Whether you’re a client or a counselor, terminating the relationship is difficult.

Here are some thoughts on how to handle it.

You’re a client who feels ill-suited to or dissatisfied with your counselor

Let’s say you find your counselor, for example, too active, too passive, too fast- or slow paced, not reading you right, not having enough specific expertise to address your problem You’ve gently offered feedback and it hasn’t helped, so you want to terminate the relationship.

It can be tempting to simply not schedule another appointment, saying, “I’ll get back to you about scheduling,” and then not. But honest feedback is of real value so, after you get home, if you feel generous and would like to slightly increase the chances of the counselor being more effective with future clients, you might want to write a note such as,

Dear Joe,

Thank you for our session today. I appreciated that you are a wellspring of knowledge about career issues but I’ve decided not to schedule another appointment because I’m sensing that we’re not a good fit. I tend to be slower, more reflective. You are fast, sometimes coming up with solutions before I even finish a sentence. Your intuitions about me may be spot-on and perhaps your speed is simply a sense of responsibility to help me as quickly and thus as inexpensively as possible but it just doesn’t feel right. I once asked you to slow down and you did so for a minute but soon you were back in gear. If I kept pressing it, I believe it would force you to be someone you’re not.

I, for one, really appreciate benevolently derived feedback and I thought perhaps you might too. If not, I apologize.

Wishing you all the best of course,

Jill Jobseeker

You’re a counselor who feels ill-suited to a client

If you felt that a client might well be better served by another counselor, you might say something like:

I certainly don’t like to turn away clients but ethically, I think you’d be better served by a career counselor who specialized in people in your situation: artsy people who have long been a stay-at-home parent and are having major issues around procrastination.  If you like, I can make a referral. Would you like one?

You’re a counselor and don’t want to work with a client

Occasionally, even if a counselor feels s/he could help a client, s/he sufficiently dislikes or disrespects the client that s/he wants to terminate the relationship.

If you feel that way during a career counseling session, you should wait for the end of the session or look for a moment when the client seemed unhappy with you. At that point, you might say something like,

You seem unhappy with me and I’m getting the sense that I can’t be the advocate for you that I need to be. Despite my having stressed the importance of your doing the homework between sessions, you haven’t. And the angry personality you admit you have trouble controlling is coming out toward me so much that I feel it’s keeping me from being as effective as I could be. And simply, personally, I have a hard time being attacked so much when---and I really have reflected on it---your anger does not seem justified. For example, when I said we had to stop for the day last week, you insisted on keeping talking. I patiently listened and when you stopped and I said we really had to stop, you called me rigid. We’re both better off with you finding someone you won’t be as angry with. I’m not a therapist. I’m a career counselor and I’m just not sufficiently equipped to be as helpful to you as I’d like. Would you like a referral to a good therapist?

The takeaway

Of course every client and every counselor is different. But both client and counselor have the right to crisply terminate the relationship while providing an explanation that while honest, where possible, allows the person to save face.

If there isn’t a face-saving way, you might want to err on the side of honesty so the person gets feedback rather than a disingenuous and unhelpful statement such as “I just don’t think we’re a good fit,” and refusing to explain why. True, your candor may evoke an angry response but that may be a price that a good counselor should be willing to pay.

Marty Nemko's bio is in Wikipedia.

Years ago a local human services director asked me to do a series of workshops on the topic of emotional safety. Since I liked the agency and the director, I agreed before I had a chance to research the subject. Of course, at the time, I found little in the professional literature that specifically addressed emotional safety. Immersing myself in the subject, I quickly began to appreciate how safety is a fundamental human need as described by the work of Abraham Maslow, a highly accomplished psychologist and personality theorist. For Maslow, safety meant security: protection from physical and emotional harm.

