Dr. Bruce's Couch

A number of highly talented young adults are living through what might be termed an “existential crisis.” Typically these are young men and women in their late teens or early-to-mid twenties, with a track record of tremendous academic and extracurricular success, who seem to “hit a wall” while in high school, college or graduate school. Dramatically and seemingly without warning, they become depressed, angry, and “lost.” Their life as they and their parents have come to know it grinds to a halt. They rebel against and at times abandon their prior styles of driven accomplishment, energetic involvement in multiple pursuits, and pride of achievement. Their traditional values of a strong work ethic, academic excellence, predictability, pleasing the adults in their life, future orientation, and linear goal-seeking is abandoned, and they and their parents struggle to make sense of it all. It is a time of high anxiety and great uncertainty for those who love them, and the young adults and their parents endure significant emotional pain and despair.

Prior to this crisis, there are a number of common characteristics that are shared by this group. Many tended toward perfectionism, and were very high achievers. They took enormous pride in being at the top of their class academically while managing multiple extracurricular activities. As “stars” they received many awards – distinguishing themselves at a young age – while seemingly basking in the glow of their parents’, teachers’, and personal pride.

What themes emerge as they engage in psychotherapy? To begin with, as they develop trust in their therapist, a history of hidden but intense fears and anxieties over the failure to perform at the very highest level began years before. Their fears would devolve into panic attacks at times – particularly when they would not turn in a top performance – and they would become severely self-critical and filled with self-loathing. In some respects they became their own “tough act to follow” through a history of near-flawless performances. They would fear being given poor grades (sometimes describing failure as achieving a “B”) and losing their “star status.” Other fears include disappointing their parents, worrying about whether they would continue to be loved or be severely criticized if they let up on their perfectionistic strivings, or did not gain admission into one of the most prestigious colleges or graduate schools. A history of emotional sensitivity, and delayed social maturity characterized by challenges in dating and finding a boyfriend or girlfriend, feeling unpopular, being identified as “nerds” or “kiss ups,” favoring adults over peers, and an unusual degree of empathy and compassion are common characteristics. At times there is a history of attention deficit disorder, inattentive type, which was masked until later in their lives because of high intelligence and a strong work ethic.

The existential crisis may be precipitated by extreme disappointment in one or more love relationships; the death of a loved one such as a friend, parent or grandparent; the transition from high school to college, college to graduate school, or university into the real world; or may have no apparent precipitant at all. Commonly, in one form or another, there is a “loss of an ideal,” and what previously provided meaning, guidance and purpose is actively repudiated.

Treatment involves initially establishing an open and non-judgmental rapport, helping the young adult understand what has happened to them, and assisting them in making sense of the dramatic turn of events in their relationship with themselves. A judicious use of medication to help them with overwhelming symptoms of anxiety and depression is not uncommon. As the therapy unfolds they begin to differentiate between values that they were taught, and values that truly represent their core personality. They distinguish between the passions they previously shared with their parents, and newfound passions that feel rock solid, and are theirs alone. Rejecting a more traditional and secure path into self-sufficient adulthood, they experiment and explore, they wander. They make mistakes. Their parents must learn to tolerate and accept ambiguity and uncertainty, feelings of great helplessness, and recognize that they have no control of their child’s life and must let go while continuing to provide love and support. While there may be many sleepless nights (at times including their therapist!), there are newly forged understandings that feel right and true, as opposed to the “falsehoods” they have been living out in the past. It is helpful to bring their parents in for sessions along this journey, to assist them in understanding, bring comfort and support, allay anxieties and fears, and develop a shared knowledge of what was and what is to become, as their child fashions a new identity.

Meaning, purpose, satisfaction, and happiness are newly discovered through self-knowledge and a greater understanding of their place and potential in the world. These overly-perfectionistic young adults learn how to play, and to love aspects of themselves unrelated to performance and stardom. Their ride, and for those that ride along with them, is filled with potholes, and unexpected twists and turns. With patient and persistent hard work they eventually launch themselves – this time with an aim that is true.

