. When we take time to develop our relationship with God and value good character traits within ourselves and others, we see the world and our expectations in a totally new light that is not based on physical looks, money, fame and power. Our expectations of what we think we deserve become — what can we do to serve others? We become unselfish, caring and giving which are ingredients for becoming a mentor and a true hero. When all three levels of being (physical, mental and spiritual) are in balance, there can be peace, joy and happiness. Over 2000 years ago King Solomon said, “As a man thinketh so is he.” Proverbs 23:7.M Happiness is about the process, not the end. We cannot just arrive at it. Pamela Teaney Thomas is currently the Safe and Drug Free Schools/Communities Coordinator for the Rapid City Area Schools in South Dakota. She is an award-winning presenter, national motivational speaker, educator and counselor. She has served on regional and state prevention advisory boards, conducted extensive training’s on prevention and building resiliency in youth. You may contact Ms. Teaney Thomas by email at pamtt@rushmore.com. Put your “Will” to work: • Live beneath your means and within your seams • Do not make excuses • Stop blaming other people • Admit it when you make a mistake • Be kind to kind people • Be even kinder to unkind people • Cultivate good manners • Let someone cut ahead of you in line • Take time to be alone • Reread a favorite book • Be humble • Pray • Find a mentor • Thank a mentor • Become a mentor • Do not sweat the small stuff • Count your blessings and name them one by one! • Dance like there is nobody watching! • Sing like there is nobody listening! • Live like this is heaven on earth! Paradigm • Fall 2003 Art Untitled by Richard Gallagher Courtesy of NARSAD How many times do we go looking for something we want — only to look in the wrong places — when all along it was right under our noses! We have become a generation rearing another generation to feel entitled to good looks, money, fame, power and feeling happy almost all the time. The new hit television reality and extreme makeover shows whet the appetite for these misguided goals. Sandwiched between the shows is a mountain of drugs advertised for every ailment. We have created a pill for every ill. positive and grateful way. This does not mean that setting goals and reaching for excellence is wrong. However, if we are to find happiness, we must count our blessings, be thankful for who we are and what we have along the journey. If our expectations are closer to what we have, then joy can abound. 11 by Nina W. Brown, Ed.D., LPC, NCC Sara dreaded hearing the telephone ring in the morning, as it was most likely one of her family members wanting her to do something for them. No matter how hard she tried to ignore the ringing, she was unable to. Almost every time she answered the phone, it was an aunt, uncle, mother, grandmother, brother, or another family member asking her to do a favor for them. She never refused the request, even though she felt that they were taking advantage of her. Too Much Too Much Empathy? Too Much Empathy? Too Much Empathy Too Too Much Empathy? Too Much EMPATHY 12 Jed wondered if his wife would be very upset if he stopped at Bill’s house on the way home as he had done for the past two weeks. Nancy, his wife, had begun to make comments about all the time he spent over there. Jed hoped that she would understand that his friend needed him as he was going through the breakup of his relationship, and Jed felt his pain and loneliness. He really felt that his friend needed him, but that Nancy did not appreciate his caring for his friend. If asked why they were so responsive in spite of their feeling, or the inconvenience, Sara and Jed would likely reply that they had too much empathy. They felt strongly that others needed them, they could feel what others were feeling, and had to do something to make them feel better. You too may be like Sara and Jed and think that you have too much empathy, and find that you are overly responsive to others’ feelings and concerns. If you feel that you have too much empathy, think again. It is really a case of “catching others emotions,” but it is not empathy. If you have ever felt paralyzed, overwhelmed, or caught up in other people’s feelings, and either felt like running away, or that you were expected to do something about their feelings; then you understand what it is like to “catch” other people’s feelings. You, and others, may think that you care too much for other people, and/or that you are too empathic, when actually you do not have sufficient boundary strength to prevent catching other’s emotions, nor are you able to keep from identifying with those emotions, and acting to reduce them. Typically the outcome is that you carry the emotions for the person, which allows that person to “feel better.” They did not resolve what produced the emotion; instead, they gave it away and you accepted it. This scenario is a major premise for, Whose life is it anyway?: When to stop taking care of their feelings and start taking care of your own (Brown, 2002). Family Enmeshment Lack of sufficient boundary strength and susceptibility to “catching” other people’s feelings begin with family enmeshment. The family is where you learn to take care of other people’s feelings, and to give their feelings and needs priority over your feelings and needs. This is a trap that allows you to be manipulated or intimated to do things you do not want to do, and/or are not in your best interest just because you were conditioned to feel responsible for the psychological and emotional well-being of other people. You may even have been a parentified child where you took care of a parent’s psychological and emotional needs instead of the parent taking care of yours. This experience caused your not being able to develop sufficient boundary strength to repel external assaults from “senders” who are trying to get rid of their uncomfortable feelings, manipulate you to do what they want you to do, and are self-absorbed. As a “catcher,” you take in the uncomfortable feelings, and allow yourself to be manipulated by your feelings of guilt and shame. These feelings are triggered by the thought that you are not taking care of the sender, and are not able to block these internal and external feelings well enough to take care of yourself. Long Term Effects If you are enmeshed or overwhelmed by other’s feelings, you can suffer some long term physical and psychological effects. You may not connect them to your family of origin experiences, but, until you are more separated and develop your own personal identity, you may not be able to effectively address many of these effects. Do you have several of the following conditions? • Chronic physical health problems such as hypertension. • Long-term depression unconnected to a specific event. • Feel that your life lacks meaning and purpose. • Few meaningful and satisfying relationships. • A feeling that life is passing you by. • Lack of power and control over your life. • A yearning for meaningful connections. • Feeling closed in. • Wanting desperately to get away. Becoming Overwhelmed You do not have too much empathy, what really happens is that you end up with other people’s unwanted feelings because your emotional shielding is not sufficient to repel external and internal assaults on yourself, and you become overwhelmed. However, once empathy is defined, one can better understand why catching other people’s feelings are not empathy. True empathy occurs when you open yourself to experience what the other person is feeling without losing your sense of yourself as separate and distinct from that person. It is the last part that many people who catch emotions lack; they do not have the ability to stay connected to oneself, and to deeply know and understand that the other person is not an extension of oneself. Some of the