When a child develops an eating disorder, it impacts everyone in the family. Parents are likely to feel shocked, scared or overwhelmed. Mothers, in particular, are susceptible to self-blame.Read More
Is there an addict in your life? Has it occurred to you that you might be doing things that keep him or her from taking responsibility for their own disease? When we love someone who engages in addictive behaviors, whether abusing substances or acting in other ways that cause self-harm, we can lose sight of what is "normal' behavior (for them and for us).Read More
In his CD, The First Year of Recovery, addictiononlogist and recovering addict Dr. Kevin McCauley outlines 10 principles essential to a 95% success rate of recovery from addiction. McCauley works with addicted pilots who are highly motivated to recover and return to flight, and his principles form the foundation of the Pilot Recovery Program. Shirking on the recovery program lessens the probability of success, and each compromise in adherence to the program’s principles can reduce the chance of a successful recovery. Impaired doctors and nurses achieve an 85 to 95% recovery rate in programs based on a similar protocol, and the Pilot Program principles can be applied to other populations with a similarly high rate of successful outcome.
McCauley’s 10 Principles:
1 – 90 Days of Residential Treatment. It has been demonstrated that 30 and 60 days of treatment are insufficient to provide a solid foundation for recovery. A full 90 days in a residential program provides a strong base for ongoing recovery.
2 – Seamless Transition into a Sober Living Environment. McCauley emphasizes that the addict should visit sober living houses — and choose the one he or she will move into — while still in residential treatment. Upon release from the inpatient facility, the recovering addict should be transported directly to the sober living environment so there is no time during this vulnerable transition for the addict to obtain drugs or alcohol.
3 – Frequent, Non-Random Drug Testing. Drug testing must continue throughout the first year of recovery and be performed at frequent enough intervals to detect any time the addict uses his or her drug of choice. Any lower frequency gives the addict a window in which to use with impunity, which is a disservice to the recovering addict: a clean test enhances motivation for recovery.
4 – Outpatient Treatment Program. While the addict is residing at a sober living environment after being released from residential care, he or she needs to continue treatment. This will entail working with a drug addiction counselor and may include individual, family and/or group therapy.
5 – A Relapse Prevention Plan. A recovering addict may be exposed to old triggers to drink or use, and new situations are likely to arise in which he or she will have impulses to use again. Very early in outpatient treatment — if this has not been done during the residential stay — it is helpful for an addict, in the presence of his or her therapist, to draw up a relapse prevention plan that spells out in detail who to call, where to go and what to do when impulses to use arise. The addict should write out his or her plan, carry it at all times, and use it religiously as needed.
6 – 90 AA Meetings in 90 Days. “90 in 90” means that the addict should attend at least 90 meetings in his first 90 days of being in outpatient treatment. This gives the recovering addict a firm footing in the recovery community of Alcoholics Anonymous. In the environment of AA, the recovering addict can learn sober ways of thinking, behaving and coping, and observe sober people who are creating sober lives for themselves. AA offers the addict a community in which to develop personal connections and to feel a sense of belonging.
7 – Meeting with an Addiction Physician. There can be medical complications resulting from addiction, and a physician versed in the physical effects of addiction, and the physical changes that accompany recovery, will be best able to help the addict understand and manage his symptoms.
8 – Meeting with an Addiction Psychiatrist. There may be psychiatric issues that preceded addiction or that arose during the period of use, and a psychiatrist who is knowledgeable about the psychological issues that accompany drug and alcohol dependence can distinguish psychological symptoms that are transitory aspects of recovery from those that may benefit from psychotropic medication. Sometimes an addict needs a period of time to be sober before a psychiatrist can determine what symptoms are likely to clear up with sobriety.
9 – Return to Work. Returning to work is an important aspect of becoming a fully functional after a lapse into addiction. Furthermore, work helps build self-esteem and offset the shame that generally accompanies addiction and job loss. Someone in early recovery may benefit from choosing a lower-stress job than he or she had previously, since the goal of working at this phase of recovery is to provide consistency, structure, responsibility and an opportunity to perform well rather than to embark on, or resume, a particular career path. For some people in recovery, return to a previous job is appropriate, but for others this is not the case. Determining what constitutes appropriate work for a specific individual is a topic that the recovering addict can person discuss with a therapist or group leader.
10 – Fun. The dopamine that has been depleted in addiction needs replenishment. Learning non-drug-using ways to produce pleasure is essential to rebuilding the natural supplies of dopamine. Without dopamine, recovery will not be appealing, the addict will experience more pain than pleasure, and the option of returning to alcohol or drugs in order to feel good will be compelling.
Following these ten principles can be a tall order, which is why the person in recovery, and his or her family, can benefit from substantial support and guidance. A counselor can reinforce these principles, and can steer the recovering person to their close adherence, for the sake of building a solid recovery platform.
For help with issues involving any type of addiction, please contact Avis Rumney at (415) 602-1403 or AvisRumney@me.com.
If you are finding that your relationship has more down moments than up ones, that anything you say seems to provoke your partner, or that things have gone from happy to ho-hum, it may be time to give your relationship a boost. Quite possibly you never had the opportunity to develop a realistic picture of what it takes to make a marriage or partnership work. If you think it should be all romance and roses, or that your partner should always want what you want, you are bound to be disappointed. And sometimes, just the ability to really talk with your partner disappears along with the novelty of first getting to know each other.
The reality is that good relationships require effort, investment and follow through. It’s not that basic partnership skills are either esoteric or difficult to understand. More often, people lack opportunities to learn relationship skills or have little guidance on how to implement them. When our parents didn’t really get along or perhaps didn’t even stay together, or we don’t want to emulate their relationship, we may have turned elsewhere for inspiration but then received a distorted and incomplete picture of what makes a relationship work. If we looked to friends’ parents for cues, we only saw a small fraction of their interactions. If television sitcoms provided our role models for marriage, with problems revealed, rehashed and resolved within twenty-six minutes, we doubtless developed a skewed sense of what it takes to make a marriage or partnership flourish. Below are some specific suggestions to help improve your relationship.
