When a spouse is impaired

The usual stock assertion in marital therapy is that spouses are more or less 50/50 responsible for the problems in the marriage. But there are also times when one spouse simply functions at a higher level most of the time than the other one. The more impaired spouse may have a problem such as an addiction, memory loss, chronic depression, or just plain and simple, he or she is constitutionally weaker from a psychological standpoint. The weaker spouse may lack self discipline, sustained follow through, and generally has a harder time making and keeping commitments.

Sometimes these differences are simply going to be there for the long haul. It's really important that if you're the stronger or healthier spouse to follow some general principles. First, don't organize your life around what your spouse is doing wrong. Compliment him/her for something done right every day.  Don't try to correct, rehabilitate or fix the other person. The impaired spouse already feels inferior and playing the role of teacher or therapist can only make this worse. Ask him or her to teach you something that they're better at than you are.

Do your best to create and sustain healthy, emotionally close relationships with friends. It's hard to expect a marriage to meet all of one's needs for closeness anyway. But this is even more the case when a spouse is impaired in some way. Support groups such as Al-Anon (when a loved is an alcoholic) or Nar-Anon (when a loved is addicted to drugs) can be invaluable to learn how to keep your sanity and even find serenity when in relationship to an addicted person.

Do your best to exercise regularly, eat right, and have a few hobbies or other pursuits to give your life more balance and enjoyment. I also try to remember such adages as "getting better at love is more important than being right." In his latest book, Flourish, Martin Seligman talks about well being using the concept of 'flourish.' To flourish is have positive emotions, flow, meaning, love, gratitude, accomplishments, growth and improved relationships with others. These can grow in us even when married to someone who is not functioning very well.

If you're trying to keep your head above water while in relationship to an impaired spouse and need assistance, in the Chicago area, contact one of the talented mental health professionals at Heritage Professional Associates. Outside of the Chicago area, ask someone whom you trust for the name of a reputable mental health professional.

Gratitude this Thanksgiving

As Thanksgiving approaches, different emotions arise for different people. For those struggling with depression, loneliness, or strained family relations, Thanksgiving can be a painful holiday. There is little to feel thankful for. Many such people wish that the holidays could pass as quickly as possibly. Some have even said that they wished they could hibernate through them and wake up on January 2nd so they could avoid them altogether.

So, why be grateful? Research has shown that whatever we focus on seems to become more prominent in our lives. Research subjects randomly assigned to track what they're grateful for ended up feeling happier than other people randomly assigned to track either neutral or negative events in their lives. Even if you have to start pretty small and simple, be grateful for the air that you breathe and for lungs to breathe it. Be grateful for a blue sky or a sunset or a sunrise. It's hard to be critical of a sunset. If you make it your resolution, you can probably find something redeeming about even the most difficult of relatives. Focus on one small thing that even an ornery relative has done in a given day. If you make that your focus, your day is likely to end up differently than if you focus on that person's more identifiable faults and weaknesses.

Small gratitudes usually lead to bigger ones. So start creating a new habit of seeing things you can be grateful for. It's a gift to give yourself this Thanksgiving. If you try and you just can't get 'there' from 'here' ask for some assistance. In the Chicago area, consider someone from Heritage Professional Associates. Outside of the Chicago area, ask someone whom you trust for the name of a reputable mental health professional.

Kids and the video game, Call of Duty

Maybe your child (using your credit card) was one of the 20 million or so customers who pre-ordered Call of Duty - 6, Modern Warfare 2, and then waited anxiously for its release on a Tuesday night (aka a school night) last November. There are few of us parents who don't feel at least a little ambivalent about allowing our kids to play a first person shooter game, especially one that has blood (as in, lots of it), and victory can be claimed by detonating a nuclear bomb, which ironically enough, appears to explode within a mile or so of the 'winning' team. Then, there's Call of Duty 'Live' for X-Box 360 in which your child is talking live with God knows who, from who knows where while shooting people and trying to 'nuke' the other team. Have we all gone mad?

So, as a clinical psychologist whose sons play this game on far more than a casual basis, let me offer some musings on the pros and cons of this game as I understand it.

The positives of this game:

1. It really is more about mastery, competence and teamwork than it is about killing and maiming. As a child of the 1960s and 1970s myself, the concern then was about watching too much television. Most of us had seen well more than 100,000 people getting killed over the course of our TV watching 'careers' prior to the age of 18. Parents were sure that we would become mass murderers or at the very least, grind the world to a stop because we had turned our brains to mush in front of the 'boob tube.' Playing Call of Duty is not going to cause people to turn into serial killers or else we would have had a catastrophic rise in the number of them over the last few years.