following behaviors, feelings and attitudes are symptomatic of being enmeshed. The concept, extensions of self, is abstract and complex and cannot be fully explained here. There is a broader discussion for this in Children of the self-absorbed (Brown, 2001), and in “The destructive narcissistic pattern” (Brown, 1998). This article offers you some idea of what is meant by that concept. Examples of an inability to see others as separate and distinct from your self include any of the following. • You cannot say no to one or more family members even when you have to make considerable personal sacrifices to take care of their needs, wishes, desires, and requests. • You take the responsibility for the harmony, happiness and well-being of adults in your family. • Whenever there is a family or social event, you work hard to ensure harmony. • You feel blamed when things do not go smoothly, or right for family members. • You get very upset when you have to say, “no” to a family member. • You are fulfilling one or both parents’ dreams for you. • There are many times when you feel overwhelmed with family responsibilities, and wish that you just had more time for yourself. • There are times when you feel that family members take advantage of you and your good nature. • Naming children derivatives of parents’ names, or the son as “Junior.” • Using others’ possessions without first asking permission. • Choosing children or partner’s friends, careers, or even their clothing to be what you like. • Making decisions for family members without any consultation. • Giving orders and expecting that they will be promptly obeyed. • Volunteering your children or partner’s services without first asking. • Touching others, such as hugs and kisses, without first asking permission. • Expectations that others can read your mind, and know what you want or mean. • Becoming angry when others do not do what you want them to do. Being Enmeshed Paradigm • Fall 2003 You do not have too much empathy, what really happens is that you end up with other people’s unwanted feelings because your emotional shielding is not sufficient to repel external and internal assaults on yourself, and you become overwhelmed. Continued on page 22 13 by JoAnn Deak, Ph.D. Girls Will Be Girls Raising Confident, Courageous Daughters Part I: Brain Science and Strudel Theory “The ‘girl thing’ has been overdone,” a national media commentator told me one day, explaining why she was not interested in doing any more shows on girl topics for the foreseeable future. It was true; there had been a wave of stories, more accurately a tidal wave of media attention on the subject of relational aggression among girls. A couple of highly publicized books on the subject had just come out, and the media had, indeed, been awash in stories about girl meanness. ... the real “girl thing” that is rarely addressed is girls’ capacity as critical thinkers and relational architects, their willingness to take the world as-is and act on it. Art Titled “Little Mommy” by Larry W alker Courtesy of NARSAD 14 I agree, “the girl thing” has been overdone, but overdone only if the “thing” we are discussing is the developmental caricature of girls as a subset of the species that is catty, gossipy and socially evil. Do girls struggle with the complexities of development? Of course — what child doesn’t? However, I have worked with girls, parents, and teachers of girls for more than twenty years, and there is more — much more — that distinguishes girl life. In addition, brain research is showing clearly that the development of language and all of the nuances of use happen much earlier for most girls than for most boys. Combine these two girl ingredients — the need to affiliate and the well-developed language facility — and you have a subset of the species that cares deeply about belonging and connecting, has a propensity for emotional expression and intimacy, and often a heightened sensitivity for reading the social scene. Put those early language skills to work expressing the very strong, visceral adolescent emotions, and find that adolescent girls can and do get hurt very much by the behavior and words of others, and can and do use their language for interactional purposes, both positive and negative. The grain of truth is this: it really matters to girls if they fit in, are liked, and have a place in the social and school community. This is a natural and needed part of the genetic makeup of the female species based in part on the evolutionary fact that females need to be somewhat preprogrammed to care for and be connected to other humans. This is the basis of human survival. Roughly translated, whether a girl is strong and independent or not, she has very strong feelings and is somewhat driven to belong. Current research is also providing evidence that under stressful or challenging conditions, females produce not only adrenaline, but also oxytocin. This chemical predisposes females to want to cluster and interact with other humans. Therefore, under social stress, girls are propelled more than ever to cluster, and clustering inevitably includes some and leaves out those who are somewhat different. However, the real “girl thing” that is rarely addressed is girls’ capacity as critical thinkers and relational architects, their willingness to take the world as-is and act on it. Girls today live on the pioneering edge of social transformation that is unprecedented in history. Theirs is a future in which girls and boys, and men and women, will seek partnership and intimacy in new relationship styles, and a future in which the very qualities of female intelligence, energy and wisdom will have currency like never before, which can transform life around the globe in ways never possible before. Nora, a high school senior described it to me this way: “It’s pretty hard being a girl nowadays. You can’t be too smart, too dumb, too pretty, too ugly, too friendly, too coy, too aggressive, too defenseless, too individual, or too programmed. If you’re too much of anything, then others envy you, or despise you because you intimidate them or make them jealous. It’s like you have to be everything and nothing all at once, without knowing which you need more of.” How could we not be talking about that, about how girls grow and what they need from us and from their environment to grow into healthy, Paradigm • Fall 2003 resilient, self-expressed women? How we can nourish and prepare girls for the extraordinary demands of our time? In my work with girls and the adults who live and work with them, I find that parents, teachers and girls themselves are hungry for two kinds of information. They want the “hard science” — specifically new information about the neurological growth of girls. Also, they want a commonsensical way of thinking about “growing up girl” that, for the adults, enables them to support girls’ growth into young women who are smart, strong and emotionally resilient. Girls themselves are eager for the information because it helps them understand themselves. It helps explain the internal and interpersonal dynamics, which they grapple with every day as a part of the relational dimension that is so compelling and vivid for them. I have found that the “hard science” is a lot easier for them to digest if I share my Strudel Theory of child development in language they enjoy and understand. Strudel Theory: Building a Life with Layers of Experience When we see a little boy turn to the box of blocks and a little girl head for the dress-up corner, we see the backdrop for the “nature versus nurture” debate: are gender preferences the result of genetic “hard-wiring,” or of socializing influences in the environment? The answer stimulates heated debates in some circles, but only in terms of how much. We accept that individuals are shaped by nature and nurture. It is the cumulative effect of nature, nurture and life experience that shapes a child, and it does so in