I would like to welcome Aetna clients at my private practice, as I am now a provider for Aetna. Aetna is not one of the more popular insurances in Rhode Island, and many mental health providers are not providers for Aetna. However, having several good insurance providers in Rhode Island is good for competition and I believe this will help improve health care. Therefore, I am happy to be a provider for Aetna and look forward to serving Aetna clients. For more information on Aetna insurance, or to learn from their health and wellness website, please visit here.
This headline in MSN jumped out at me — “How To Improve Your Marriage Without Talking About it” — because I recently talked with a couple about needing to talk to each other less. That’s right — to make their relationship work better, talk less. The corollary for their situation was: do more. Talk less, do more. Show your love in other ways — by being on time, by following through on promised projects, by nourishing each other with good food.
It looks like Patricia Love and Steven Stosny, the co-authors who wrote the new self-help marriage shocker, How to Improve Your Marriage Without Talking About It, have some compelling research to present about how men and women differ in communication patterns. From MSN:
[...] According to Stosny’s analysis of several hundred human and animal studies, male and female responses to stress are distinct from birth. “When a baby girl hears a loud noise or gets anxious, she wants to make eye contact with someone, but a baby boy will react to the same sound by looking around, in a fight-or-flight response,” he says. What’s more, while newborn girls are much more easily frightened, boys have five times as many “startle” reactions, which are emotionally neutral but pump up adrenaline. Boys need to intermittently withdraw into themselves to keep from becoming overstimulated. These differences hold true for most social animals and correlate with our biological roles: The female’s fear response is an early warning system that serves to detect threats and alert the males of the pack to danger.
As girls grow, they go beyond needing eye contact and refine a coping strategy identified by UCLA psychologists as “tend and befriend.” If there’s a conflict, girls and women want to talk about it. Boys and men, however, need to pull away. A man’s greatest suffering, Stosny says, comes from the shame he feels when he doesn’t measure up—which is why discussing relationship problems (i.e., what he’s doing wrong) offers about as much comfort as sleeping on a bed of nails.
Similar to Stosny and Love’s approach is the idea of the diversity of ways to express love described in The Five Love Languages. For many couples, there is a much greater need for showing their partner that they care about the relationship by attending to the children, or doing chores, or being on top of finances — by what Gary Chapman calls “Acts of Service.” For others, gifts and quality time are more important, and still others are primarily concerned with physical touch. Finding out which of the love languages is primary for you and your partner can help you reflect and build a better relationship. And sometimes what you might learn is that you want to talk less.
I’ve been doing a lot of thinking and reading about marriage and family lately, due to my practicing more couples therapy and wanting to beef up my knowledge and technique, as well as just general curiosity about what makes a marriage or a family into something enriching and rewarding. I set out googling and goodsearching to answer two basic questions: what makes a family work and what makes a marriage work?
These do not seem to be burning questions in the minds of many other people. In America today, we seem to be too busy trying to exclude people from marriage (i.e. same-sex couples, although this is changing, slowly, state by state, with NH signing it into law yesterday and RI destined to be dead last in following suit) to notice that our institution is in serious disrepair, with 50% of US marriages ending in divorce, and a rate for children growing up in single-parent households that continues to steadily rise.
In my quest for information on what makes marriage work, I discovered some fascinating research called State of Our Union by Barbara Dafoe Whitehead and David Popenoe, who work out of the National Marriage Project at Rutgers University. The Project at Rutgers has studied marriage from several different angles including a comparative study with Scandinavian families and their divorce rates. Here is how they describe the ideal family environment for raising young children:
[...] I have suggested that the ideal family environment for raising young children has the following traits: an enduring two-biological parent family that engages regularly in activities together, has developed its own routines, traditions and stories, and provides a great deal of contact time between adults and children. Surrounded by a community that is child friendly and supportive of parents, the family is able to develop a vibrant family subculture that provides a rich legacy of meaning and values for children throughout their lives.(9) Scandinavians certainly fall short on the enduring two-biological parent part of this ideal (yet even there they are currently ahead of the United States), but on the key ingredients of structured and consistent contact time between parents and their children in a family friendly environment, they are well ahead of us.
The authors go on to describe how difficult it is in America to achieve this ideal environment:
In America today the achievement of this ideal family environment requires what many parents are coming to consider a Herculean countercultural effort, one that involves trying to work fewer hours and adopting the mantra of “voluntary simplicity” for those who can afford it; turning off the TV set and avoiding popular culture; seeking employment in firms that have family-friendly policies such as flexible working hours; and residing in areas that are better designed for children and where the cost of living is lower. Families in Scandinavia need not be so countercultural to achieve these goals because the traits of the ideal child-rearing environment are to a larger degree already built into their societies.
