Is Rehab Hogwash?

Early this summer, after yet another celeb exited rehab, I posted The "Lohan" Phenomenon - Do Celebs in Rehab Diminish the Recovery Process? With last week's rehab-release fiasco, I felt the need to reiterate some important points about serious people who seriously want to kick addiction. There seems to be a general outcry/backlash occurring all over the media - from celebrity-focused TV shows, court television, newspapers, etc. Everyone has an opinion.

But what do experts in addiction treatment have to say? WebMD has two excellent pieces, the first - Rehab's Role in Treating Addiction, gives a very clear description of the addiction treatment process. Family Poll: Half of Addicts Seek Help - Survey Shows that Most Who Go for Treatment Get Better, which discusses a recent Gallup poll showing that although only half of family members seek treatment, 82% of those who seek help get better.

Although not an addiction professional, the alcoholism and drug abuse "guide" at About.com has a helpful post, Components of Effective Treatment Programs that includes a key component to successful treatment and recovery: Strong Patient Motivation, "All approaches to (alcoholism) recovery depend on the desire of the person to get and remain sober."

So, although most media stories on this topic have entertainment value, to really understand the treatment and rehab process, read what the experts in the addictions field have to say.

Making Friendships a Priority

The Importance of a Good Support System

A recent long phone conversation with a best friend reminded me of why I value my friendships so highly. What sets this friendship apart? We laugh. A lot. We cheer each other up. We "get" each other. One of the key elements of this relationship is that we can be ourselves - no posing or concern about what the other thinks of us.

It's not news that friendships and healthy support systems are important to our well-being. But when I began to do research for this post, I Googled "relationships" and got mostly sites about romantic or intimate relationships. Magazines, advice columns and other popular media are loaded with information about these. Why don't we place as much emphasis on our friendships?

As part of an initial assessment of a patient, I ask about the quality of their support system. Do they have one? Do they utilize it? I'm often surprised that most people report that this area of their lives is lacking. As a treatment goal, I list increasing that support system as a top priority. But I do acknowledge that making friends as an adult is difficult. We no longer have the school playground or classroom to meet new people or potential friends. The U.S. Department of Health and Human Service's SAMHSA (Substance Abuse and Mental Health Services Administration) division has an online publication, "Making and Keeping Friends - A Self-Help Guide" . It lists qualities we need to bring to our friendships:

• • being independent and
    self-sufficient
  • being positive, upbeat and warm
  • talking about others in a positive way
  • being honest and dependable
  • doing your share of both the talking and listening
  • being respectful of the other person's feelings
  • keeping yourself clean and well-groomed
  • accepting your individual differences
  • listening closely without interrupting
  • being nonjudgmental
  • giving the other person plenty of "space"

The article goes on to include activities for the reader to do to increase their friendships and examine their current ones.

As I mentioned above, a fundamental quality of my closest friendships is that I am free to be myself. We all need time and space to "let our hair down." The many life roles that I and others have to assume - wife, daughter, sister, therapist, artist, writer, neighbor, employee, etc. require different personas. Many of our roles necessitate constantly meeting other people's needs, which can be exhausting. Many of my women patients, who are mothers, report that they see themselves only as "Bob's wife and Tom's mommy" and that it often feels limiting and confusing. I encourage them to carve out more time with close friends who will reinforce their role as a grown-up, intelligent, interesting individual who has many more facets than simply "wife and mother." They might see themselves reflected more accurately in friends with whom they've had long-term relationships.

I can hear you saying, "But I barely have time to do the essential things I need to accomplish each day. When do I have time for my friends?!" One of the advantages of our electronically-connected world is that you can maintain contact with friends via phone, e-mails, texting, IMing, through online forums, etc. Many of my friendships are e-relationships - we've never met, but keep our relationships going through the 'Net. Of course, it does take time and effort to grow and nourish these important connections, but the returns are immeasurable.

Psychic Hotline Addiction Costs $33,000 a year

According to a researcher at Auckland University, psychic phone line addicts, are spending up to NZ$33,000 per year (US$26,500) to seek guidance on their finances, their love life and other burning issues from psychics, tarot card readers, astrologers and other telephone hotline services. The average expenditure is in the range of NZ$6,000-7,000 (US$4,770-5,565).


Dr Robin-Marie Shepherd, from the Centre for Gambling Studies at University of Auckland is conducting global research into users of psychic hotlines. Preliminary data from approximately 30 regular phone line users has been analysed to date.

“Users of psychic hotlines seem to demonstrate a number of addictive behaviours,” says Dr Shepherd of the Faculty of Medical and Health Sciences. “Regular users talk of relapsing or needing a fix, and many exhibit signs of anxiety or depression. This study is looking at why people call psychics and whether this behaviour should be viewed as addictive and require policymakers to take notice.”