some special ways from the very beginning when that child is a girl. Basic Strudel Theory says that each of us is born with the main ingredient (our nature), but it is the layering of that with other ingredients (nurturing) and the interaction of them all together over time (life experience) that creates the finished product. Think about a girl you know well — maybe a student, maybe your own daughter — and her personality, and label it either sweet cherries or tart apples. Starting with that main ingredient, imagine adding a cup of sugar (your loving attention), some salt and spices (friends and family interactions), a pastry crust (home and school environments), and some heat (the excitement and pressures of everyday life) and bake it all together. No matter how carefully you measure or mix those ingredients, each strudel is going to turn out a little differently, depending on the characteristics of the fruit and spices, and the chemistry that occurs in the mixing and baking. In human terms, Strudel Theory says that whatever qualities a girl’s basic nature brings to the mix, the layering of experiences and actions over time, on an hourly, daily, weekly, monthly and yearly basis, leave a lasting impression on a girl and profoundly shape her image of herself and herself in relation to others. Research offers insights into the nature of girls and the distinctly female development of the core neurological system, which includes thinking, perceiving, feeling and movement — in other words, the nature of a girl’s experiences. A few simple points about brain development help set the stage for understanding the female experience of life and learning from the earliest days of life, when the layering begins. Girl Brains: The Accent on Caring and Complex Thought We each are born with an existing pattern and number of neurons, or nerve cells, that conduct impulses throughout the body and to and from the brain. However, with each experience and with layered experiences using the same sets of neurons, two things happen. First, the axon, or nerve cell body, becomes thicker with added coats of the myelin, a fatty covering on a nerve that conducts an impulse faster and more effectively as it grows thicker. The entire neuron grows thicker through this process of myelination. Basically, as a neuron or set of neurons is used, it gets bigger and better. Second, the dendrites, branch-like connections between neurons, also grow “bushier” with use. With no or little use, dendrites do not grow, and with time, are naturally “pruned out” of the system. Neurons with more dendrites conduct impulses, or thoughts, more effectively and efficiently, so we want to grow dendrites and have “bushy” areas in many parts of our brains. From birth to about age three, the human nervous system is primed for growth. Just like a tree, it grows quickly during this early stage, and that growth establishes the basic pattern for our brain “tree” development. Those areas that develop the most branches (dendrites) and the sturdiest branches will be the strongest part of the tree, or in this case, the brain. We now know that this process of dendritic growth can, and does, happen all through life. However, just like the tree, it is harder to prune large branches, or habits, than smaller branches. Once something is learned or felt for a long enough period of time, it is harder to change. It is also easier to grow bigger branches early in the tree’s life than later when the patterns of growth have already been established. The lower or mid-brain, called the limbic system, and more specifically, an almond-size portion of the mid-brain, called the amygdala is the neurological home of our emotions. The amygdala has a powerful influence on all thoughts and behaviors, especially in the female. Females seem to have a very sensitive and active amygdala. The thought process in both the female and male brain, intertwine the activity of the cortex (the pecan-shaped gray matter, which is the center of rational thought) and this amygdala, the emotional center of the brain. This tells us that there is no such thing as totally rational thought; our thoughts always have amygdala involvement. However, research indicates that the female brain usually has more amygdala involvement than the male brain under the same circumstances. Research has not yet discerned an explanation for this, but evolutionary scientists suggest there must be a survival advantage for the female of a species to be hard-wired to feel some emotions, especially negative ones, more frequently and more intensely than the male of the species. What does all this mean? To use the Strudel Theory metaphor, the female “strudel” is very different from the Paradigm • Fall 2003 It is the cumulative effect of nature, nurture and life experience that shapes a child, and it does so in some special ways from the very beginning when that child is a girl. Continued on page 18 15 Perspectives S ET IH EZ MI ONM EGN T SEIZING THE S E I Z I N G M O MMoment ENT MOMENT THE MOMENT ENT SEIZING THE MOMENT SEIZING the SEIZING THE by Grace Jo P. O’Leary, C.A.D.C. Although we may live in the moment, we want a guarantee that our self-expression will not be misunderstood, judged, or appear awkward. Art Untitled by Jeffery Guerin Courtesy of NARSAD 16 Seize the moment when you encounter: a stranger, an acquaintance or a friend. You can decide how it will go. Whether it is a brief smile, an elevator exchange, or the beginning of a beautiful day. You can set the tone, tune in the sunshine. This article suggests that seizing a moment of connection may build a wave, which washes clear certain misperceptions. Many of us are wary. The culture and life experiences teach us that we may not measure up to others’ expectations. We respond by hedging on spontaneity. Although we may live in the moment, we want a guarantee that our selfexpression will not be misunderstood, judged, or appear awkward. Being safe is to be condemned to someone else’s worldview. That is a huge sacrifice to make unknowingly. The barriers to seizing a moment of connection are selfpreservation and shame. First, never overlook the uh-oh feeling. John Bradshaw’s book, Healing the Shame that Binds You opens by saying, “Because of its preverbal origins, shame is difficult to define.” The healthy type is an acknowledgment of limitations. The toxic variety has been internalized from others. My parents learned their shame from someone, they gave it to me, and from me my children learned theirs. The cycle is endless. We get it, and we give it until we thrust a stick in the spokes to stop it. But first, it is necessary to acknowledge, in the secret place where you hate someone for dying, that you can recognize in yourself the effects of shame. I am describing patient recovery or the fairly normal stuff. The acknowledgment of my own shame unlocked the paralysis of waiting for someone to tell me how to be. Let me start with a moment in January of this year. The Insight On a bitter Chicago morning, I sat near the door listening to the Sunday speaker. Michael, a longtime acquaintance, was cutting out early. I glanced up at the feeling of being watched. Our eyes met. Instead of smiling broadly because I like him, I waited for Michael’s cue. This was a shame-based response. The greater loss unfolded during the week. I awoke the following Sunday morning with an understanding. When I had perceived Michael’s attention, I could have looked up, smiled, and shared the moment. Instead, I waited for his signal. The moment was stillborn, a missed opportunity for both of us. Our power, as John Bradshaw says, comes from admitting “the shame that binds” us. I realized I could decide in the moment how I want to think and feel on that Sunday morning. I became aware that it is my own thoughts that need fixing. Instead of waiting, as I am culturally conformed to do, I can originate the feelings, I want to experience, the outcome I desire. An