If you want to keep going with learning about marriage, Poponoe and Whitehead publish a yearly version of “State of Our Unions.” In the most recent version I could find online, Poponoe talks about ways to recommit to marriage, and suggests we’d need a cultural awakening to pull it off. Here is a link to the 2007 essay.
With regard to the question of what the key ingredients are of stable long-term relationships, here are some very telling statistic from Poponoe and Whitehead:
By now almost everyone has heard that the national divorce rate is close to 50% of all marriages. This is true, but the rate must be interpreted with caution and several important caveats. For many people, the actual chances of divorce are far below 50/50.
The background characteristics of people entering a marriage have major implications for their risk of divorce. Here are some percentage point decreases in the risk of divorce or separation during the first ten years of marriage, according to various personal and social factors:
Percent Decrease in Risk of Divorce:
Annual income over $50,000 (vs. under $25,000) — -30%
Having a baby seven months or more after marriage (vs. before marriage) — -24%
Marrying over 25 years of age (vs. under 18) — -24%
Own family of origin intact (vs. divorced parents) — -14%
Religious affiliation (vs. none) — -14%
Some college (vs. high-school dropout) — -13%
So, you want to reduce your risk of divorce? Have a household income of more than 50 K. That’s right, all those people who try to tell you money doesn’t count in love, well guess what? It does. If you have a household income of less than 50 K and you are still married, you are beating some pretty stiff odds. You should probably find some cheap way to celebrate your amazing luck and good fortune in relationships.
You want to do something else to reduce your risk of divorce? Be at least 25 before you tie the knot. Go to college and think about what kind of person you want to spend the rest of your life with.
Want to reduce your risk even more? Join a church. Get around a good group of people who share your core values.
Oh, and one more thing. Use birth control (and hope that it doesn’t fail) until you are married. It helps.
And finally, if you are having trouble in your marriage, you might want to consider going to a professional (not that I’m biased!). The biggest problem I see with couples is that by the time they get to making an appointment to see a therapist, they are often feeling extremely burned out about the relationship. They are sick and tired of fighting and want things to be better, but their ability to feel hopeful about the other person or the relationship is quite damaged.
Couples therapy does not need to be a long, involved process. Many times the process of a therapist suggesting some reflection and communication exercises is enough to get the ball rolling. You can also read up on your own and try being your own therapist. I recommend John Gottman and the Gottman Institute, particularly the book 10 Lessons to Transform Your Marriage. For a more spiritually-centered approach, I also recommend Gary Chapman and The Five Love Languages.
Over the years I have treated many children with reactive attachment issues and, while sometimes heartbreaking, there is also a great deal of joy in the work. Reactive Attachment Disorder (RAD) is a cluster of behavioral and emotional issues that are believed to relate to a child’s lack of appropriate early bonding with a primary caregiver. RAD is often what is going on when a child asks if I can be his mommy during the first session, or when a child makes little or no eye contact and behaves as if he doesn’t want to interact with me. Usually with RAD, there are clear markers in the child’s history — sometimes in utero, sometimes after birth in the first three years — when there was no stable primary caregiver.
It happens a lot with foster children, naturally, if they have been moved around a lot, or if their reunification plans with bio family keeps falling through. I also think there is an argument to be made that reactive attachment can start off in utero, when a child is exposed to high levels of stress hormones. Mark Brady, PhD, has a great post in which he describes the developmental problems resulting from neglect and early stress. He quotes Dr. Bruce Perry, author of The Boy Who Was Raised by a Dog, talking about how the human brain responds to childhood neglect:
“As you grow, the brain is essentially like a sponge. It’s absorbing all kinds of experiences. So if a child is not held, touched, talked to, interacted with, loved, literally neurons do not make those connections, and many of them actually will die.”
“Big, big ventricular spaces (show up in stressed out kids), which will impact sleep, regulation of anxiety, regulation of mood, whether or not you’re very happy or sad.”
“Simple things like eye contact, touch, rocking and humming can make all the difference to a baby. It makes neurons grow, it makes them make connections. Then, it makes the brain more functional.”
One of the most impactful experiences I have had working with a RAD client was working with a little boy who had been raised for his first three years in an extremely neglectful environment — to the point where when he was moved to foster care, he did not know how to play other than to lay on his belly on the floor and put his fingers in front of his face and move them around. There were very few toys in his early home, and even less of a primary person paying attention to his needs and giving him the closeness he would need to understand the world emotionally. He had come a long way by the time I was seeing him, could play and interact with others, had probably quadrupled his vocabulary in the year he had been in a stable home, but he was still a very skinny kid with rotted teeth that had to be capped and lots of ear infections and other illnesses constantly weighing him down.
Part of my message to RAD kids is the constant reminder to them (and to their brains!) that they are growing, expanding, developing, changing, become whole, becoming strong. I say these things not only because they are true but also because they are the mantra of our shared hope — that their growth will now take place, that they will be able to make up for lost time and accelerate fast enough to get the ABC’s and color identification and some decent social skills in before kindergarten starts. And most of all, because I want them to know that I see them. I see them. They are here.