Express appreciation of your partner in many ways, as often as you can. This may be a stretch if you are feeling irritated, angry or distant, but look for the areas that you aren’t at odds about, and acknowledge those. Focusing on resentments and collecting more items to justify your anger is going to increase your negative feelings. You may have a really good case, but you will also have a really unhappy relationship.If you are having trouble thinking of what you appreciate about your partner, consider what your relationship gives to you that did not have when you were single. How have you grown in this relationship? Remember the early days of your relationship and what you really liked about your partner then. Chances are, those qualities are still there, although they may be obscured by disagreements or life events. Use words, gestures, touch and actions to acknowledge your partner in positive ways. Think of the things you know your partner likes to be appreciated for, and pay special attention to those. And, when your partner acknowledges you, make sure to say thank you. I hear aggrieved partners in therapy saying far too often ”I don’t think she ever notices when I open the door for her or take out the dog, or clean up the sink, or buy her favorite kind of tomato sauce.”
Resolve your differences in an effective, non-damaging way. Remember that this is a partnership – you are both on the same side. Disagreements come up, and it’s important to resolve them when possible. Sometimes this means compromise. However, most couples have a few areas where they cannot agree or come to any kind of compromise. In many situations, there are no “right” or “wrong” positions, but simply differing viewpoints. However, it is ok to agree to disagree. Where some kind of agreement is required, then negotiation is necessary and achieving some kind of resolution is important, although neither one of you is likely to get 100% of what you want. There are many situations where it is more a matter of principle – that one partner doesn’t want to “give in.” As one colleague says succinctly “Would you rather be right or be married?”
Speak up about what you want and need. The etiquette of good communication is simple: say what you mean, mean what you say, but don’t be mean when you say it. Before speaking up, ask your partner if he or she is available to hear you. If your partner is absorbed in a magazine and you simply start talking, your words, no matter how eloquently spoken, are likely to be unheard and felt as intrusive. When speaking, if you use “I” statements and feeling words, and are specific about what you need or want, you are more likely to get at least some of what you are asking for. Blaming and criticizing your partner are indirect and hurtful ways of expressing needs. How much differently do you think your partner will respond to “You never call me during the day from work” than to “I would really like it if you would give me a call from work tomorrow. I miss talking with you during the day.”
When your partner is talking to you, LISTEN! Don’t interrupt, roll your eyes, mutter under your breath, or gaze off into the distance. Be respectful and attentive. Stone-walling or giving a cold shoulder are forms of communicating: They say: I don’t want to hear what you say, I don’t care what you think, and I’m not going to make any effort to try and listen. Is that the message you want to give your mate? If you aren’t available to listen, say so, rather than pretending to be available when you are not. If you don’t agree with your partner, wait your turn to talk about your view. Probably the biggest gripe partners of both genders have about their relationships is not feeling understood. Paraphrasing St. Francis of Assissi, seek not to be understood, but to understand. How can you understand if you don’t even listen? Show you are listening by making eye contact, nodding, and asking questions, repeating back what you heard your partner say and asking clarifying questions. Your mate will be more likely to offer you the same courtesy.
When you are angry, breathe, take a time out, and get rational before talking. Words blurted out in anger are often regretted. The feelings are valid; the expression of those feelings needs to be constructive, not undermining, hurtful and destructive. Mishandled anger can be very damaging to a partnership. Many of us never learned reliable communication skills, much less how to argue in ways that express feelings directly but without venom. We are often angry about something our partner has said or done, but if anger gets expressed viciously, it becomes more global. The issues get muddied, and the battle becomes about who is the better person, not about whatever the original concern was. As in verbalizing other needs, make sure your partner is available to listen and use I statements to talk about your feelings, not about why the other person is wrong.
Plan a date night every week. Schedule a consistent time each week just for the two of you to do something fun. Take turns deciding what to do. This is not just a time to hang out at home and see what’s new on TV. But it doesn’t need to be costly, either. It can be taking a leisurely walk in a new part of town or going out to watch the sunset and stopping for tea. It can be an evening spent at home, but one that has been choreographed to create something special. If a weekend afternoon is better than an evening, schedule it for then. If your schedules don’t allow for a consistent time each week, then plan ahead and get times on your calendars well in advance. What’s important is that this is an opportunity to enjoy each other’s company and do something pleasurable that enhances your relationship. Fun is the glue that keeps our relationships alive and healthy.
For help with issues involving your relationship, please contact Avis Rumney at (415) 602-1403 or AvisRumney@me.com.
Why is body dissatisfaction at an all-time high in this country? Why in this era of acute weight-consciousness are people in fact gaining more weight while spending enormous amounts of money trying to lose weight? Why as people try harder to do the thing they say they want to do, do they in fact sabotage their efforts?
The problem is complex and multifaceted in origin. But the solution is paradoxical: it requires a paradigm shift. “Trying to control” is at best a slippery slope when we are dealing with issues that have biological, psychological, sociological and spiritual components. We keep trying to apply the tenets of behavior modification to aspects of our lives that encompass alienation from ourselves, disconnection from our bodies and disassociation from reality. Our cultural values do not take into account genetic truths or biological laws, much less psychosocial dynamics or existential dilemmas. And neurobiologists are discovering that our midbrains – our emotional center – have a more powerful role in directing our behavior than has ever been suspected.