exponential change! However, absent any conscious decision and reframing, my subliminal mapping willingly supplies shame-filled preordained choices. In its quest for security, the culture shames spontaneity. Yet, spontaneity is the power of the moment. It is in the moment that God’s grace lingers. Now that I recognize this enormous and transitory power, how can I implement such revolutionary choices? First, I contacted Michael to share this revelation. Although acknowledging he probably noticed me on his way out, Michael did not recall the details — others to whom I related the experience identified immediately. The Keys There are three keys: awareness, altering expectations, and transforming automatic shame-based behavior into the willingness for something positive. This may appear to require more courage than you think you have. Initially, it may feel awkward, artificial, and disingenuous. Harder perhaps for women, for it might mean rejection and Paradigm • Fall 2003 ridicule at first. It was difficult for me at first. Status quo is a powerful inhibitor. On a subsequent Sunday, I walked in late. Matt, someone I have known for several years and whom I respect and admire, caught my eye. I looked away instead of smiling to acknowledge someone else I like and learn from. Yet, the awareness was instant. Afterward, Matt and I talked about my looking away and the change I was making. There is no question, being open with the people in your life is hard. Awareness Awareness is not only being in the absolute moment, it is a consciousness of its details. Serendipity hides in the moment. Taking advantage of chance encounters gains the power of the moment. Such power imprints and energizes. It is suspecting that even an enemy might smile because you are both wearing the same color. Scriptwriter clichés and ancient expectations dilute and distort this power by reducing it to repetition of the same old same old. To be aware of others requires focusing on their wants and needs. Perhaps pivotal to awareness of others is prayer. In my daily affairs, I come in contact with many in need of my prayers. Therefore, my encounter may well be a person for whom I have already sought God’s goodness and generosity. Expectation The second key is expecting that the other person might also enjoy a human connection — not sex, coffee, and forever — just a brief exchange. It is attributing good motives instead of bad ones. Perhaps the stranger is in desperate need of a smile. Perhaps the woman across the table is not after your job; she just wants your friendship and your expertise. Perhaps the other person is waiting for you to smile or to speak. When you insist that the other person speak first, nod first, or risk first, you hand over the moment’s power as surely as cash at the checkout stand with nothing to show for it. You are not gaining respect and control; you are robbing both of you. Isn’t the sunshine of another’s smile what you deserve? By delaying your response, are you tricking them into believing you are valuable? The odds are excellent that the other person simply seeks the sunshine of your smile. If not, maybe you have softened the ice rather than adding another layer. Shame was finally identified for me in such a visceral way, I recognized its presence as intimately as drops of my own blood. Bonnie DenDooven, speaking about attachment disorders as they are expressed in work and money addictions, finally lanced the vein that even I could see. Presented by The Meadows of Wickenburg, AZ, her workshop was attended by those charged with the emotional well being of others. I finally had the courage to acknowledge that the shame was mine, not my patients’, not my parents’, not my children’s, not my friends’ and not recovery peers’. It was mine. Once I named it and admitted to it, I had the power to understand it. From that came greater acceptance of myself and others, and the freedom to risk creating something I want rather than once again settling for what I get. I had to accept that I am okay just as I am. Caveats If this sounds scary or impossible, place this article in your planner six months hence. You will be amazed at what happens during the incubation. If, like me, you did not receive much emotional nourishment in childhood and getting beyond the shriveling shame seems impossible, talk to someone you trust. Before I started recovery, I was invalidated on a regular basis, indecisive, and the person I am today was so deeply buried that no one would have predicted the success I have accomplished. Now I know I am making progress when I start to sing too early and that shriveling feeling is missing. In the months since this revelation, I have had many opportunities to practice seizing the moment. The start was small and fleeting. I wished a CTA motorman a good day. I smiled at people I passed. Not condescendingly, but recognizing them as deserving, too. When I get to work I am smiling. It is easier to give people the benefit of the doubt. Although I was raised in a culture that devalued women, I have come to see them as important, as worthy of my respect and as friends. Sensitivity and prudence are also warranted in seizing the moment. Our instant impressions are usually accurate. Over time we learn to trust them. Ultimately, the goal is to thrive with others, instead of just trying to impress or control them.M Expectation is a powerful shaper of the future. It kicks people out of hospitals, kicks them upstairs, and kicks in the vault. A smile for someone you think has no use for you will make them wonder. Who has not been warmed and lifted by an unexpected smile, an unexpected connection or an unexpected encouragement? Grace Jo O’Leary began her writing career in the Pentagon as an editorial assistant creating position books for the Joint Chiefs of Staff. She has written articles, newspaper features, reports and authored a series of group-work exercises for DUI clients. Further, Ms. O’Leary has authored a novel, Dragged Out of the Future, which explores addiction: “what it was like, what happened, what it’s like now.” Currently, she is working on a sequel, and creates marketing and newsletters for Roger J. French, Attorney at Law in Chicago, IL. You may contact Ms. O’Leary by email at goleary@rogerfrenchiplaw.com. Transforming Shame Cited Work and Bibliography The third key is transforming automatic shame-based behavior into its diametric possibility. It is removing programmed distortions for possibilities which enhance. Shame is the huge barrier everyone pretends is not there. Kind of like debt — its effects are pungent and profound, but we want to overlook ours while focusing on someone else’s. Our instant impressions are usually accurate. Over time we learn to trust them. Bradshaw, John. Healing the Shame That Binds You. Deerfield Beach, FL: Health Communications Inc., (1988). Herman, Judith Lewis. Trauma and Recovery: The aftermath of violence-from domestic abuse to political terror. New York: Basic Books, (1997). Miller, Alice. The Drama of the Gifted Child. Trans. Ruth Ward. New York: Basic Books, Inc., (1981). Wegscheider-Cruse, Sharon. Choice-Making. Pompano Beach, FL: Health Communications, Inc., (1985). Paradigm • Fall 2003 17 Raising Confident, Courageous Daughters Continued from page 15 We cannot make a girl develop a certain way, but we can intentionally layer opportunities and experiences to support and enhance optimal development. male “strudel” at the most basic level. The combination of different “ingredients” by gender and by individual combine with the experiences layered over time to exert a strong influence on the end product [i.e. each individual]. This readiness of the system, not just psychologically, but in terms of the hardwiring of the brain, is very important in thinking about the earliest parenting responses to girls and responses throughout a girl’s life. Females and males seem to have differing timelines of physical and brain