“Once upon a time there was a man named Narcissus who came across a deep pool in a forest from which he took a drink. As he did, he saw his reflection for the first time in his life, and fell in love with the beautiful boy who was staring back at him. Realizing that he could not kiss or hold his own image, (only the water), he pines, withers away, and dies.” (From Greek Mythology)

Much has been written about the Narcissistic Personality in the last 30 years in the psychoanalytic literature and in popular psychology. There are important lessons that can be gleaned from this research in how to identify the Narcissist in love and at work…such that you can avoid unnecessary pain in relationships with Narcissists… as they inevitably result in breached commitments, dishonored contracts, and broken hearts.

What are some of the hallmarks of the Narcissistic personality? First and foremost is excessive self absorption. The Narcissist is rarely, if ever, truly interested in others. He or she may go on at length about themselves, but rarely demonstrate a meaningful interest in you.

Second, Narcissists are incapable of true empathy. They may be able to feign empathy because they are intelligent enough to have learned the concept of empathy, and may use it as a technique to manipulate others and win people over. But true empathy requires compassion and understanding – capacities that the Narcissist sorely lacks. When he or she attempts empathy, it has a shallow quality that will not resonate within you emotionally, and will lack a feeling of emotional connection. Genuine empathy is felt as a deep emotional resonance within your heart that comes along with a caring emotional connection with another human being.

Third, the Narcissist is only interested in his or her own happiness, and you exist only to make them happy. A Narcissist attends to your happiness only when it can bring them something they desire or covet – whether it is showing you off to others, getting you into bed, or manipulating some favor. It is all about boosting their self esteem and sense of self by fulfilling their needs. In contrast, someone capable of mature love is concerned about his or her own happiness, but is also genuinely committed to helping you find happiness in your own life.

The Narcissist may be extremely attractive, charming, interesting, fun and exciting for quite some time in the early phase of a relationship. They may sweet talk you – saying how important you are to them and how much they need you in their life. However, the Narcissist can “talk-the-talk” but cannot “walk-the -walk.” Count on the Narcissist to bolt when reality, ambivalence, or conflict that isn’t resolved in their favor start to enter the relationship. “Bolting” may take place at an emotional level where they withdraw from you into self-absorbtion, or it may involve their ending the relationship to move onto the next object of their Narcissistic pleasure. When the inevitable conflicts arise in a real relationship, count on the Narcissist to focus on your flaws and the various ways you don’t satisfy them, as opposed to working toward an understanding your point of view, as well as expressing their own, to enable a win-win resolution of conflicts.

The Narcissist can outwardly radiate a great aura of confidence and competence that may be beguiling. At times this personality trait may be expressed as arrogance. This posturing often masks deep feelings of insecurity, inadequacy, and unmet dependency needs that are threatening and frightening to them at an unconscious level. The Narcissist may jealously and possessively attempt to control you, or alternatively remain at an emotional distance, as a result of his or her unresolved dependency needs, which threaten the development of true intimacy. Thus a relationship with a Narcissist can feel like a very lonely place, even while being physically together and participating in an active social life.

Not all narcissism is bad. “Healthy Narcissism” is a positive trait that brings along with it positive self-regard and self-esteem; an appreciation of one’s strengths and capabilities; the confidence to explore the world, adult relationships, and one’s own inner life; the ability to ensure that one’s own needs are met in a relationship, along with a keen interest in meeting the needs of one’s partner, and a willingness to compromise to achieve mutual happiness; and a rock-solid set of principles and virtues that are not shaken or influenced by external pressures. If one has healthy narcissism and finds themselves becoming involved with a Narcissist, they typically have the inner strength to break away and move on, even if it means bearing the feelings of loneliness, and living alone.

Many adults repeatedly become engaged with Narcissistic Personalities. Due to unconscious forces, lack of self esteem, a repetition of earlier formative relationships, and a compulsion to repeat self-sabotaging behaviors, they seek out love relationships (and enter business relationships) that from the beginning are destined to bring heartache and failure.

“Knowing Yourself is the Beginning of All Wisdom.” Many clients first come in for psychotherapy in the midst of a crisis, or when they have recognized a pattern in their lives where they have been involved in a series of relationships that don’t work out, and where they feel chronically unhappy. We come to learn in the course of therapy that they repeatedly choose Narcissists as lovers and companions. We also uncover the sources of their low self-esteem that serve to perpetuate this pattern. Through psychotherapy, the unconscious determinants and propagators of this pattern can be identified and resolved, and healthy narcissism can be nurtured and strengthened. Through the process of therapy one makes healthier choices – seeking out and finding true partners who provide mature love, an emotional connection, empathy, support, and a durable love. Successful therapy helps to ensure that future relationships do not wither away and die, but remain alive and vibrant.

