I was explaining to a neighbor that someone we were talking about had Attention Deficit Disorder (ADD), and she got miffed and said it was unnecessary to label people. This happened during the same week that a client mentioned to her sister that I suggested she (the sister) might carry the diagnosis of Borderline Personality Disorder and that caused trouble in already dysfunctional family dynamics. In my first post-grad school job, I was required to submit a DSM (Diagnostic Statistical Manual) diagnosis. Ditto when I was an insurance provider. I didn’t think much about mental health diagnosing until a friend explained to me how it had negatively impacted her brother with schizophrenia and I started looking at it from the client’s point of view, that is, feeling that they were being reduced to a psychiatric label. I understood how harmful this could be. Years later, I had two clients in my...

Many dysregulated eaters have difficulty setting boundaries. All/nothing thinking leads them to accept everyone into their lives and allow people to walk all over them or keeps them emotionally defended and alone. This is known as having loose or tight boundaries. One is not better than the other. Boundaries need to be set according to what’s necessary. Like doors, boundaries can be open, closed or swing back and forth.  We learn about boundaries from parents and other adults who take care of themselves and others and say yes and no appropriately on a case-by-case basis. Boundaries are fluid—like swinging doors—set according to varying people and situations. Wise parents are sometimes available to their children and sometimes not. They watch out for them and themselves and are clear about what they will and won’t do for others. Alternately, parents with poor boundary setting provide unhealthy models for their children. Maybe they feel...

My book review originally published at NY Journal of Books This life-altering book stands head and shoulders above the countless how-to guides aiming to teach couples how to repair broken relationships. Its brilliance lies in both its macro-analysis of how cultural over-valuing of the individual undermines loving partnerships, and its detailed strategies to get back on track by learning to hold the well-being of the union above the happiness of each member. Written in plain language, the author’s generous sharing of therapy sessions will make readers cry with his clients and laugh at themselves. Terrence Real, LICSW, internationally recognized family therapist, speaker, and multi-book author, is the founder of the Relational Life Institute. The power of his message comes from professional wisdom, topnotch writing, deep introspection, and exceptional frankness about the challenges he’s faced to become not only the man his wife would like him to be, but the man he,...

So often when I suggest to clients that they may be co-dependent, they say, “Who me?” They can’t see what I see about them because they’re so entrenched in their interactional patterns and fail to recognize that they’re more other than self-focused. Here’s a major clue that you might lean toward co-dependence.  One major tip off is when I ask a client about how they’re feeling and they don’t talk about themselves but start talking about another person’s feelings. For example, I was asking a client how she felt about a break-up with her boyfriend and she responded, “Well, you know it’s his choice. He thinks we should try to work it out, but I’ve tried everything to make things work. I guess I just don’t meet his standards.”  A slightly different example happened during a conversation I had with a client about his narcissistic mother. Again, I asked my client...

A conflict that comes up a good deal in therapy is whether we can care about someone but no longer want to be responsible for taking care of them. Discussion of this topic arises more often with people who are co-dependent than with those who aren’t. In fact, it’s often a tip off of their over-focusing on other’s needs.  Here are two examples. A client broke off a long-term relationship with her boyfriend in another state. They hadn’t lived together for a while and slowly became more friends than lovers. My client made great strides in therapy, more or less leaving her ex in the dust, while he continued to be jobless, live with his parents, and do drugs. They’d been each other’s support for decades and she still had deep feelings for him, but she was tired of him calling to complain and always make himself out to be a...

Many clients who’ve suffered dysfunctional childhoods either over or under respond to trauma. Easily stressed by typical family and work problems, when there’s major mayhem or abuse in their lives, they either don’t recognize it or act as if nothing’s wrong. The goal is to have a healthy window of tolerance for stress and stressors. Over-reacting to situations only causes more stress. For example, when you need to keep calling repeatedly to get information from a bank or doctor’s office, this is simply how life works. Bureaucracy takes time as well as a toll on us. But if you quickly get frustrated, you can make the situation worse by being verbally abusive or giving up on finding out information that’s crucial to your well-being. Alternately, when you let your Mom or Dad scream at your children for no good reason and make excuses for their abuse, you’re under-reacting which will cause...

Clients often complain about the narcissists in their lives and I’ve written several blogs about coping with them. I was thinking about them when I was waiting for someone in a doctor’s office and clocked fellow A talking non-stop to fellow B for 40 minutes! I couldn’t believe fellow B sat patiently, injecting only a few questions. Nor could I suppress a silent cheer when fellow A finally stopped talking and fellow B said, “But, you never answered my original question.”  We needn’t become captive to narcissists, especially the ones who drone on and on (and on and on) talking about themselves. I recently read about a technique called “gray rocking” which is one tool to try out. According to Deborah Ashway, LMHC, the term describes the person on the receiving end of an interaction trying “to make themselves as boring and nonreactive as possible to decrease the amount of provoking...

I blog a lot about adverse environments in child-rearing, but what makes for a great childhood is equally as important. This blog is as much for those of you who still blame yourselves for your lack of success or happiness as for those thinking about how to parent future generations. According to “Children Are More Likely to Succeed If They Live in this Type of Environment”, parents can go a long way toward ensuring their progeny’s success. The main ingredient, according to the article, is positive connection, based on these categories: care, support, safety, respect and participation. If you’re thinking about your own childhood, how did things measure up? Did you feel physically and emotionally safe and well cared for? Did you receive adequate and age-appropriate support? Were your opinions and needs respected and did family members treat each other respectfully? Was there a strong sense of belonging in spite of...

We’ve all experienced the ouch of “taking things personally,” but what does the term mean? I saw a movie decades ago where someone told someone else, “Well, don’t take it personally” and she responded, “I’m a person, so how can I not take it personally?” The fact is that we can avoid doing so and will benefit from ditching this reaction. Taking things personally means being offended or upset by what someone says or does. However, we have a choice to not be offended or upset. We can avoid it by thickening our skin and giving a different meaning to what others say or do. As I’ve said a million times, just because someone says something to or about us—even if our name is attached—it’s about the speaker, the message sender, not us, the receiver. If someone tells me I’m a bad person because I drink alcohol and will burn in...

I was at a birthday bash when, the birthday “girl” announced to some 60 guests that dessert would be served, urging everyone to get up and on line for it. “Who doesn’t want cake?” she asked. Her question reminded me of another blog I’d written about cake which got me thinking about what it is about this food that makes it such a draw. One thought is that cake is viewed as special, traditionally served on certain occasions only such as birthday, nuptial and anniversary celebrations and holidays. We think “cake” and it reminds us of happy times which usually involve friends or family or both. So, cake represents joy, coming together, and a festive mood. Who wouldn’t want that? Cake is also served at the end of a meal, leaving us on a high note, signaling that the meal is over and leaving us with a sweet taste in our...