We attribute magical powers to a slice of sourdough bread or a rich chocolate brownie: a few “forbidden bites” confer comfort, solace, relief from whatever emotional conundrum we face, or even euphoria; those same bites also induce conflict, guilt, self-castigation, and a resolution to restrain ourselves forevermore. What do we truly seek, and why do we think we will find it in a piece of pastry? And why do we repeat this ritual that inevitably recreates a roller-coaster of emotional and physical repercussions?
Our self-alienation has become so profound that few of us consider how we feel or what we truly need, or if we stop to ask and answer that question, we seldom take it a step further to reflect on how to manage that need. Our body alienation is equally intact. We think less about our relationship with our body, how best to care for our physical self and how to respect and nurture our body, than we think about caring for our family, pets or even our cars. Yet our relationship with our body has major impact on the quality of our life, our relationships with others, our satisfaction, self-esteem and mood.
Plus we fight our genetics and discard healthy life style habits in favor of health-eroding schemes in an attempt to defy our heritage and emulate a body type possessed by at most 1% of the population, and no one over the age of 30. We have bought the message promulgated by the media that if we change our bodies, we will change ourselves, that success can be measured in pounds lost and that dieting is the royal road to happiness. Food is both the enemy and the solution to whatever ails us emotionally – we want both to soothe our souls with the substance whose original role was to provide us with energy and nourishment, yet to end up with fashion-perfect physiques.
And food itself has lost much of its former value as nourishment because so much of what we eat now has been sprayed with pesticides, amended with hormones, flavored artificially, colored, pulverized and processed. In our idolization of technology and obsession with speed, we rarely take the time to purchase, prepare and thoughtfully taste and chew wholesome meals. Fast food is easy, accessible, and quick to get and to gobble. We prioritize neither healthful food nor healthy eating habits.
With unrealistic body image expectations, distorted body attitudes, and skewed use of food, it is not surprising that we are unhappy with our bodies, and our lives. But the answer is not to keep trying to do more of what is already not working: emulating the impossible; alternately dieting and overeating; and finding new food substitutes with fewer calories, less taste and no nutrition. A shift needs to happen in our approach, perspective and expectations. We need to seek recovery not from living in a body we perceive as fat, misshapen or imperfect, but from being unhappy with what we cannot change. We need to learn what we can change. We need to build a relationship with our body that is founded not on false expectations of how we should look but that fosters self-care and body respect. We need to seek help to modify our views and to manage the emotional issues that keep us trapped in the myths of body change and food misuse as the means to forge a better self. And we need to discover what is truly valuable in ourselves and what has real meaning for us beyond the size and shape of our bodies.
These may seem like daunting tasks, but a therapist can help you, step by step, unravel the attitudes and beliefs that prevent you from developing a peaceful relationship with yourself and with your body. The media offers us unrealistic expectations and skewed perspectives; psychotherapy provides an opportunity and a safe place to explore and clarify our own truths and to separate fact from fiction. Instead of continuing to focus on what is wrong with yourself and your body, and how you don’t fit a fictitious ideal, you can learn to honor and respect yourself, your unique qualities, and the body that allows you to move and work and play. You can develop a new relationship with food, with your body and with yourself where serenity, not self-judgment, is central to your daily life.
For help with issues involving weight and body image, please contact Avis Rumney at (415) 602-1403 or AvisRumney@me.com.
It’s a school night and Mom has just made dinner for 14-year old Johnny and his 10-year old sister:
Mother: Johnny, it’s time for dinner.
Johnny: In a few minutes, mom.
[10 minutes later]
Mother: Johnny!! Dinner!! Now!!
Johnny: I CAN’T, Mom.
Mother: Johnny! Now!
Johnny: NO, Mom, I CAN’T! I can’t leave my clan like this! They need my help!
Mother: JOHNNY, NOW! It’s a game! Turn it OFF!!
Johnny: NO MOM!! I CAN’T! I CAN’T! If I leave now, my clan will DIE!!!
Johnny: We’re in the middle of a raid and I can’t just STOP!
Mother: JOHNNY! It’s a GAME! Turn it off NOW or I’ll unplug the computer!!
Johnny: NO, MOM, NOOOOO!! YOU DON’T GET IT!! [Johnny is now sobbing and screaming] I CAN’T JUST GO! THEY’LL DIIIIEEEEE WITHOUT ME!!!! I CAN’T LEAVE THEM!!
[Mother unplugs the computer. Johnny sobs hysterically, lies face down on his bed, pumps his fists into his pillows, and wails.]
In the vignette above, Johnny’s mother intervened. Appropriately, she stopped her son, who was riveted to the screen, absorbed in the action. It's a parent’s job to set limits that promote healthy behavior. Clearly, Johnny would far rather have continued to play than join his family for dinner.
But suppose that Mom had caved in. Instead of unplugging Johnny’s computer, she could have thrown up her hands, walked away from his room, and served dinner without him. Johnny would continue gaming, to his detriment, taking time away from family interaction, missing a meal, possibly not doing his homework and staying up late. Virtual reality is enticing and exhilarating. Were Johnny to continue these behaviors night after night without parental limits, he might become dependent on gaming for fun and excitement, get insufficient sleep, neglect homework, lose interest in other kinds of recreational activities like sports and being with friends, and ultimately stunt his psychological, emotional and social development. This is the danger of letting a child play computer games without parental monitoring and intervention – unlimited playing can lead to dependency and addiction.
An Internet game can grip a child’s attention. Wrapped in the myth and mystery of an alternative existence, the individual crosses the threshold into a different world and his perception of reality becomes distorted. Gaming is one of the newest potentially addicting pastimes to hit the scene, and it is rife not just among teens, but also among younger kids and adults. Some computer games are healthy and can teach valuable skills, such as concentration, creativity, problem-solving, and mastery of a task. Some computer games are educational, with puzzles or problems that enhance math or verbal skills. Most games promote creativity and offer novelty and an opportunity for master. They offer enjoyment, play and relaxation.