development, especially during the formative years. In terms of phonics or spelling readiness, girls can and do move into reading earlier than boys, often up to two years earlier. Boys are able to do spatial tasks much earlier than girls like building those Lego models, for instance. Society thought that this was due to experience, toys, or other influences that were gender stereotypes. Brain research now clearly shows that the structure of the female and male brain is different at birth. Female brains have more neurons in certain areas than male brains as a result of having more estrogen “bathing” them during fetal development. It is thought that about 80 percent of girls come into the world with this “female differentiated” brain, and about 20 percent arrive with a more “male differentiated” brain. (This only references neurological predispositions — not sexuality.) The infant girl in the 80 percent group comes into the world with three key predispositions as a result of femaledifferentiated brain: • She is more likely to be more highly developed in the cognitive areas of language facility, auditory skills, fine motor skills, and sequential/detailed thinking. • In comparison to the male brain, the female has a more decentralized brain that uses many parts for a singular task: a more integrated brain, which uses both hemispheres for most tasks, a more developed corpus callosum, the bridge between the left and right hemispheres that allows communication back and forth, and enhances the integration of those brain activities. • The limbic system appears to be more sensitive and more active in females. Consequently, females’ thoughts are more integrated with the emotional system more frequently and more intensely than most males. In everyday activity, a girl views the moment with both the rational and emotional parts of her brain, so seemingly “unemotional” situations contain an emotional component for her. In the layering of experience, the world can and does intervene. Early experiences can exacerbate these slight gender predispositions or modify them in the other direction. During the formative years, what is experienced has significant impact on the wiring of the brain and the development of the personality. Keep in mind that use increases the dendritic branching, and neuron growth; this growth improves the facility of thinking in the used area, and the formative years are the high neurologic “tree” growth time. This means that boys who are quickly building those Lego models use their spatial neurons because they are good at it, and there is a brain comfort factor with this activity. As boys continue to 18 engage in this kind of play, they are growing even more dendrites and making these particular neurological connections even stronger. Girls, on the other hand, are spending hardly any time in the block area and are, therefore, not increasing dendritic growth and neurologic strength in that area, but are probably “pruning back” the number of dendrites there because of little usage. This is the area of the brain that deals with math and logic-based problem-solving later in life. It is a critical area of development in terms of later success in school and in life in general. ‘Logging in’ for Optimal Brain Growth I refer to usage and time spent in a particular skill area as “log in” time. It is important for girls (and boys) to spend “log in” time in areas that are counter to their neurologic “grain.” Translation, for optimal lifelong neurological balancing and growth, girls generally need to spend more time in the block corner and boys need to spend more time in the writing/drawing corner. Provided in an enjoyable way, these early against-the-grain gender experiences help create a well-balanced brain that is better equipped to handle the range of tasks and challenges that brain will have to contend with throughout life. This concept can be expanded to many areas. Young girls need to be spending time in all of the areas that they are not as hard-wired to choose early on of their own accord. For the 80 percent, that would be: • Gross motor tasks: skipping, riding a bike, climbing • Spatial tasks: puzzles, tangrams, carpentry, orienteering • Strategy and problem solving: team games and sports, checkers • Risk taking: doing anything that takes a bit of courage on a particular girl’s part. This can range tremendously by individual. If you have a “20 percent” girl, then she needs to spend more time on: • Fine motor tasks: painting, drawing, tying, zipping • Auditory tasks: books on tape, rhyming, reading poems and stories aloud • Sequential and detailed thinking: hidden word puzzles, jigsaw puzzles, putting things in order, alphabetizing • Connecting with others: cooperative play, volunteer work We cannot make a girl develop a certain way, but we can intentionally layer opportunities and experiences to support and enhance optimal development. Part II of this article will discuss more about some patterns of neurological development, and the role of ambiguity in divergent thinking in girls.M Dr. JoAnn Deak has worked for more than twenty years as an educator and school psychologist, helping children develop into confident and competent adults. She is an advisor to Outward Bound, a past chair of the National Committee for Girls and Women in Independent Schools, a member of the advisory board at the Seattle Girls’ School, Power Play and Girls Can Do. Dr. Deak is the author of How Girls Thrive (National Association of Independent Schools, 1998), The Book of Hopes and Dreams (2000) and Girls Will Be Girls: Raising Confident and Courageous Daughters (Hyperion, 2002). She consults with organizations and schools nationally and internationally and has been named the Visiting Scholar in New Zealand for 2004. You may contact Dr. Deak at www.DEAKgroup.com. Paradigm • Fall 2003 STRESS USING HUMOR TO REDUCE STRESS by Linda Hutchinson What is the greatest source of stress? In her wonderful book, The Search for Signs of Intelligent Life in the Universe, Jane Wagner answers, “Reality is the greatest source of stress amongst those in touch with it.” Since she put reality on the back burner, her life has been jampacked and fun-filled. One way of reducing tension in our lives is to invent a lighter view of reality — to lighten up. What is your interpretation of reality? I grew up with the notion that life is hard work. When I put that notion on the back burner, my life is jam-packed and fun-filled. In my “humor shops” we explore various ways to use humor to turn tense situations around and to reduce the impact of stress on our lives. One of my main messages for preventing tension is: Do not be offended, even if it is intended. Easier said than done. As humorous beings, we are great at turning molehills into mountains. Since I have applied the practice of not being offended, I am a lot happier and more serene. On the other hand, do not allow people to degrade you. It is a paradox. Do not be offended and do not allow putdowns. Pick your battles. People who are offended by toxic humor should use the offense as an opportunity to educate. One simple technique is to ask them to explain the joke or comment. Often, jokes and other forms of humor lose the “funny” when it has to be explained. There are different ways to address tense situations. If you can, avoid tense situation. Do not entertain people you experience as offensive. Another way is to build your immune system - be prepared. Humor does not have to be spontaneous. Prepare humorous comebacks for situations or circumstances that repeatedly happen. For the majority of us “fight or flight” is the automatic reaction to tension or conflict. It is possible to develop a third way to respond to conflict that is going with the flow. Imagine a world where we are not just reacting, but consciously choosing whether to fight, flee, or go with the flow. Thomas Crum teaches the martial art Aikido as a metaphor for embracing conflict as