2. Call of Duty is about strategy, learning from one's mistakes, communicating with other people, and getting better at something through sustained focus and repetition.

3. Then there's the fascinating element to the game called 'Prestige.' This comes when you voluntarily give back all you have accomplished and basically say, "it wasn't good enough. I want to start all over again." This is something like telling your child to re-do their major paper because it wasn't good enough. Kids choose prestige, sometimes multiple times. Of course there's certain badges of recognition for doing this, but it requires a lot of persistence, humility and determination. These are not bad aspects of a game for use in real life.

4. There's the teamwork involved in playing the game 'live.' Listening to my kids' animated chat with other people on the game is way more activity than when I sat on the couch as a child watching Tom and Jerry hit each other with sledge hammers and steel anvils, always without injury.

When the game becomes unhealthy:

There are certainly times when the game is not healthy for kids. Here are some telltale signs:

1. They won't get off of the game when you tell them to. Kids then stay up too late, and avoid other more important activities such as homework, general studying, exercise, or getting together with friends face-to-face and doing something besides, well, Call of Duty.

2. Siblings argue and / or get into physical altercations about whose turn it is to play the game. Time, I say, to give the video game a time out.

3. Meeting someone on line and then agreeing to meet them in person without telling you about it. Obviously, this is a problem and time to disable the internet connection to the game.

4. You are using the game as a convenient babysitter so you can get things done, but in the process, spend less time with your kids.

Most of the problems surrounding this game can be negotiated with your kids by regular dialogue. The best ways to have obedient kids include spending time with them, consistency of discipline and rules in general, and taking time out of the general busyness of life for more focused time with your kids. If you're having trouble accomplishing these, and your child is seeming to get more and more hooked on 'screens' then contact a reputable mental health professional. In the Chicagoland areas, consider one of the mental health providers at Heritage Professional Associates.

Couples and money

Money holds a unique place in long term committed relationships. It's the number one thing that people lie about in a relationship, and is one of the most common causes of arguments. Money, together with time, sex, and food (meal preparation), is a powerful 'currency' which symbolizes the giving and receiving of love. Are you giving out more than you're getting back?

Money is a focus in a relationship for a number of reasons. It's tangible. You can see in black and white terms what a bank balance is, how much is owed on a credit card, and whether payments are late. It's far harder to get one's 'arms' around more murky, but more important issues like the amount of kindness and tenderness there is in a relationship. How about compassion, understanding, and empathy? These, too, are crucial, but they're harder to define, measure, and therefore, talk about.

Money looms very large in our culture as the standard of success and security. And of course, money is important. But we shouldn't let it loom larger than kindness, tenderness, understanding, empathy, moral decency and living a meaningful life. Research has shown that once we're out of total poverty, subsequent increases in wealth don't really impact our overall happiness very much.

So, keep money in perspective. If you're going to have a money talk with your partner, keep in mind what you love and respect about the other person and tell this to him/her. Say aloud what values and virtues you cherish in the other, and then have a candid talk about money. Look at your financial realities square in the 'face' and come up with a solid plan to live your life within your means and make sustainable financial goals for your life now and for the future. But, as you do this, keep it all in perspective. Money really doesn't buy happiness. But, emotionally intimate, emotionally secure relationships do.

If you've lost perspective on this and need some guidance, in the Chicago area, consider a mental health professional at Heritage Professional Associates. Outside of the Chicago area, ask someone whom you trust for the name of a reputable mental health professional.

What is ADHD / ADD?

The letters ADHD / ADD can be confusing. The current diagnostic term is ADHD for all forms of ADD. ADHD stands for attention deficit hyperactivity disorder and it comes in three types: the inattentive type, the hyperactive type, and the combined type in which both inattention and hyperactivity are present.

Attention deficit hyperactivity disorder is not a very good way to label the syndrome. ADHD inattentive type is actually a compilation of several executive function symptoms. These can include: getting started on important (but boring) tasks, planning, organization, sustained mental effort (again on something that is important but not terribly interesting), attention, concentration, freedom from distractibility, being able to check one's work for legibility and careless mistakes, and finally, working memory.