Some games have therapeutic purposes, such as virtual sensation games, in which for example, scenes of icy fjords can be used to cool a burn patient. Games can also provide a social connection for people who have physical impairments that keep them housebound. There can be a social element to gaming when players gather to play games – although each player is entirely engrossed in his or her own computer screen. Healthy social elements exist in online games where individuals learn the value of cooperation.
And games can provide social interaction when played with others – for example, two boys playing X-box or a girl and her father challenging each other at Nintendo.
But there is a new generation of games, games which can be seductive, absorbing and potentially addictive. Gaming can lead to addiction in the same way as drinking or using drugs. Scientists have shown that gaming releases adrenaline (which causes excitement) and dopamine (the pleasure neurotransmitter.) The game becomes so exciting that reality pales by comparison. The player enters a vivid, surreal scene that no real-world setting can approximate. He picks up a weapon or launches a super cyber-craft into space and immediately is imbued with euphoria and quivering with the rush of power and control.
In addition, some Internet games are interactive, and the online persona, or avatar, created by one player is involved with other avatars, represented by other people. Each player is then involved in the fate of his fellow avatars as they challenge deadly monsters in hostile territories. Suddenly the gamer has a whole network of otherworldly allies he can band with yet never meet in person. From playing occasionally, to an hour or so a day, the individual progresses to playing every day for more and more hours, staying up late, losing sleep, missing out on face-to-face social interactions, falling asleep in class or on the job. Gaming becomes compulsive and the impulses to play become uncontrollable; the player continues to play despite harmful consequences. At this point, the gamer has stepped over the line into addiction.
Addiction to gaming, like any other addiction, is treatable. Addictions characteristically have biological, psychological and social aspects, and each of these areas needs to be addressed. With appropriate, effective treatment, recovery is possible. For children, effective treatment includes the family.
It is estimated that worldwide over 160 million people play computer games. Over 11 million of these play the popular multi-player online game, World of Warcraft. Adult gamers comprise a large percentage of the game-playing population, with females over 18 representing a significantly greater portion of the game-playing population than boys 17 or younger. However, virtual worlds have been created for children as young as three years of age. Gaming is particularly dangerous in children as their brains are still maturing. Children are especially susceptible to behaviors that cause brain changes which can result in addiction.
Most video games initially engage the curious individual through beautiful scenery or surrealistic visual effects enhanced by a reverberating sound track. The player becomes excited – adrenalin starts to surge – similar to the experience of watching the opening scenes of a five star epic movie on IMAX. In starting the game, the player begins to explore a new world, create a story, score points, or accomplish a task. Awash with feelings of pleasure and success, the player can get seduced into wanting more and more. A game can be exhilarating and uplifting. It creates a high.
In today’s world of increasing speed and complexity of technology, games have evolved that weren’t even imaginable a few years ago. Pac Man played in video arcades several decades ago has morphed into sophisticated software available for the home computer. Many computers come with some simple games already installed. Most of today’s popular games require the purchase of additional programs. There are “simulation” games in which the individual builds a city, and also more advanced strategy-based simulations in which the player can fight a battle, race a car or fly a plane. Another category of game is the First Person Shooter, where the player is involved alone in some aggressive act – Grand Theft Auto is a popular one in this category. And there are adventure games like Oblivion in which the individual creates an avatar and ventures into a make-believe world to embark on a journey or begin a quest.
While all the games listed so far carry with them the risk of addiction, most of them are solitary (which itself can be problematic), and do not engage the player in any kind of joint venture. However, unlike their tamer cousins, MMORPG’s — Massive Multiplayer Online Role Playing Games, such as the World of Warcraft (WOW) – involve the avatar in an online guild or clan (a group) of other avatars. This takes on the flavor of a team sport – except that the team members are imaginary characters who appear on a screen to interact with the equally imaginary character of the player. Gamers communicate online to strategize the moves of their avatars against a horrific monster, and the success of the team in fighting the Mobs (monsters) depends on the co-operation of the avatars. If one player leaves during a raid – that is, while his clan is fighting off a monster – it threatens the success of the raid as well as the survival of his fellow avatars.
Computer gaming becomes dangerous, especially for kids, when the content of the game is inappropriate, and either overtly or implicitly sexual or overly violent in nature. Gaming can become expensive when gear or equipment is offered to enhance the wardrobe, weapons or environment of the player, and gamers are lured into expanding their possessions. Although these items are bought with “virtual dollars,” virtual money is purchased with real money. Some games require subscription fees and monthly payments. Gaming becomes damaging and potentially addictive when the high of gaming supplants the pleasure of all other recreational pursuits. Virtual reality takes over real-world reality and robs the person of a healthy perspective, time for real-world life, and the opportunity to interface with real people. Gaming is harmful and destructive when a gamer chooses playing games at the cost of health, or interpersonal, educational and age-appropriate developmental activities such as sports, dating or having a job.
If you are the parent of a child who is interested in games, look below for some pointers to protect your child. Do not enable your child by letting him or her play computer games unmonitored or without setting time limits. If your child needs additional help or support, don’t hesitate to call an addiction counselor or fool yourself into thinking “he’ll grow out of it.” More often than not, just like with drugs, a person gets progressively more involved as he spends more time gaming. Recognize that if your child is in trouble, the family must be involved in the treatment process. If you are an adult, and an adult loved one is suffering from the fallout of excessive or addictive gaming, do not enable that person. Let them know, in a firm but loving way, that you are concerned about him or her, and that you will not in any way support his gaming habit. If you are an adult and you are having trouble with excessive gaming, call for help today. The sooner you get help, the sooner you can begin to heal and recover. Recovery is possible and help is available.