an opportunity. The same movement for an attack is the same movement for a dance. Rather than fighting back or running away, you learn to go with the flow, to embrace the energy. Crum urges us to relate to conflict as a gift of energy, in which neither side loses and a new dance is created. Another example of humor as Aikido or “tongue-fu” from Joel Goodman, Director of the Humor Project, is the story of a woman who got an obscene phone call at three o’clock in the morning. The voice on the other end of the line asked, “Can I take your clothes off?” The woman yelled into the phone, “Well, what the hell are you doing with them on anyway?” Wouldn’t you like to be that quick-witted at three in the afternoon, let alone three in the morning? In one of the best basic books about humor, The Healing Power of Humor, author Allen Klein uses the metaphor of another martial art, Jujitsu, in which you “gain an advantage over your opponent by turning his strength and weight against him.” Klein refers to “joke-jitsu” as the ability to give a difficult situation a twist, reversing the energy and sending it spinning in the opposite direction. He tells how actress Eve Arden dealt with a co-star, a prankster, who arranged to have the telephone ring when it was not supposed to on stage during a live performance. Arden calmly answers the phone; then she hands it over to the prankster saying, “It’s for you.” “The secret of living without frustration and worry — is to avoid becoming personally involved in your own life.” Besides using humor as Aikido, joke-jitsu, and tongu-fu, there is also humor therapy. What is it that you take too seriously? What would you like to lighten up about? Humor therapist, Annette Goodheart, recommends that you say out loud what it is that you take too seriously and at the end of the statement, you say, “Tee Hee!” There are many kinds of tense situations in which to use humor: ill health, terminal illness, death, natural disasters, and all forms of human conflict. Of course, there is one foolproof method of avoiding tension — from the wisdom of the cartoon character, Ziggy, “The secret of living without frustration and worry — is to avoid becoming personally involved in your own life.”M Linda Hutchinson is an adult educator, keynote speaker, consultant and author with 30 years of professional experience designing and delivering training programs for large and small corporations, non-profit organizations and professional associations. Owner of Hutchinson Associates, Linda also teaches college courses on humor and spirituality. She is currently completing a book about the uses of humor that will be released this fall. You may contact Ms. Hutchinson by email at Linda@haha-team.com or visit the Web site www.haha-team.com.Web site www.haha-team.com. Paradigm • Fall 2003 19 OBSESSED L olita with Modeling and the Welcome to the consequences of this worldwide obsession with Lolita. internet, it isn’t On Tuesday July 15, 2003 at 7:30 AM, America heard on one five-minute segment of NBC’s Today Show. just modeling to some — and what’s the harm anyway? by Dorn Checkley The Internet has thrown fuel on the embers of this old fire and one of the latest accelerants are child modeling Web sites. Two years ago a South Florida TV news station did an investigative report that uncovered another new phenomenon driven by the Internet — child modeling Web sites. The investigation focused on a Fort Lauderdale company called Webe Web that runs dozens of child modeling Web sites. Sites like “Little Amber.” The site’s home page features a dozen pictures of Amber, a pretty blonde pre-teen, modeling clothes and bathing suits. However, few of these pictures look like the snapshots that you would take of your 9-year-old daughter. Although there is no nudity, young Amber poses like a woman who knows how to appear sexy. Patrons can pay a monthly fee of $19.95 for the privilege of seeing hundreds of more pictures updated regularly. Webe Web claims that Amber and her parents earn approximately $1,000 a month. Not surprisingly, the TV news investigation uncovered that the Webe Web Company also operates at least 14 adult pornographic Web sites. But the revelations didn’t end there. Little Amber’s mother knew something about modeling herself. She appeared nude last year on a pornographic Web site named “Kandiland!” Welcome to the worldwide obsession with Lolita. Nabokov’s literary character of a pretty waif-like young girl, innocent yet seductive, uninitiated yet bursting with latent sexuality, lives on as a powerful sexual icon pursued by, perhaps, millions of men worldwide. The Internet has thrown fuel on the embers of this old fire and one of the latest accelerants are child modeling Web sites. Are these sites mere promotion or exploitation? Are they innocent or shrewd? Are they harmless or a powerful medium of initiating and reinforcing a dangerous addiction? Could they be all of the above? Child modeling is, of course, an accepted part of commercial marketing. Advertising needs children, but do hundreds of child modeling Web sites help talent agents find the next Brooke Shields for the 21st century? Hardly. In a statement issued to CBS News, the Ford Modeling Agency, which represents 300 teenage and child models, said they do not surf the web seeking new talent. What then drives this market for child modeling Web sites? Men. Forty plus men, who subscribe monthly, pay $150 extra for “Stacy Starlet” to model particular clothes and 20 send gifts to their favorite models. Jeff Libman, one of the co-owners of Webe Web admitted, “It gives these guys that do like young girls [sick] like that would be normally gawking at these teenagers in the mall, you know, an outlet to relieve themselves of their frustrations I guess.” Sixteen- year old Renee knows exactly what drives these men. Renee is a “cam girl” who runs her own highly profitable Web site featuring a 24-hour web cam sitting on top of her computer in her bedroom. “They’re hoping to see goodies,” she said. “But they fail to realize that I’m not getting nude.” Renee’s hopelessly naive mother told CBS News that she was “mystified” by her daughter’s success. Renee makes approximately $2,000 a month selling her peeping Tom subscribers a whiff of hope that they will see the “goodies.” It is not just dirty old men that are obsessed with Lolita. Lolita is the commercial image that Madonna, Brittany Spears and Christina Aquilera have shrewdly cultivated for millions of dollars in revenue. “I’m not that innocent!” Brittany sang in her MTV video while busting out of a grade school Catholic uniform. Girls want to be like them. Boys lust, masturbate and try to land the girl with the bare midriff whose demeanor is like the iconic image. Children are becoming sexualized in the image of Lolita by society. While the mother of CindyModel.com insists, “I would never exploit my daughter. I am promoting her natural beauty,” she knows that Cindy makes $450 a week from adult men who pay $15.00 a month to ogle her daughter. “Older men will look at Cindy in real life, so why not online?” Dr. Fred Berlin, a psychiatrist at Johns Hopkins University Hospital who treats patients with sexual disorders, told CBS News, “I think adults who are doing this have some sort of infatuation with this youngster. And I think in some cases they may have romantic fantasies. In some cases sexualized fantasies.” Some men go further than just sexualized fantasies. Gary Smith is a 35-year old convicted sex offender on the Illinois registry. Smith photographs girls from all over the country for his child modeling Web sites. He was convicted in 1998 of sexually abusing a 15-year Chicago girl. Federal authorities arrested him in 2002 for three counts of child pornography for forcing a 12-year old girl to pose nude in a Missouri hotel room. Paradigm • Fall 2003 1. “Coming up next on Today — Ex-child porn star Traci Lords discusses her new book, Underneath It All — a disturbing look back at her involvement in the sordid world of pornography....” 