Examining the emotional aspect of safety for this training, I realize that empathy is at the heart I'm emotional safety. Empathy helps create emotional safety by affirming that our struggles are okay – not necessarily right or wrong, but okay. This helps us to let down our negative judgment and barriers. When you felt "Safe "as a child, you explored your surroundings. When you felt "safe "in the classroom, you raise your hand without fear. When you feel safe in your relationship you can express your emotional needs and be true to them – that's emotional safety. And that's a beautiful thing!

Emotional safety has also been discussed by psychologist Don R. Catherall. Proponents of his emotional safety model contend that shifts in feeling secure in a relationship are precipitated by a partner's perception of change in the other's affective tone regarding their emotional relationship (i.e. the partners' feelings about themselves, each other, and their relationship).

As I discuss n my book, Why Can't You Read My Mind?, here are more ways to gain a sense of emotional safety with your partner.

1. Identify and challenge your toxic thoughts toward your partner.  Overcoming your toxic thoughts toward your partner is imperative to create an emotionally safe relationship. Please see my recent blog, Do Any Of These Toxic Thoughts Threaten Your Relationship? for more on this topic.

2. Be Consistent. It is very emotionally draining and unsafe for your partner (and for you, as well) if you are moody and unpredictable. Being this way can sabotage feelings of emotional safety. As discussed in another recent blog, What Head Games Look Like in Lasting Relationships, avoid unwittingly or wittingly saying one thing and doing another.

3. Demonstrate Commitment. Protect your relationship.  Don't destructively trash your partner to your friends or family. Be faithful and be supportive. Doing this will help you navigate choppy waters in your relationship and get you both to a better place. 

References:

Catherall, Don R. (2007). Emotional Safety: viewing couples through the lens of affect. New York: Routledge. 

http://www.psychologytoday.com/blog/the-middle-ground/201111/emot...

En.wikipedia.org/wiki/Emotional_safety#cite_note-1

http://nationalcenterdvtraumamh.org/wp-content/uploads/2012/01/Ti...

oveandlifetoolbox.com/emotional-safety-and-your-relationship-by-richard-nicastro-phd/

Dr. Jeffrey Bernstein is a psychologist with over 23 years of experience specializing in child, adolescent, couples, and family therapy.  He holds a Ph.D. in Counseling Psychology from the State University of New York at Albany and completed his post-doctoral internship at the University of Pennsylvania Counseling Center. He has appeared on the Today Show, Court TV as an expert advisor, CBS Eyewitness News Philadelphia, 10! Philadelphia—NBC, and public radio. Dr. Bernstein has authored four books, including the highly popular 10 Days to a Less Defiant Child (Perseus Books, 2006), 10 Days to a Less Distracted Child (Perseus Books 2007), Why Can't You Read My Mind? , and Liking the Child You Love, Perseus Books 2009). 

Doing a TED talk is the quickest way to establish yourself as an expert and thought leader. After I did my TEDx talk, I heard from speaker bureaus I’d never worked with and my book sales soared, but mostly I ended up with a terrific video that expresses, as it says on the application, “an idea worth spreading.”

 Here are 12 tips to help you find your idea worth sharing and compose your TED talk:

1. Identify your audience. TEDx talks are usually geared to a specific audience. Decide who would benefit from hearing your message, i.e. women entrepenuers, techies, realtors, bankers, maybe students.

2. On the TED application, focus on what problems your topic solves for the listeners. Don’t make the mistake of sharing YOU.

3. Consider the consequences of the problems that you stated. For example, if entrepreneuers are finding themselves stressed, what is the result of that stress? Connect your topic to issues of money, health, or relationships; those are things that matter to everyone.

4. Make it personal. Find your own story with a mess to success journey, indicating how you solved the very problem you chose to talk about.

5. Identify a specific scene in your story with a “Eureka Moment.” This is where you identified the problem and figured out how to solve it.

6. When you tell your story, be in it; don’t just tell it. It helps to act out the dialogue, reveal what you were thinking, and use present tense verbs to make it more dynamic. For example... “There I am...” Rather than, “There I was...”