The Questions Parents Often Ask:
How can I know which games are OK and which ones aren’t?
Games have ratings that suggest the appropriate age level for play and the level of filtering or blocking the parent can do from another computer. Review the ratings and familiarize yourself with the filtering information that comes with the games.
Educational games like Big Brain or Brain Fitness are good. Games that have “endings” and games the player can stop at any time are safer than games that can’t easily be stopped during play:
A player can stop simulation games like auto racing, Sim City, and Microsoft Simulator X, although they don’t have a defined “ending.” Some simulation games are good choices for teens.
First-person shooter games such as Halo 3 and Grand Theft Auto can be stopped.
Games that are hard to stop during play are the MMOGRP’s (Massive Multiplayer Online Role Player Games), in which a raid can last 12 or more hours and the player drives a sense of importance and loyalty from staying in the game to the end of the raid – leaving mid-game means abandoning his online friends. This category includes the very popular World of Warcraft (WOW).
Games with significant violence and sexuality are not good choices. WOW is violent. Guild Wars is hypersexualized.
How can I keep my kid safe around games?
Monitor how much time your child plays games – spending two hours per day in front of all electronic media is the maximum limit of exposure recommended for children by the American Psychological Association. Other tips:
- Role-model moderate use of electronic media.
- Allow game-playing only after homework and household chores are done.
- Place the computer in a common area of the house.
- Spend time with your kid having him or her teach you about the games he is playing.
- Monitor the types of games your child plays. Don’t allow games that have significant violence, sexuality, or that cannot be stopped without major upset to the player, like World of Warcraft.
- Make sure you actually know what is on your child’s computer.
- Check your credit card bill. If the game requires a subscription fee, or the purchase of virtual money to buy gear, who is paying for these charges?
- Manage the technology. Use a password to protect your operating system. Contact your ISP (Internet Service Provider) to block ports.
How can I know if my kid is safe?
Look for the same signs that let you know your kid is safe in other ways:
- How is he or she doing at school?
- Have there been changes in his behavior at home?
- Have there been changes in sleep patterns? Hygiene?
- Have you noticed mood shifts?
- Is he participating in other recreational activities?
- How are his peer relationships? Is he socializing?
What should I do if I’m concerned my child is already playing games too much?
Call and make an appointment to meet with an addictions counselor who has expertise in working with gaming. Be aware that if your child is gaming excessively or possibly is addicted, stopping gaming can cause withdrawal and significant mood and behavior changes. It is better to work with a counselor versed in gaming addiction than to intervene by yourself.
How do you work with gaming addiction?
This depends on the extent to which the individual is involved in the gaming world. As with any other addiction, the addictive behavior needs to stop and ample support must be provided. It is essential to manage the emotional and behavioral symptoms of withdrawal. The individual needs to resume the developmental tasks that were arrested when gaming became primary. Real-life recreational activities need to take the place of gaming.
Recovery from addiction to gaming is a process similar to recovery from any other addiction – it is behavioral, psychological and social in nature. Family involvement is key. Developing social relationships is important. In time it will be essential to assess whether psychological problems existed before gaming became excessive. The addicted gamer needs help to pursue recovery in every area of life that has been affected – health, sleep, hygiene, school, work, relationships, and care of home or surroundings. Recovery is possible and help is available. By following the guidance of an addictions counselor, a gamer can recover and develop a healthy, sober life.
If you know of a child who is involved in excessive gaming or is overusing other electronic media, please contact Avis Rumney at (415) 602-1403 or AvisRumney@me.com. The earlier the intervention, the sooner the child can return to normal development and healthy functioning.
by Avis Rumney, LMFT
What parental qualities contribute to creating a healthy child? Love and discipline – a generous measure of each – form a solid base for healthy child development. Out-of-control teens generally have missed out on some aspects of healthy parenting. In the 1990s, three experienced professionals – a police officer who worked with juveniles and two licensed psychologists who treated families and teens – formed the Parent Project, an educational and support organization designed to teach parents how to work with their out-of-control kids. The Parent Project described the parental elements that support the development of healthy, functional, kids, and developed strategies to teach these skills to distraught and hapless parents.
Love is the underpinning of a child’s sense of value. Parental love and affection communicate to the child that he or she matters and is cared about. Love fosters a child’s development of a healthy self and an inner self-image of him or herself as a person of worth. But discipline – which must continue through the teen years – is equally vital to healthy development. Although teenagers need encouragement to take on more responsibility, make good decisions and move towards autonomy, the reality is that the prefrontal cortex – which governs judgment and critical thinking – simply is not fully developed until the early twenties. Kids need parental guidance, and interpret their parent’s lack of boundary-setting or follow-through as a lack of caring and concern.
The founders of the Parent Project described four parenting styles which they differentiated according to the proportion of love and discipline that characterize each. High love and high discipline, their Authoritative Style, is the ideal approach to good parenting. With significant demonstration of affection and attention (love) coupled with clear, consistent limit-setting and appropriate consequences (discipline, which is an act of love), kids have the highest probability of successful development. Kids in this kind of environment feel seen and appreciated. They possess the foundation for healthy self-esteem and good relationships. Their successes are acknowledged, and they feel motivated to achieve and stretch into new territory. They can discriminate healthy from unhealthy behavior. And when they stray outside the lines, which all kids do in the normal course of exploration and individuation, their parents rein them in with immediate, consistent and situation-appropriate consequences. These kids feel loved and safe.