Working memory is the human equivalent of RAM memory on a computer. It is the ability to take in multiple pieces of information, hold onto them, and plan a series of responses to each one without losing track of the other ones. It is central to being able to follow a set of instructions, to multi-task, to remember a phone number briefly, and to compute math problems in one's head. Having low working memory is like a computer that has limited RAM memory. Applications are processed in a more sluggish and inefficient manner.

The hyperactive side of ADHD can include fidgety behaviors, restlessness, impulsivity, and feeling like one is being driven by a motor.

A good work-up for ADHD includes interviews, taking a thorough family history (ADHD appears to be inherited), using current and valid rating forms to compare the person to others of the same gender and age, and using performance measures of ADHD to measure directly such things as attention, concentration, and working memory. It is also important to check for things which can mimic ADHD such as anxiety problems, depression, motivational problems, learning disabilities or other processing problems, and even underlying psychotic conditions. Finally, very bright children (especially boys) can be mis-diagnosed with ADHD. Hence the need for a comprehensive evaluation.

For a good ADHD evaluation in the Chicago area, see one of our diagnosticians at Heritage Professional Associates. Outside of the Chicago area, ask someone whom you trust for the name of a reputable mental health care professional who is equipped to do these kind of evaluations.

What leaves someone vulnerable to infidelity?

The factors which leave someone vulnerable to infidelity are present long before the unfaithful behavior begins. There is a build up of entitlement (I deserve to be happy; because my spouse is ignoring me, I deserve to get my needs met somewhere else; I am entitled to physical intimacy). There often is a growing sense of loneliness. Many spouses who stray do not know how to effectively communicate their needs. They operate under the false premise of "If you really love me, then you'd know how I feel without me having to tell you."

Many wayward spouses are conflict avoidant. They don't want to hurt their spouse by telling them how distant they feel, how unhappy they are, etc. What is actually going on is that the wayward spouse becomes anxious around bringing up difficult, conflictual subjects. So, he/she goes quiet, acts out, and hurts their spouse much more deeply in the long run.

An excellent book to help couples after an affair is called, Surviving an Affair by Harley and Chalmer. And of course, counseling is essential to help couples as well. Affairs simply don't happen when a marriage is in good shape. It's essential to look at what left the couple vulnerable to an affair to begin with. If you're in the Chicago area, check out one of our therapists at Heritage Professional Associates. Outside of the Chicago area, ask someone whom you trust for the name of a reputable mental health professional.

The Holidays....Here They Come Again.....

Your energy is already low, life seems to go by so fast, and it's hard to keep up under normal circumstances. Now, here come the holidays with the extra demands, time commitments and financial burdens. So, it's to be expected that you may not be in the most enthusiastic and cheerful moods as the holidays approach.

Another set-up, if you will, is that about expectations. I remember seeing Christmas decorations first show up in some stores in September! Anytime there is such a long build-up to a celebrated event (like a wedding, the birth of a child, or a major holiday like Christmas), it's easy for expectations to build as the anticipated event looms closer. What's the phrase? "Expectations are pre-meditated resentments." The more we expect, the more likely we are going to be disappointed when reality can't possibly measure up to our fantasied ideal.

Part of the strategy for surviving the holidays is to watch your pace. Don't try to do everything. Simplify. Don't go to every party or send a holiday greeting card to everyone you know. Try to preserve an oasis or two in the middle of the holiday season. This could mean just one day out of every ten that is off limits to scheduling. Use the day to slow things down. Lower the stimulation. Go for a walk. Listen to music. Sit by the fire. Have a slower conversation with a friend or companion that isn't about the un-ending events of the day.

Be willing to scale things down a little when putting on a 'spread.' You don't always have to pull out the fine china (which has to be washed by hand), or use linen table cloths. A side dish or two works just as well as five of them. We tend to eat too much as it is.

I don't know how many times when I ask people to share their favorite memories of childhood, they treasure more the simpler interactions with loved ones. It's about sitting around a campfire, playing a board game with the family, going for a walk or a hike. Rarely do people refer to exotic trips or expensive gifts as their most treasure memories. So, no one's Christmas is going to be ruined if things are simplified a little bit in the gift 'department' as well.

If the holidays are getting the best of you (instead of your family getting the best of you), try talking with one of our mental health professionals at Heritage Professional Associates. Outside of the Chicagoland area, ask someone whom you trust for the name of a reputable mental health professional.