In television, movies, and books, consumers are frequently presented with an image of love that is passionate, blissful, and all-encompassing. Characters such as Wesley and Buttercup in the movie The Princess Bride, and Edward and Bella in the movie Twilight, exhibit undying devotion and affection which sustains them through every hardship they encounter. These movies, and others in this genre in which we have been immersed since childhood, present an idealized view of a love relationship, which may cause us to develop unrealistic expectations for the love relationships in our own lives. To have a successful romantic relationship, one must first understand the components of a REAL love life, as opposed to a fantasy.

A romantic relationship may evolve through three phases – the first phase is what we might call the “romanticized phase,” or “phase of idealization.” This is where you feel enraptured and incredibly excited about the other person. You think about them almost all of the time, there are frequent calls and/or text messages, and you feel that they are the greatest thing that has ever happened to you. Feeling as if you are on Cloud 9 can last as little as a night or two, or as much as several months. However, it is important to note that this romanticized phase will always end. (This does not necessarily mean the end of romance in the relationship, which is different).

The second phase is what we might call the beginning of the “reality phase.” This phase begins when you are still having fun together and are attracted to each other, yet you begin to notice the flaws in the other person, or they comment upon flaws in you. You begin to feel disappointed in a variety of ways. They may let you down or make you angry…or you may feel neglected or poorly treated. Some of this may be normal disillusionment and expectable in a real relationship. At other times it may be that the person is too self-absorbed and narcissistic to be able to truly satisfy your basic needs. (Look for a subsequent blog on “The Narcissist”).The beginning of the reality phase of a romantic relationship can be a difficult phase to negotiate, and for this reason many romantic relationships end here.

However, there is hope for conquering this phase. It is important that you talk with your romantic interest about some of your feelings and concerns, and listen to theirs. Do you try to resolve conflicts together? Are you willing to compromise? It is important to get good at talking, listening, and finding a middle ground, with a willingness to make some changes. Intimacy and commitment can feel scary, and make you or your partner want to run away from the relationship, but those feelings can be talked through as opposed to acted upon. Past deep disappointments in love, significant unresolved losses of a loved one, parental divorce, or growing up in a family where the relationships were characterized by emotional distance, can all result in fears of a close and lasting commitment. If you have persisting fears of intimacy that interfere with your love life, or you repeatedly end promising relationships before they can mature, then these issues can be addressed and resolved in psychotherapy . The therapeutic process can assist you in moving on into a healthier and more satisfying relationship.

At this point you may be thinking, “This sounds too complicated. Is there anything I can do to prevent this phase and continue the romanticized phase?” Unfortunately, there is no way to prevent the reality phase from emerging. However, take comfort in the fact that YOU get to decide whether your partner’s traits are satisfying enough to continue on. It is important to recognize that without self- reflection on the part of your partner, independently or through psychotherapy, their negative traits will persist over time. If they frequently disappoint or make you feel inadequate – such that you never develop a comfortable contentment – you may choose to end the relationship.

In the alternative, if you feel that you can fully accept your partner’s flaws, and that the good attributes outweigh the bad, then you may feel willing to continue. Ultimately, if you can each accept each other for who you are, within the context of working on the relationship to bring greater satisfaction, then the bond can develop into a real and durable one.

Sometimes your romantic interest decides to end the relationship. This may elicit feelings of self-doubt, or fears that you are flawed and not good enough. You may question whether you should have behaved differently. Feelings of confusion may arise if you and your partner had seemingly enjoyed your time together both emotionally and physically. There are no simple answers to these questions. Perhaps you chose someone with significant narcissistic problems, who is incapable of mature love. Alternatively, perhaps your own fears of intimacy, excessive emotional dependency, rushing the relationship, or holding back emotionally or physically may have contributed to the demise of the relationship. Sometimes these patterns of thinking, feeling and behaving are unconscious and result from earlier dysfunctional love relationships in your life, and can be addressed and resolved in psychotherapy.