Lots of love without sufficient discipline is termed Permissive in style. Kids parented this way tend to feel entitled but be out-of-control – they are missing the clear and necessary boundaries that help them feel safe and secure. Their entitlement, untempered by appropriate limits, leaves them prone to act out to provoke the attention and boundaries they crave. Their self-esteem may be rocky because entitlement does not translate to feeling good inside. The paucity of limits can leave them feeling not seen and cared about, because discipline is a necessary component of attentive parenting.
In her book, The Price of Privilege, psychotherapist Madeline Levine describes in detail the impact of permissive parenting on child development. Examples of kids parented permissively abound in the upwardly mobile and often well-off families where parents provide ample material goods and a slew of extracurricular activities for their children but are lax in supplying solid boundaries and clear consequences. It is often parents who grew up with strict parenting who then vow to create a different family environment for their own offspring. A perfect example of this dynamic is the story of 15-year old Kenny. His mother worked as a buyer at a high-end clothing store and his father was an investment banker. Both parents had grown up in households with strict rules, and neither wanted to replicate their childhood situations as parents. When Kenny was a high school sophomore, he started hanging out late on weekends with his friends (he had no firm curfew). His grades slipped and his mood shifted. It turned out that he had become enamored of pot, and smoking weed not only sapped his energy in the moment, but also left him listless and unmotivated in general. Kenny’s parents didn’t recognize the signs of drug use, and for many months ascribed his behavior to “growing pains.” Only when Kenny’s situation worsened and he was suspended from school one day for smoking pot on school grounds did his parents wake up to the reality and the fact they needed help to get Kenny – and themselves – on track.
The third style of parenting described by the Parent Project is termed Authoritarian. It is characterized by a large measure of discipline, coupled with a corresponding love and attention, resulting in a bullying style – kids may be well-behaved to avoid negative consequences, but their infinite small successes and good behaviors are seldom acknowledged. Eventually these kids rebel against the overbearing parenting they receive. They are likely to have low self-esteem and tend toward depression. They use anger and acting out to try to find a way to quell their pain. Rather than feeling safe, since the discipline is not coupled with the affection and attention that makes them feel good about themselves, these kids feel controlled and punished.
14-year-old Carey fits this description. Her father was a harsh disciplinarian, stern and unyielding. Carey’s mother was meek and mild-mannered, and generally caved to her husband’s rules. Carey despised both her father’s rigidity and her mother’s spinelessness. She began to sneak out of the house at night and hang out with friends, often getting drunk and sneaking back into the house before her parents woke. Then Carey was too exhausted to get up for school, and would claim to have a migraine so she could miss school. Needless to say, Carey’s grades suffered and the home situation deteriorated with her father getting angrier than ever. Fortunately, Carey’s mom finally realized that something different was needed besides her husband’s yelling at their daughter and establishing ever more punitive consequences, or Carey was likely to run away from home. Carey’s mom called a local drug counselor for help.
The fourth parenting style the Parent Project terms Neglectful. Characterized by a deficiency in love and discipline, neglectful parenting leaves a child feeling abandoned and empty. A child that grows up in this environment is likely to feel unmotivated and lack motivation to achieve. He or she often remains emotionally immature, lacks interpersonal skills, has very poor self-esteem and does not feel safe. Unboundaried and unloved, a child that is parented neglectfully is likely to be unhappy, and to act out both to get attention and boundaries.
People generally parent by modeling after how they were parented, and continue the pattern they know best, or do the opposite, determined not to repeat the mistakes their parents made. When parenting has been deficient in love or in discipline, overdoing the undersupplied element in the next generation generally does not make for a great outcome. If a girl who felt unloved by her parents determines to compensate and super-love her kids when she becomes a mother, it can backfire. This mother may neglect her own needs, model poor self-care, over-caretake her kids and become resentful. And kids in this situation often have little opportunity to learn self-responsibility – mother does everything for them in the name of love.
The good news is that parents can grow and change, just like kids. They can learn to parent with calmness and consistency, to be attentive and acknowledging, to set and maintain good boundaries, to deliver immediate and appropriate consequences. And they can discover that healthier parenting means less strain and distress for them, as well as producing better-behaved kids and more rewarding parent-child relationships. Even with a child who is already an acting-out teen or a young adult, it’s never too late to become a better parent.
The foundation of successful parenting is love, attention, consistency and consequences. Love must be the basis of all behavior, and be communicated in a million little ways every day. The Parent Project suggests that you tell your teen you love them through words, voice tone, touch, hugs, notes, gestures, and eye contact. Catch your teen doing something right ten times more often than you catch them doing something wrong. Show interest in your teen and your teen’s friends, hobbies, classes, life, but refrain from intrusion – simply respond with appreciation to whatever your teen shares with you. This is attention – orienting yourself toward your teen, making time to be with them, giving them time without allowing yourself to be interrupted. Spend time with them doing something they enjoy – listen to their music (it’s not all just noise), play their video games, let them choose a movie and go with them. Find activities you like and can do with them. Dads can go to ball games, car shows, play golf, basketball or other games with their sons. Moms can chat and just be with their daughters, go for a walk, ride bikes, play tennis, make beaded jewelry, cook or garden.
Setting limits and imposing appropriate consequences are loving acts – you are taking care of your teen, providing protection and helping him or her learn healthy behavior – and these are necessary for your teen to feel safe. Communicating these consequences works much better when it is done in a calm, rational and logical manner. Not only does this model adult communication for your teen, it is more effective and productive than reactive, emotional interchanges. Parents get angry – kids do provocative things – but if you can’t cool down enough to act calmly, you can let your teen know there will be a consequence, and take a time out to let yourself cool down. Take a walk, or get absorbed in something that takes your mind from an emotional tsunami to a place of adult thinking and logic, and then return to talk with your child.