2. “In the news today — Police in London are searching for a missing teenage girl who ran off to Paris with a 31 year old American man whom the police suspect she met on the Internet....” 3. “Take a look at this disturbing surveillance tape from a Target store in Kansas. A man, who appears to be in his 30’s, is calmly stalking a teenage girl who is shopping alone while her mother is in another area of the store. The man walks up to the girl, identifies himself as a store detective and accuses the girl of shoplifting. He then escorts her to another part of the store and sexually assaults her. With us here on the live-line is the Police Chief....” And it is not just a Western problem. In India, Thailand and the Balkans, young girls are routinely sold into virtual sex slavery. In the former Soviet Union the worldwide demand for young blue-eyed blondes has created an orgy of exploitation by parents, pimps and pornographers. And in Japan, the New York Times recently reported a widespread phenomenon of teen girls prostituting themselves to middle-aged men in exchange for shopping spree money. It is plain to see that there is a growing problem of child sexual exploitation around the world. What may not be as clear is whether child-modeling sites play a role in Lolita obsession and its aftermath. The root causes of Lolita obsession, on which most psychologists, researchers and law enforcement officials agree, do not tend to include hard-core pornography, or child modeling sites. Those causes are: child sexual abuse; unresolved childhood conflict or trauma that solaces itself in the seduction and control of children; emotional fixation at an immature stage compounded by a lack of social skills and finally, plain old lust, opportunism and the proximity of a vulnerable child. What is more controversial is whether or not exposure to visual stimuli alone can cause sexually obsessive behavior. Some psychologists, addiction counselors and law enforcement officials armed with case studies of their clients believe that exposure to hard core and/or child pornography during sexual formation and conditioned sexual response (masturbation and orgasm) to images of sexualized children can and do lead to sexually obsessive behavior. However, researchers have not been able to consistently verify those results in lab studies. Specialists do agree that pornography, child porn and child modeling sites can and do play an important role in the maintenance and growth of sexually obsessive behavior. In other words, whatever the origin of their behavior, when Lolita obsessives collect, trade, produce, lust and masturbate to sexualized images of children their behavior gets worse. At the very least the exacerbation of this obsessive compulsive behavior is the driving force behind the worldwide child pornography market, the international sex trafficking of children and even 16-year-old Renee’s $2,000 a month income from her web-cam site. However, some believe that visual stimuli alone can cause Lolita obsession and lead to the actual abuse of children. If they are right in this belief then the siren call of the Internet (availability, anonymity and approval) is very troubling. The Internet is introducing millions of men (and some women) to sexual stimuli that heretofore was unavailable and taboo. As a result thousands, and perhaps hundreds of thousands, of people have entered the first level of sexually addictive behavior — obsessive fantasy and masturbation. In this modus operandi scenario it is terribly naive to think that child modeling Web sites do not inflame Lolita obsession — even for those not predisposed to it. The producers of these sites know exactly what market they exploit — one prominent site is even named, “Sunny Lolitas.” I believe the worldwide increase of child sexual abuse is due the permission giving effect of the Internet on a growing number of people — many of whom are now progressing to the acting-out stages of addiction and moral depravity. Unfortunately, the moral and legal response of our culture to child modeling Web sites has been hesitant and muted. In response to a Florida TV News investigation, two Congressmen introduced the Child Modeling Exploitation Prevention Act in 2002, but it died in committee over legitimate legal concerns of overbreadth and heavy lobbying from the usual free speech extremists. As for now, it is entirely up to parents to exercise wisdom and restraint in regards to allowing their children to be featured on child modeling or web-cam sites and whether or not to allow their children to visit such sites. ... it is terribly naive to think that child modeling Web sites do not inflame Lolita obsession — even for those not predisposed to it. In a more global sense the very idea of childhood as a protected state of development is under attack. Historians and anthropologists will point out that state of childhood is a modern Western creation that may be an artificial construct. Some go further and argue that childhood is a sexually repressive construct and the time has come to grow out of it. Childhood may be relatively new but it is still a good and progressive idea. And a society that cannot decide that the child modeling sites found on the Web today are exploitive and contribute to dangerous behavior is very troubled indeed.M To participate in a renewed legislative effort to address child modeling Web sites or help to educate your community about this problem, contact Dorn Checkley at (412) 281-4565 or pghcoal@pittsburghcoalition.com. Mr. Dorn Checkley, Executive Director of the Pittsburgh Coalition Against Pornography (PCAP) since March of 1986, is a lifetime resident of Pittsburgh. He earned a Bachelors of Fine Arts degree in Filmmaking from Emerson College in Boston, Massachusetts, in 1980. Following college Mr. Checkley joined Covenant House of New York City to help runaway and homeless youth. Many of the young people whom he counseled were prostitutes or were sexually exploited by the pornography industry. Paradigm • Fall 2003 21 ILLINOIS INSTITUTE FOR ADDICTION RECOVERY Continued from page 13 Psychological Boundaries When you have a good understanding of where you end, and where other people begin, you are well on your way to developing sufficient psychological boundary strength. Discussed in Whose life is it anyway? are several psychological boundaries: strong and resilient, soft, spongy and rigid. Strong and resilient boundaries are those that are flexible enough to let someone in, and inflexible enough to repel assaults. Soft boundaries occur when people lack psychic strength. These are the people who can easily become enmeshed or overwhelmed. Rigid or inflexible boundaries are held by people who are fearful of becoming enmeshed or overwhelmed and will not let anyone in. Spongy boundaries are a combination of soft and rigid where large parts of the self are closed to the person, and he/she is unaware of becoming enmeshed or overwhelmed. People with strong and resilient boundaries are able to decide: True empathy occurs when you open yourself to • When to stop taking care of others’ feelings. • When their feelings are most important, and self-care experience is appropriate. what the other • To use emotional shielding appropriately. • To open self to being empathic, but do not “catch” person is others’ feelings. feeling without • That they have control of their lives and their feelings to a sufficient degree. losing your sense of Stop Catching Emotions can you protect yourself from catching others’ yourself as How emotions? How can you prevent your uncomfortable separate and feelings from becoming triggered by contact with other’s distinct from emotions? The first situation is an external assault where the other person is sending or projecting their feelings of that person. discomfort, and you are open to catching them. The second is an internal