The third phase of a romantic relationship is what we might call the “durable real” phase. Here, you have a wide range of feelings toward that other person. At times you feel love, affection, and sexual excitement. You really enjoy being with them and can’t wait to see them. At other times you may feel furious, and want out. You may feel relatively neutral at times, and just experience your partner as a companion. At other times you may feel ambivalent, as your partner can meet some of your needs, but not others. These conflicting feelings and impulses are the hallmark of a REAL relationship. If you work hard to keep the relationship alive, and motivate yourself to understand your partner; prioritize their happiness in addition to your own, and genuinely try to please them; then it’s possible to build a life together of passion, trust, and devotion. To develop and maintain an adult love relationship, it is essential to align your thoughts and expectations toward what is possible and real (as opposed to fantasized).

At times even a satisfying, mature love relationship can fall into crisis, manifested by stagnation or intense and persistent conflict. Prior repressed emotional traumas, upsetting life events , and aging and health concerns can all serve to undermine what had been very satisfying. Here again individual and/or couple’s therapy can make a significant difference in bringing about understanding that will “unstick” the relationship, provide a tangible pathway toward improvement, and restore the prior feelings of satisfaction and an intimate bond.

One of the more challenging epochs for a parent who is actively and lovingly engaged in their child’s emotional growth and development is when their child enters young adulthood. As a parent, having one’s child “graduate” into adulthood emotionally healthy and independent is a source of great pride and personal satisfaction – and of course brings with it a feeling of tremendous relief! There are numerous issues and bumps in the road that arise along this shared journey, most of which relate to the dynamic tension that arises as one’s child begins to assert his or her independence, often bringing about life events that fall short of the ideals that we hold out for them, or that they hold out for themselves.

How do we simultaneously let go, yet remain involved and engaged at a level where our child feels adequately supported, without undermining his or her independence, and the confidence that comes from their tackling the challenges of the outside world and progressively mastering them? How do we tolerate and accept the emotional pain that comes along with the process of letting go, while accepting a diminished role in our child’s life? How do we simultaneously endure the ups and downs of their alternately neglecting us, or vigorously and at times excessively asserting themselves against us? How do we not feel like an outmoded dinosaur, but feel relevant and important in their lives in newly created ways?

There are no easy answers to these questions. Our children at this phase of their lives are going through what has been called the second phase of separation and individuation (the first phase occurs in early childhood). Here they consolidate an adult identity, choose a career path, and engage in more mature love relationships, eventually settling on a mate. This process takes place over a period of years, and rarely occurs without setbacks. The challenge we face as parents is to let go, yet remain engaged. This means sitting back and watching the inevitable mistakes and lack of judgment unfold as our child engages with the real world, and stepping in only when we believe that a seriously harmful result is about to take place.

As Siddhartha lamented to his friend Govinda (in the book, Siddhartha, by Herman Hesse):
“Wisdom cannot be passed on. Wisdom which a wise man tries to pass on to someone always sounds like foolishness… Knowledge can be conveyed, but not wisdom. It can be found, it can be lived, it is possible to be carried by it, miracles can be performed with it, but it cannot be expressed in words and taught.”

Our children develop wisdom through life experience – it is not something that we can impart to them – and through experiencing and overcoming disappointments and losses they become more adept at managing adult world challenges. When we try offering our wisdom it drives them away. Well then, if we can’t provide the benefits of our wisdom, how can we effectively parent during this phase? The best options include providing active empathy – listening in a supportive fashion to the issues and struggles they are living through without passing judgment. Advice may be offered if requested, otherwise keep it to yourself. Networking contacts can be valuable to help your child get launched. Offer them up and then step back and let your child decide if they want to avail themselves of your introductions.

If you get into unproductive struggles with your child, take a step back, and then speak with them about how they (and you) are going through a major readjustment of roles and responsibilities at this phase of their life, and let them know that you are there to help them, and that you will take the lead from them and wait for them to ask for help, and let you know what they need and when they need it. A book that may prove useful for some children to read is Tina Selig’s “What I Wish I Knew When I Was 20”

It is important to speak frequently with your spouse during this phase, both to give and receive support, to commiserate, and to strategize on what interventions (if any) are called for. Speaking with friends whose children have successfully navigated this phase, receiving their support, and gaining their valuable knowledge and insights, can also really help.