16-year-old Suzie was living alternate weeks with each of her parents who had divorced each other when she was nine. Suzie’s mother, Alice, and her daughter tended to butt heads over Suzie not doing her homework, staying up too late talking on the phone, leaving her room a mess, driving her friends to places despite the fact that she was underage. Plus Suzie was now coming home occasional evenings out red-eyed and smelling of alcohol. Typically, Suzie’s mom would get angry, ask Suzie why she was doing the most recent “terrible thing,” reprimand her for whatever current behavior she had manifested, and ground her indefinitely. It was never clear how long Suzie was grounded for or just what it meant that she was grounded. Suzie would often walk out of the room while her mother was talking. At this point, Alice would raise her voice and a yelling match between mother and daughter would ensue. Alice would then call Susie’s dad, telling him hysterically “to do something about his daughter.”
Alice loved her daughter and simply wanted her to act responsibly and to think about the consequences of her actions. However, without clear, consistent, enforced boundaries delivered in a reasonable way, Suzie did not feel safe. Her mother was getting angry and setting limits without following through. Plus, whether Suzie was driving her friends, which was against the law, or not cleaning up her room, her mother levied the same penalty. Suzie tended not to think about the consequences of her actions because there were none – except her mother’s wrath.
When Suzie’s mother brought her daughter and ex-husband in for therapy regarding their “out-f-control” daughter, she was surprised to learn she had a role in her daughter’s behavior – and in her daughter’s behaving better. Alice learned to differentiate which battles were worth fighting – a point stressed by the Parent Project. In the hierarchy of transgressions, those behaviors that threaten health are paramount, particularly those that involve illegal behavior (driving others under age eighteen before permitted; using drugs or alcohol when underage) are of most significance, and the consequences for lapses in these areas need to reflect their importance. When Alice focused on the important issues and let go of some of the more trivial ones, the frequency of battles subsided. And as Alice learned how to better communicate with her daughter and to set clear, consistent boundaries and consequences that limited Suzie’s privileges, Suzie’s behavior improved.
While limits and consequences are situation-dependent and family-specific, they have common elements that give the growing teenager containment and structure. Therapist and author Michael Riera in his book Uncommon Sense for Parents of Teenagers describes the function of limits and structure as “providing security for adolescents through consistency, clear expectations, appropriate guidelines, direct feedback, acknowledgement, and the separation of consequences and moral lessons” (Riera, 2007, p. 73). Furthermore, Riera states that “only when teenagers experientially understand and trust the structure around them are they able to fully develop” (Riera, p.73). Kids need age-appropriate structure, reasonable limits and relevant consequences to quell the anxieties innate to adolescence so they can go undertake the business of being a kid – learning, growing, experiencing and integrating new things and getting to know themselves. This is what healthy parenting provides: the love and containment that gives children the best opportunity to become fully functioning, curious and vital young beings who have a solid foundation for maturing into healthy, happy adults.
If your kids’ behavior has become problematic for you, know that you are not alone and that help is available. You can meet with a family counselor who can help you build on what is working and strategize with you and support you in changing the patterns that aren’t working. You can foster happier, healthier lives for your kids, as well as create a life of less stress and more contentment for yourself.
For help with family issues, please contact Avis Rumney at (415) 602-1403 or AvisRumney@me.com .
By Avis Rumney
This is the core dilemma for the codependent. Someone who becomes codependent has generally learned since childhood to focus on the needs of others. When a child grows up with a parent who is depressed, alcoholic, ill, or prone to criticism, anger or rage, the youngster intuits that his survival and safety depend on his parent’s mood. In these situations, a child becomes attuned to the emotional state of the parent and learns to calibrate his behavior to fit his perception of what will soothe the parent or ease the situation. In quest of safety, the developing child continues to focus on what is going on outside of him, on what others need and on what he can do to best control the environment or meet the unspoken wishes of others.
This is a very big job for a child, and one that is inherently impossible – no amount of accommodating behavior can really “fix” another person or control events. It is not surprising that a child who grows up in a family where these dynamics predominate can end up feeling anxious and overwhelmed. This child is also likely to feel defeated and inadequate because his task is insurmountable. Yet his very existence is at stake and this is not a quest he can easily relinquish.
The emotional pressure to take care of others and to try to control others’ behavior and feelings becomes embedded in the individual’s core. His feelings, thoughts and behaviors become inextricably intertwined in the compulsion to monitor others and to manipulate situations to produce a semblance of safety and security.
The term “codependent” originally was applied to someone in a relationship with an alcoholic or addict. The addict is dependent on his drug to survive and is driven by the anxiety of an overwhelming, uncontrollable urge to drink or use. The codependent is dependent on controlling the addict to survive and is driven by an equally overpowering compulsion to manage the addict. Partners, children, or others in relationship with an addict can be affected by an addict’s unpredictable behavior. Similar survival fears fuel the behavior of a child growing up in a family where his safety feels precarious and threatened.
For a person who has grown up with these pressures, it can be very difficult as an adult to behave differently when it becomes apparent that these tactics are not creating the desired results. The codependent may find that intervening on behalf of others is frustrating and energy-depleting. Putting others’ needs first eventually sparks resentment. When the codependent’s generosity is taken for granted, he can feel used instead of feeling safer. Yet the anxiety that drives the codependent to act persists – this is hard-wired. Behaviors, which were valuable and useful as children while growing up in less than ideal households do not serve well as adults. No longer do these actions seem to mollify others and encourage peace. They are conducive neither to healthy relationships nor to serenity in life. As grownups, we need to learn to rely on other resources, within and outside of ourselves, to create the safety we need.