I suspect many users were exhibiting signs of anxiety or depression prior to phoning. From my discussions with users and providers of psychic hotline services, the majority of callers are lonely, sad or facing difficult decisions. Many use psychic hotlines in place of counsellors to provide guidance in life issues, or when they are in need of someone to fill them with hope about the future.

Dr Shepherd is looking for more psychic phone line users to participate in this global study. She's also interested in hearing from people who work for psychic hotlines or others involved in the industry. You can contact Dr Shepherd via email or telephone +64 (0)9 373 7599 ext 86573.

Take Time for Gratitude Every Day

There has been a lot written recently about the so-called "happiness/positive psychology" movement. I'm not sure why, but that has provoked a negative reaction in me; maybe because some of the literature has presented it as an innovative, ground-breaking thought - "be happy!" I think most of us would agree, achieving some level of happiness in our lives is a fundamental goal. But it concerns me that much like the latest fad diet, achieving happiness is presented as a simplistic 1-2-3-step formula in a typical pop-psychology, self-help format.

A blogging colleague, TherapyDoc, expressed a similar opinion re: positive psychology in this post: The Sunny Side of Therapy: :) :) :). I agree with one very important point - the power of positive thinking is great, but not always a viable quick fix for folks who suffer from clinical depression or other psychiatric disorders. Cognitive restructuring (learning to recognize negative and/or non-productive thinking patterns) is a basic tenet of Cognitive Behavioral Therapy (CBT). CBT certainly could be labeled "positive psychology", but unlike some of the current literature, it is a proven theory and therapy method used to treat depression and anxiety and backed by years of scientific research.

So how can tapping into positive energy be applied to treating patients in therapy and also our everyday lives? When I worked in a drug and alcohol treatment program, one very effective and important aspect of recovery for patients was the concept of "gratitude." All the alcoholics/addicts I know are very adept at listing a litany of negative aspects of their lives. So a frequent homework assignment I gave was - make a "gratitude list" of 6-10 things every night. Most lists contained being grateful for another day of sobriety - that was easy. But this assignment almost always precipitated a much deeper self-examination and began a process of reframing their thinking processes.

Now I challenge patients to make a daily gratitude list. I ask couples in therapy to share their gratitude lists with each other. It helps them focus on the positive aspects of their relationships and lives. I apply it to my own life when I am having a particularly whiny, negative day.

I recently came across a therapist colleague's writing that inspired me. Although the content relates more to our spiritual lives, I think it also applies to gratitude. For me, it was thought-provoking and also an important reminder.

My son interviewed me for a high school assignment, inquiring how parents balance personal, family and work life. He asked questions to determine how daily time was divided. I was surprised to discover that I spend an hour a day on spiritual development. I have infused Spirit into my day effortlessly over the years, which has enriched life for me and those with whom I come in contact. Here are a few tips on how one might integrate Spirit without "robbing" time from family or work:

Including Spirit In Each Day

by Cheryl Meisterman, Ph.D., LISW

Wife, Mother of three, Psychologist, Social Worker

• Upon awakening, think of four things for which you are grateful
• Close your eyes and breathe deeply three times, think about the gift of breath
• Listen to inspiring audio books or music in the car or while walking with earphones
• Pray for guidance and wisdom, throughout the day
• Meditate for peace while doing repetitive chores: washing dishes, gardening, setting the table, mowing the lawn, etc.
• Be in nature daily and give thanks for the wonders around you
• Light a candle and give thanks for the light
• Give thanks at the end of the day for the opportunities granted and for the people you love
• Sing or play an instrument with thanks for that ability
• Recognize beauty in simple things (the smell of food, the touch of plants, the comfort of pets, etc.)
• Read 15 minutes of inspirational literature daily
• Do something nice for someone else daily

My family recites nightly prayers. No need to wait until bedtime to talk to Spirit. We have the blessings to connect any second of the day.

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Try making your own daily gratitude list and also time for the spiritual part of your lives.

7 Common Misconceptions About Therapy

(The following reflects my own theoretical orientation and practice principles when doing therapy. All therapists have different approaches to the therapeutic process and may have different perspectives.)

1. Therapy is a long, complex process that will take many years.

While some diagnoses and life experiences may require a longer time in therapy, the majority of patients I see benefit from brief therapy - 2 to 8 months. Psychoanalysis as portrayed in early Woody Allen movies had patients seeing a therapist 3 times a week! Most people couldn't afford the time or money to do that, nor is it clinically warranted.

2. Therapy costs a lot of money.

Most working people with health insurance benefits also have a behavioral health benefit. Many times the patient's financial obligation is a small percentage of the therapist's fee or a co-pay like that charged by a doctor's office. For folks without insurance, there are community mental health centers that operate on a sliding-fee scale. This fee is usually calculated on the patient's ability to pay.

3. If my employer pays for my insurance, they will find out if I see a therapist.

There are many safeguards in place to maintain the confidentiality of your sessions with a therapist. Most employers contract with a separate insurance company that administers the insurance benefit. In addition, all licensed therapists are under strict confidentiality guidelines. There are severe penalties for violating a patient's confidentiality.