If your child develops symptoms of excessive anxiety or depression, or suspicions develop that they may be trying to cope by using drugs or alcohol, then professional help is warranted. An existential crisis in one’s child as they emerge into adulthood becomes a crisis for the entire family. While not every story has a happy ending, most children end up consolidating an adult identity that brings them independence and newfound freedom. While this process may take up to a decade to accomplish, particularly in today’s increasingly complicated and fast moving world, by age thirty most young adults have consolidated their adult identity, and have successfully created a career path and secured a mate. For their parents, it brings a newfound freedom, and a great sense of relief.

We all know that regular cardiovascular fitness promotes healthy heart, lung and blood vessel function; and can Improve symptoms of anxiety and depression and promote healthy longevity.

Evidence increasingly supports that “cognitive fitness” comparably benefits our brains as well. One of the fastest growing areas of neuroscience relates to how brain structure and function can be preserved and enhanced as we age.

Brain fitness is expected to become increasingly important as baby boomers age, and along with increased longevity will come a predicted rise in cognitive diseases (so called “neurodegenerative disorders”) such as Alzheimer’s. There is good evidence that regularly scheduled cognitive exercises and activities can help delay the onset of the clinical symptoms of these dementias.

For example, a European study of elderly identical twin nuns demonstrated that the twin that engaged in regular cardiovascular exercise, combined with significant cognitive stimulation, was able to absorb five times the number of “senile plaques” (abnormal protein deposits in brains cells of Alzheimer’s patients) than their sedentary twin, before developing the clinical signs and symptoms of dementia.

In a separate study reported in SharpBrains, for every “activity day” (participation in one activity for one day a week) the study participants subjects engaged in, the onset of rapid memory loss associated with dementia was delayed for about two months.

In this study the positive effect of brain-stimulating activities appeared to be unrelated to the person’s level of education.

What these studies suggest is that cognitive stimulation and fitness build up ones “brain reserve” which determines how much brain cell damage can be absorbed prior to demonstrating clinical symptoms of dementia. There is evidence that part of the development of this reserve results from the cognitive stimulation causing the brain cells to release molecules that bathe the cell prior to them (the “presynaptic neuron”) with what are called “neurotrophic factors” that preserve and protect the cells from damage. The studies support that the more brain stimulating activities one does and the more often one does them, the better the results for a stronger cognitive reserve.

The bottom line is that by committing yourself to a regular program of intellectual stimulation, cardiovascular fitness, and social engagement you will help to keep your brain more fit, and provide yourself a richer life experience!

Regular exercise has a variety of beneficial effects on differing emotional disorders in both children and adults. First, let’s consider its effects on Attention Deficit Disorder. According to a recent article in Medscape, ADD affects at least 8%-10% of children, and almost as many adults. It’s now considered a biological brain disorder and may have genetic components. Exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. Norepinephrine and dopamine are both believed to be drivers of the attention system. Therefore, a dose of exercise is like taking a bit of methylphenidate (Ritalin®) or amphetamine/dextroamphetamine (Adderall® or Vyvanse®) – it’s similar to taking a stimulant.

Over time exercise has two additional benefits – it helps to increase the quantity of neurotransmitters in the brain as well as increasing the number of brain cell receptors that respond to the neurotransmitters. Chronic exercise eventually causes growth of the attentional system circuitry. The more fit that you are, the better the attentional system will work.

Exercise activates the frontal cortex, home to executive brain function, in all age groups. Many ADD symptoms are related to the brain’s executive functions which are located in the frontal cortex.

Neurology is paying more attention to exercise. It appears that exercise may help protect against some of the symptoms in Alzheimer’s as well as Parkinson’s disease.

Exercise is increasingly gaining respect as a treatment option in ADD. Historically, it started in cardiology studies, where psychologists noted that the people in cardiac rehab following heart attacks were improving emotionally as well as physically. The psychologists looked at depression, anxiety, hostility, aggression, and stress in people who started an exercise regimen for cardiac protection or healing, and found improvements in a number of these symptoms.