Codependency is different from the caretaking that is essential in situations where an infant, child, or person with an illness or disabilities is dependent on another. The distinction is that the parent of an infant or child, or the caregiver of someone who is ill, fosters the well-being of the dependent person by performing tasks that the other person truly does not have the capacity for, rather than tasks that the other person could do but isn’t. Sometimes this distinction gets muddied as children begin to grow up and their well-meaning parents continue doing for the children tasks the kids need to learn to handle on their own. In these cases, parents rob their kids of the opportunity to learn new challenges. Parents often walk a narrow tightrope as they foster their kid’s development. They need to distinguish when help is truly helpful, and when it is better to let junior learn to tie his own shoelaces and ask for rides instead of simply expecting Mom will provide automatic taxi service.
Another distinction is important – people can be generous and giving without their generosity being maligned and labeled as co-dependence. The distinction here rests mainly on the motives behind the actions and the feelings evoked in the giver. True generosity is from the heart, with no need by the giver to create safety, or forestall feelings of potential rejection, and no expectation of any particular response or return on the part of the recipient. Thus, resentment does not follow generosity – the gift, once given, is surrendered. Of course, the giver may feel pleasure or reward in giving, but his state is not conditional on the response of the recipient.
If you suspect you have codependent traits, here are some steps to take to help yourself:
Awareness is the first step. You cannot change any behavior without being aware of it. Begin to notice the feelings that come up when you are doing or offering to do something. Ask yourself what your motive is – is this something you want to do? Or are you anxious or concerned about the consequences for someone else if you don’t do this?
Scan your feelings for incidents of resentment. Resentment can be a clue that you are taking care of someone else rather than paying attention to what you need and want.
Be patient with yourself. If you notice impulses to take care of others, or resentment for actions you have taken in the past, know that these behaviors have been your protection and have helped assure your safety in the past. These behaviors have doubtless been there for a long time, and learning and implementing new ways to act is a process that takes time.
Do not judge or criticize yourself for the ways you have acted. You did the best you could with the information you had.
Let yourself be curious about how these behaviors have helped you and in what circumstances they have come up.
Find resources and support for yourself. The anxiety and loss that accompany behavior change can be painful, and support is an important component of recovering from dysfunctional behaviors. This could mean seeking the help of a therapist or of a 12-step program such as Al-Anon.
Notice what you can and what you cannot control. You cannot control another person, or the outcome of events. You can control your own actions.
Give yourself permission to take care of yourself. Your focus has been outside of yourself: on taking care of others. This may mean that you don’t know what you want, and that it is uncomfortable to look inside and particularly to feel confused or anxious or directionless. Change is hard work – and you might need some help at first to begin moving in a new direction.
For help with issues involving codependency, please contact Avis Rumney at AvisRumney@me.com or (415) 602-1403.
By Avis Rumney
Summer is the season of bathing suits, sundresses and shorts. It is the time for pool parties and barbecues. For many of us, these thoughts conjure up happy memories, relaxed times and occasions to look forward to. However, for anyone with an eating disorder (and unfortunately, for many others, because society indoctrinates us to criticize our shape and size), summer – with its norm of more revealing clothing and events that call for dressing accordingly – evokes dread, discomfort and despair. It is sad when people measure their worth by their weight, and this is exactly what anyone with an eating disorder does.
If you are the mother of an eating disordered daughter, doubtless you have watched your daughter dress in all manner of camouflaging clothing, whatever the weather or the season. People with eating disorders feel shame about their bodies – regardless of their actual body size – and do their best to disguise their real shape. In addition, those suffering from anorexia have little body protection from the cold and get chilled easily. It is not unusual to see a young woman with an eating disorder wearing a blouse, sweatshirt and a jacket at times most others are clad in short sleeved or sleeveless attire.
Uncomfortable though it may be to witness your daughter dressing in this manner, know that it is not something you can or should try to change. Nor is it something she can change at this time. Body image distortion is central to any eating disorder. Even though many body image issues are rooted in self-image problems – that is, the person directs her self-hatred toward her body and then focuses on trying to fix her body – no amount of persuasion that her body is not ugly or disgusting will cause your daughter to change her mind. It is only through therapy and the process of healing her relationship with herself that she can, in time, come to terms with her body.
It is likely that you feel sad and perhaps even frustrated and discouraged. This is where help comes in the form of patience and the serenity prayer [excerpted from the original written by Reinhold Niebuhr over 60 years ago, which has been modified for use by 12 Step Programs]: “Grant me the serenity to accept the things I cannot change.” Your daughter’s attitude about her body and how she wants to cover it is something you cannot change. Only she can change it, and only in her own time. Better to put your energy elsewhere, such as into having enjoyable, non-food, non-clothing, non-appearance-focused outings with her. And, as always, let her know you love her for who she is. Connect with her around the things you can relate to that interest her. Build a bond between you, if you both are open to that, founded on an appreciation of who she is now, not on how you remember her or wish she could or would be. If she is in recovery, she is on the road – albeit often a very long one – toward accepting herself, and it is for this that she needs your support and acknowledgment.
When your daughter develops an eating disorder, it can be painful and frightening. Of course your immediate impulse is to “fix” her, and your first reaction may be to blame yourself for her situation. Hopefully the tips included here will guide you to take actions that are helpful for both you and her, and to adopt a perspective that is compassionate towards both of you. The anxiety and challenges that this situation evokes are unavoidable, but your response to these can make a difference in how you feel and how you contribute to your daughter’s recovery.
Whether your daughter has just recently developed an eating disorder, or has been struggling for a while, know that you do not have to face this situation alone. There is hope for recovery and help is available – for your daughter, for you, and for your family.
For more useful, everyday suggestions, read my booklet Tips for Mothers of Daughters with Eating Disorders: How to Take Care of Yourself While Supporting Your Daughter’s Recovery (see my Books page). If you would like additional resources or assistance, please feel free to call me at (415) 602-1403. Ask me about telephone-based coaching for mothers with eating disordered daughters.