One exception might be if an employee receives a mandatory managerial referral to counseling due to problematic behavior on the job - using alcohol/drugs or being aggressive with a co-worker, for example. Most of these kinds of referrals are through an Employee Assistance Program (EAP). In my experience with these types of referrals, the only thing I'm required to report is if the employee is compliant, i.e., if they kept their appointment, etc. I have never had to reveal any specific content of my sessions.

4. I will have to do everything my therapist tells me to do.

I probably encounter this "myth" more than any other in my work with patients. Therapists really shouldn't be dictating to patients. A good therapist will make suggestions based their experience with similar situations, on observations and cues they are picking up from the patient and what they believe may be helpful. Please tell your therapist if they are suggesting something that makes you feel very uncomfortable or isn't a good "fit" for you. If they continue to insist, it may be time for a new therapist.

5. I should share everything that happens in therapy with my spouse, friends, co-workers and/or family.

This is, of course, your choice, but I wouldn't suggest it. Therapy is for you. I find when you share your experiences often those close to you feel the need to make suggestions, offer opinions and make judgments. This can be counterproductive to making healthy and productive changes in therapy.

6. The therapist will want to know about my childhood and will only focus on that.

While some patients need to heal childhood "wounds" and this is a critical part of the therapy process, in my own practice examining childhood and developmental issues is only part of of my evaluation and focus. I believe that adults are the sum of their childhood, genetics, upbringing and life experiences to date. In the brief therapy model in which I work, addressing a patient's most pressing concerns is my primary goal. If achieving their goals are significantly impeded by the childhood issues, I will address them as needed.

7. Therapy is a painful process.

Change is difficult for most people. And therapy often is about making changes in unhealthy and nonproductive behavior. But there is also the opportunity for patients to discover hidden strengths and new, exciting perspectives. I often tell patients that it is very rare for someone to wake up in the morning and say, "Wow, I think I'd like to get into therapy!" There may be aspects of the process that are uncomfortable or unfamiliar, but a good therapist will help you through it.

- - -

These are just a few of the common concerns that patients have expressed to me over the years. I feel very strongly that therapy shouldn't be portrayed as a "magical" or "mysterious" process. Patients have the right to be informed and enlightened about this service that we therapists perform.

Defining Healthy Boundaries in Parenting

My post last week, Defining Healthy Boundaries and Setting Limits, was an overview of the implications of healthy boundaries and limit-setting in adult relationships. Some comments and feedback I've received on this topic and also my post on Codependency prompted me to explore these topics further. How do these important concepts play out in young adult/adult - parent relationships?

In my therapy practice, I work with adolescents and adult patients and as I do not have specific expertise working with children under 12, I can't properly address boundary issues with that population. For a good discussion of boundaries in the child-parent relationship, I refer you to Implications of Parent-Child Boundary Dissolution for Developmental Psychopathology: Who is the Parent and Who is the Child? by Patricia K. Kerig, PhD and some of the many other books on the subject.

What's wrong with your parent being your BFF (Best Friend Forever)?
Although a close relationship with a parent can be a healthy, important aspect of growing up, I often hear adolescents and young adults describe their mothers as "friends" or "just like a sister." That always sends up a red flag for me. How can you parent someone who sees you as a sister or friend? In our popular, celebrity culture, we are bombarded with examples of this - the most extreme being the mothers or fathers of (underage!) alcohol/drug-abusing celebrities who seem to implicitly approve of their children's behavior, often to the point of going "clubbing" with them!

But what of the "normal" folk? Kristen King, who writes the Lively Women blog, forwarded me a link to this recent New York Times article by Stephanie Rosenbloom, "Mommy is Truly Dearest." The article describes young adult women, living on their own who may check in and talk to their mothers as many as 4-5 times a day. And the content of these conversations? One woman tells her mother about the quality of her sex life with her husband.

Beyond the blurred boundaries of these relationships, the article talks about a level of dependency not seen in previous generations.

Additionally, parent-child contact during the college years has dramatically
increased. Professors say that many students these days stroll around campus
talking into cellphones — and not to one another. It is not surprising, experts
say, that some of that behavior spills over into the post-college years,
including a reliance on parents to continue to pay the bills.

Some level of financial dependence on parents during the college years is to be expected. But a recent Wall Street Journal article "When Kids Don't Leave the Digital Nest" described a 29 year-old woman, who although gainfully employed, still has her cell phone bill paid by her father! Of course this can be a way to maintain communication with your adult children - no doubt one of the perks of this arrangement for the parents.

With this high level of parent-child dependence AND codependency, how do children learn to be autonomous? How do young adults learn to have appropriate relationships with authority figures like bosses? Without adequate boundaries modeled for them in their parent-child relationship, they have no point of reference for healthy, productive behavior within these relationships.