Someone with ADD could benefit from an exercise break of 10 minutes every hour or so. It helps everyone, not just patients with ADD. Exercise doesn’t have to be for very long each time, just enough time to get the heart rate up for at least a few minutes. Benefits persist for a while after exercise. Doctors should advise patients to exercise at least once daily, once they are medically approved for strenuous physical exertion. Whatever medical treatment has begun, exercise needs to be included, too. Aerobic and strength training is fine. Balance training is important in patients with ADD and can be accomplished with yoga, tai chi, or balance exercises. Exercise needs to become a lifestyle, a habit that is positive and enjoyable.

A number of patients who exercise regularly are able to come off their ADD medication completely, while others may successfully reduce the dosage and find equivalent benefits to the higher dosage. In people who have trouble finding the right medication regimen, exercise can also really help. The exercises chosen should be fun so that you will want to do them.

Finally, there is a spectrum of severity in ADD. There are plenty of marathon runners who still need medicine. A number of super athletes have ADD. A prime example today is Olympic swimmer Michael Phelps who was diagnosed at the age of 9 and put on medicine. He found it impossible to stay still in school because of ADD. Then he began swimming. When he got up to 3 hours of daily exercise, he didn’t need medication anymore.

Many of the children suffering from ADD also develop a “learned helplessness syndrome.” They’ve failed so much in the past with respect to their school work, and at times in important relationships, that they continually expect to fail. As a result of the learned helplessness, they may get depressed, use drugs, or play video games all day. Exercise prevents these children from getting into these maladaptive ways of living. According to Medscape, animal studies have shown that exercise makes it tougher to develop learned helplessness.

In conclusion, ADD, Depression, Heart Health and other positive medicinal benefits come from regular exercise. In advance of beginning any strenuous exercise program you should first be examined by your doctor, and build up the duration and intensity of the program gradually over time. You will feel better, have a sharper focus, and feel more satisfied with your life!

Read more about Benefits of Exercise for ADD treatment.

The population of our metropolitan area has the highest ratio of professionals with advanced degrees in the country. With this distinction comes a particular type of “Empty Nest Syndrome” that I have observed in couples that I have treated over the years. Typically, both husband and wife are driven to succeed at work and at home. They strive to provide the best possible life for their children – an excellent education, active engagement in sports and other extracurricular activities, a full social life, tutoring support for challenging courses and SAT preparation – to prepare their children for an increasingly complex and competitive world. For those mothers or fathers who “stay-at-home,” this becomes nearly a full-time occupation, and is a source of great commitment and pride.
At the same time one or both are climbing as high as they possibly can in their careers, to achieve the tangible and intangible rewards that come with significant professional accomplishment.

What not infrequently gets neglected, what often gets pushed aside, is devoting the same level of energy, drive and commitment to their marital relationship. All too often, there is a wakeup call when the last child leaves for college, and suddenly the couple is alone at home, truly facing each other for the first time in many years. For some there is the frightening realization of “Who is this stranger that I’m married to?”

There may be a painful awareness of having drifted apart over the years, with emotional intimacy a distant memory. This may also coincide with a time in life when one is increasingly aware of one’s own mortality, and all of the issues that come along with the typical midlife crisis. The general feeling can be one of an “emotional divorce,” which is the result of years of neglecting the marriage itself.

This situation may provoke a marital crisis resulting in separation and divorce. However, there are a number of steps the couple can take to prevent this outcome. The first is to acknowledge and talk about their sense of loss around their children moving out and moving on, and actively reminisce about their life together when the kids lived at home. At the same time this life stage can bring about a newfound sense of freedom that can be both exhilarating and a bit bewildering, at least at first. There is the opportunity to reacquaint one another with pursuits that were pleasurable before the children were born, such as travel, entertainment, and visiting friends in distant cities. There is also the opportunity to rediscover old hobbies that were once individually rewarding, and jointly discover new pursuits that can rebuild an emotional connection. This process entails the same hard work and diligence that was devoted to climbing up the career ladder, and enabling their children to build capabilities and leave home for college. Without actively focusing on and discussing their relationship, the couple is at higher risk of separation and divorce, or remaining involved in a marriage that is stagnant and breeds loneliness. With a consistent focus on rebuilding the relationship can come a newly enriched life together, and an invigorating freedom.

More on Empty Nest Syndrome

Why Psychotherapy?