assault where your uncomfortable feelings are set off because of your unresolved issues, such as family of origin issues, unfinished business from past experiences, and old parental messages. The external assault can be easier to repel or prevent than can the internal assault as the latter calls for an awareness of, and working through these unresolved issues. However, even the more difficult prevention of an internal assault can be somewhat implemented by prevention of the external assault where you do not catch others’ emotions; thereby, reducing the chances of having you identify with and act on the caught feelings. The following suggestions and strategies can help you to stop catching others’ emotions. • Develop your emotional shielding. • Stay alert to the possibility that you are susceptible to “catching” emotions. • Use some simple nonverbal behaviors to ward off “catching.” • When you begin catching other’s feelings, monitor your emotions to prevent further harm. • Use distracting behavior. Emotional shielding is visualizing a barrier between you and the other person. This barrier allows the words to get 22 through, but stops their feelings from getting through to you. Your shield will be personal for you. That is, it can be whatever you think will do the job to protect you. Your shield can be a curtain, a brick or steel wall, a shade, force field, or battle shield. There are many ways to visualize your shield. Stay alert to the possibility that you are susceptible to catching others’ emotions. Just accept this about yourself until you have time to strengthen your psychological boundaries, and set your emotional shielding in place to protect yourself. Simple nonverbal behaviors, such as the following can be very helpful to prevent you from catching others’ emotions. • Turn your body slightly away from the other person. • Do not maintain eye contact. Look at the person’s forehead, across their shoulder, or around the room. • Put something between you and the person, for example a purse, pillow, table, chair, etc. • Attend to something on your person, such as clothes, hair, fingernails, etc. These are the opposite of showing interest, and that you are really listening to the other person. Distracting behaviors can be very effective at protecting you. Change the topic, call someone over to join you, turn away, pick up something from the floor, or take stuff out of your pocket or purse; the list is long. The behavior will distract you, and the other person. There may be times when you are unaware of the snare and start to be captured by the other person’s emotions. Do not give up, or give in. Instead, start to think to keep from becoming ensnared by their feelings. Think of your emotional shielding, and quickly put it in place. Some feelings will have gotten through, but many more can be repelled. Thinking can also remind you to use your nonverbal withdrawal strategies. These suggestions will work as the short-term barriers. However, you do not want them to become your habitual behavior as they will negatively affect your other relationships that you want to maintain. This means that you should consciously use the strategies, be aware of using them, and understand that these are short-term strategies. The long-term solution is to build your psychological boundaries to be strong and resilient.M Dr. Nina W. Brown is a professor and eminent scholar of counseling in the Educational Leadership and Counseling Department at Old Dominion University in Norfolk, Virginia. She received her doctorate from The College of William and Mary and additional training in group psychotherapy from the American Group Psychotherapy Association. Dr. Brown is a licensed professional counselor, a nationally certified counselor and the author of 13 published books. Her latest books are Working with the Self-Absorbed (New Harbinger) and The Unfolding Life: Counseling Across the Lifespan (with Parker; Greenwood Press). You may contact Dr. Brown by email at nbrown@odu.edu. Paradigm • Fall 2003 2003 TRAINING AND WORKSHOP SCHEDULE PROBLEM AND COMPULSIVE GAMBLING Presented by the Staff of the Illinois Institute for Addiction Recovery. This training will consist of a 30hour course delivered throughout a five-day series. It will provide participants with the requisite knowledge for the State of Illinois written certification exam for counselors of problem and compulsive gambling. At the end of this workshop, participants will have developed a strong clinical base for compulsive gambling issues as well as cultural competencies and client-centered treatment for compulsive gamblers and their families. Please call for additional information and training dates. WE ALSO INVITE YOU TO COME VISIT OUR BOOTH AT THE FOLLOWING CONFERENCES: October 14-17 24-25 November 5-9 2003 PROGRAM WORKSHOP NOVEMBER 21, 2003 Topic: Co-occurring Psychiatric and Substance Use Disorders: Assessment, Diagnosis and Treatment Seth Eisenberg M.D. Co-occurring psychiatric and substance use disorders are common in most settings that provide behavioral healthcare services. Being able to accurately assess symptoms and discern a differential diagnosis is essential to effective treatment. This workshop will review the challenges of assessment and diagnosis for this population and discuss various treatment approaches most effective for the dually diagnosed patient. About the speaker Dr. Eisenberg is the Medical Director of the Illinois Office of Alcoholism and Substance Abuse and Director of the Addiction Psychiatry Residency Training program at Northwestern University Medical School. He provides clinical psychiatric outpatient services for the Midwest Physicians group in Orland Park, Illinois. Dr. Eisenberg is a licensed psychiatrist who has over 20 years experience with adult psychiatry, child and adolescent psychiatry and addiction medicine. REGISTRATION AND CEU INFORMATION CEU credits have been requested through the Illinois Department of Professional regulation for social workers and LPC/LCPC, IAODAPCA, EAPA, and the National Council on Problem Gambling. Registration deadline is one week prior to the workshop. American Bar Association Lawyer’s Assistance Program Victoria, British Columbia National Eating Disorders Association St. Charles, Illinois Summit on Clinical Excellence Scottsdale, Arizona 19-22 Association for Financial Counseling and Planning Education Savannah, Georgia 21-24 Employee Assistance Professionals Assoc. New Orleans, Louisiana (Booth #410) December 4-7 American Academy of Addiction Psychiatry New Orleans, Louisiana 5-6 Women’s Healing Chicago, Illinois The Counseling Center at Proctor Hospital Individual, Couple, Family or Group sessions for: • Stress Management • Depression • Coping with Medical • Anxiety Problems • Relationship Problems • Divorce Adjustment • Grief & Loss • Abuse Recovery • Anger Management Above trainings will be held at the Proctor Professional Bldg., Peoria, IL. For registration and lodging information, call 1 (800) 522-3784 or visit the Web site www.addictionrecov.org. (309) 689-6008 or 1 (800) 522-3784 5409 N. Knoxville Ave. Peoria, IL 61614 If you have questions regarding addictions, call 1 (800) 522-3784, or write to Eric Zehr at Proctor Hospital, 5409 N. Knoxville Ave., Peoria, IL 61614. On the Internet, contact: Eric.Zehr@Proctor.org For more answers, visit our interactive Web site at http://www.addictionrecov.org Paradigm • Fall 2003 23 Addiction devastates lives. We can rebuild them. Our professionals are uniquely qualified to help men, women and adolescents live without addictive chemicals or behaviors. We offer inpatient and outpatient treatment for addictions to chemicals, gambling, food, spending, sex, and the Internet, as well as treatment for chronic pain with addiction, all with options for extended care. Pick up the phone, and start picking up the pieces. Call today for a confidential consultation. 800-522-3784 or 309-691-1055 www.addictionrecov.org