The importance of this knocked my socks off one day in session with this little guy, who I’ll call James. I was giving him the message that he was growing, asking him how old he would be turning on his next birthday, reinforcing that he would soon be in kindergarten, when suddenly James said, “When I was a baby, I was invisible. Now that I’m older, I have skin and bones.”
“Indeed,” I said, to draw out the moment. “And you have your whole body. And you’re growing bigger all the time.” When I had James create himself on “Mi” on the Wii (I did the controls as he was behind most kids on video game skills) he created a person who was as tall and big-boned as possible, with a big head of black hair. He wanted to be big. And compared to how small he had been made to feel in his birth home, he was indeed a big guy now.
We all need closeness in order to know we exist. If no one knows who you are, knows you internally, knows your needs and how to fill them, you grow up feeling invisible. Anyone who has ever been in a situation where everyone around them was deliberately ignoring them knows how awful it is to feel invisible. Imagine this being the world you are born into. Imagine how devastating that would be.
The good news is that most of us are not born into such cruel environments. Even in families where there is physical and emotional abuse, there is often still a sense of attachment for the child — that their needs are still very high on the list of things that get taken care of. It was enlightening, but also frightening, working with James — realizing just how powerfully he was experiencing the arrival of his identity, and how much catching up there was to do.
(cross-posted at Kmareka.com)
Here is an enlightening piece of research for those of us raising the strange little creatures known as preschoolers, and those of us providing treatment to families raising the little barbarians as well. Research by Colorado Professor Yuko Munakata suggests that three-year-olds are often listening when you give them directions — they simply choose to ignore you until there is evidence that the directions are needed. From Science Daily:
“… For example, let’s say it’s cold outside and you tell your 3-year-old to go get his jacket out of his bedroom and get ready to go outside. You might expect the child to plan for the future, think ‘OK it’s cold outside so the jacket will keep me warm,’ ” said Chatham. “But what we suggest is that this isn’t what goes on in a 3-year-old’s brain. Rather, they run outside, discover that it is cold, and then retrieve the memory of where their jacket is, and then they go get it.”
Munakata doesn’t claim to be a parental expert, but she does think their new study has relevance to parents’ daily interactions with their toddlers.
“If you just repeat something again and again that requires your young child to prepare for something in advance, that is not likely to be effective,” Munakata said. “What would be more effective would be to somehow try to trigger this reactive function. So don’t do something that requires them to plan ahead in their mind, but rather try to highlight the conflict that they are going to face. Perhaps you could say something like ‘I know you don’t want to take your coat now, but when you’re standing in the yard shivering later, remember that you can get your coat from your bedroom.”
I would argue that this tendency to ignore advice until there is evidence to support its necessity extends beyond preschool — I still go through this with my nine-year-old! The point is, you can probably save your breath and a lot of extra annoyed feelings by accepting that your small child’s brain does not operate in a way that tends to accept futuristic warnings. Showing them what will happen if they don’t listen, or helping them imagine the scenario of how they will benefit if they heed your directions, will probably be more effective than just repeating yourself ad nauseum.
In an online interview at Sharpbrains.com, Neuroscientist Dr. Michael Posner shares about some new research on ways to train self-regulation and attentions skills. From the interview:
Dr. Posner, many thanks for your time today. I really enjoyed the James Arthur Lecture monograph on Evolution and Development of Self-Regulation that you delivered last year. Could you provide a summary of the research you presented?
I would emphasize that we human beings can regulate our thoughts, emotions, and actions to a greater degree than other primates. For example, we can choose to pass up an immediate reward for a larger, delayed reward.
We can plan ahead, resist distractions, be goal-oriented. These human characteristics appear to depend upon what we often call “self-regulation.” What is exciting these days is that progress in neuroimaging and in genetics make it possible to think about self-regulation in terms of specific brain-based networks.
Can you explain what self-regulation is?
All parents have seen this in their kids. Parents can see the remarkable transformation as their children develop the ability to regulate emotions and to persist with goals in the face of distractions. That ability is usually labeled ‘‘self-regulation.’’
Dr. Posner goes on to talk in detail about new research being done with video games in training attention and self-regulation, two of the most important executive functions. There is promising research indicating that training these functions, and training them early, can make for positive long-term outcomes.
Now that we’ve gotten that pesky election out of the way, we can talk about really important things like Self Help Video Games!
Seriously, though, there is interesting news for therapists and gamers out there – a whole new fleet of video games are being developed to help people combat problems such as smoking and being overweight, with video games for depression, anxiety, and anger management not far off, I’m sure. Are therapists about to be replaced by Nintendo? Maybe for some people, but more than likely this transition will mean that for a select group of people, therapists will have a new tool to use to help people help themselves.