As parents we instinctively wish to shield our children from traumatic experiences. There is a significant value to creating an “envelope” around younger children in their most formative years, to bring them an increased feeling of stability and security. There is a significant likelihood that a child, adolescent or young adult will experience a traumatic event such as the death of a grandparent, parent of a schoolmate, or rarely, even the death of a good friend; or other traumatic events or losses. How does a parent best respond to such an event, and when is a psychiatric evaluation warranted?

It is important to provide your child with a supportive and empathetic response following such a trauma. Be a good and active listener. Don’t be afraid to share your own feelings about the loss, and be actively empathizing with their child’s emotional pain. Most often this approach, along with the support of friends and teachers, will enable your child to get through the traumatic event without the need for therapy.

Is there a way to predict which children are at risk for developing Post Traumatic Stress Disorder? A parental history of anxiety disorders is the best predictor of the development and persistence of post-traumatic stress disorder (PTSD) in children and adolescents who have undergone a traumatic event, according to data presented at the 9th World Congress of Biological Psychiatry.

The data showed that children with a parental history of anxiety disorders were 3 times as likely to have PTSD symptoms at 1 month, and 2 times as likely to have symptoms that persisted at 5 years, as children without a parental history of any anxiety disorder.

While some children and teenagers spontaneously recover from PTSD over time, the results suggest that victims with a parental history of anxiety disorders, including generalized anxiety disorders, obsessive-compulsive disorders, PTSD, and phobias, may deserve special attention from mental-health professionals, since they may be at heightened risk for developing PTSD after traumatic experiences.

If you have an anxiety history, you may also want to consider having a psychiatric evaluation and treatment following the traumatic event, to prevent the development of PTSD.

Humiliation has been characterized as the most painful of all human emotions. Humiliation is a “public emotion” in that it involves a belief that others will view us as diminished, and will likely mock us. When we are humiliated, particularly by someone that we love, it can engender deep feelings of disappointment, hurt, anger, and even rageful behavior. If the humiliation occurs at a time when one is also feeling generally despondent about their life, the predisposition to anger and ragefulness is even greater. Severe humiliation may create a higher risk of suicide. For example, we have recently witnessed this phenomenon during the severe recession, when several previously prominent and highly affluent professionals lost their jobs, incomes, and much of their assets, and they committed suicide. This is because reduced self-esteem increases one’s general emotional vulnerability, reduces one’s “emotional reserve,” and then the experience of humiliation worsens one’s self-esteem all the more, leading to a downward spiral of hopelessness and a feeling that “there is no way out.”

Why is this dynamic important to recognize, prevent, and treat? To begin with, many of the anger management and depression challenges that our adult clients present to us have at their root persisting childhood experiences of humiliation by one or more parents, or by friends or teachers. As a humiliated child they felt “even smaller,” and at times the feeling of humiliation was so intense that they would feel like disappearing altogether, just to escape the emotional pain. A berating or overly critical parent; the persisting educational challenges posed by Attention Deficit Disorder; a loss of socioeconomic status; a parent suffering from mental illness, alcohol or drug abuse; poor athletic ability; delayed physical maturation; or an older sibling with far greater talent can all contribute to childhood feelings of humiliation, and a persisting vulnerability into adulthood.

From a prevention standpoint, praising a child when they behave in a way that makes them (and you) feel proud, helping a child gain confidence and mastery in their life by supporting activities about which they feel passionate, and helping them over life’s hurdles (without stepping in to take care of the problem, unless absolutely necessary) can assist a child in building healthy self esteem that provides greater resistance to feeling humiliated. There is no absolute means of prevention, as the experience of humiliation is inevitable; and providing empathic parental support goes a long way toward restoring positive self-esteem.

Treatment involves uncovering and explore the childhood experiences of humiliation, and all of the attendant feelings that once came along with these events, and developing a new perspective on them, in an empathic and supportive therapeutic environment. At times, medication can also be helpful in treating an underlying mood or anxiety disorder that has increased one’s vulnerability to feeling humiliated. Sometimes during the treatment process “the cure can feel worse than the disease.” But through a diligent and persistent approach to therapy the client can learn to understand the origins of their vulnerability, how they repeatedly play it out or even unconsciously bring it about in present day life, and then learn to leave it behind them and move on to a healthier, more positive and resilient way of living.

More about Humiliation.

Want to know why psychotherapy is important?