7. Make the audience aware of your goal in your story, what was driving you.

8. Tell about the obstacles that got in the way of you getting what you wanted. They may be physical (such as traffic, weather, a presidential motorcade), other people, or internal obstacles such as childhood trauma.

9. After telling your story, give the audience specific actions so they, too, can have successful results.

10. When you give action steps, make sure you don't confuse them with results. For example, telling people to be more confident -- that's a result. A step towards being more confident would be: speak up at a meeting by asking questions. 

11. Always end your talk with a call to action. Give the audience things they can actually do. Don’t say, “Go home and write thirty pages of your new book.” It’s better to say, "Picture your book signing. Ask yourself who and what do you need to appreciate.” Give the audience an assignment that is do-able in the moment.

12. When adding humor to your talk, keep it authentic. Don’t insert jokes. Relate to your audience and to yourself with humor that is relevant to you and to your topic.

More humor tips at JudyCarter.com

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Apple and Facebook Pay for Egg Freezing:  Support for Women or Is It?

Joann Paley Galst, Ph.D.

              Yesterday, both Apple and Facebook announced on NBC (http://www.nbcnews.com/news/us-news/perk-facebook-apple-now-pay-women-freeze-eggs-n225011) that they are offering to pay for their female employees to freeze their eggs if they choose. They are doing this ostensibly to attract and keep top female talent to these traditionally male-dominated Silicon Valley firms in an ongoing Silicon Valley “perks arms race.” Already both companies admirably offer benefits for fertility treatments and adoption and Facebook gives $4,000 to new parents in “baby cash” to use however they wish.

              In my previous blog (http://www.psychologytoday.com/blog/fertility-factor/201405/egg-freezing-modern-fertility-conundrum), it was made clear that egg cryopreservation offers a valuable option to women, although one which does not come with a guarantee that any of the frozen eggs will result in a live birth when the woman is ready to use her eggs.  Thus, I am thrilled when I hear of companies’ awareness of how career demands compete with family building, particularly for women, and for women being given additional opportunities and choices in their reproductive freedom. However, my gut reaction was ambivalent to this news, as I saw it as corporate America continuing to ignore problems in the U.S. workplace that lead to women having babies later in life, not addressing the need for societal support for working mothers (and fathers), continuing to give less support to families regarding maternity and paternity leaves, and contributing to the United States’ ongoing lag far behind most industrialized countries in this regard.

              Reflected in my most cynical light, I wonder if this is just a ploy to entice women to sell their souls, and their potential future children, to their employer, sacrificing their childbearing years for the promise of raises and promotions. Egg freezing necessitates a healthy woman exposing herself to high levels of ovarian stimulating hormones and high technological intervention to have a child. In addition, it may carry the false expectation of a secured family building option down the road when it certainly does not offer a guarantee of successful pregnancy or the birth of a healthy child, though many women believe it does. This offer may also pressure women into postponing pregnancy until advanced maternal age will which result in children being born to older parents. This raises issues both for the medical risks to the woman during such a pregnancy and for the health and long-term welfare of the child.

              To what must women agree in order to take advantage of this perk? Must they agree to work at a company for a specified period of time to recoup the employer’s investment, much like an indentured servant? Does it send a message to young women, already woefully uneducated regarding how fertility actually works, that fertility can be postponed indefinitely and turned on at will? Might it not also decrease corporate America’s support for women who wish to have children at younger ages? And, doesn’t this enticement also continue the trend of fertility advances being available primarily to the affluent while less advantaged women face obstacles in building a family with no financial support?

              While I commend Apple and Facebook in considering the conflicts which women face in confronting career and family-building decisions, I would emphasize the importance that women be given all of the facts, both the pros and the cons, about later-life pregnancy and parenting before making the decision to freeze their eggs.  To make informed decisions, they need realistic present-day success rates by age for egg freezing as well as information about the medical intervention and risks that they will undergo both to freeze their eggs and to undergo fertilization of their embryos and future transfer of embryos. In addition, I hope that conversations about what we prioritize in our society and in the workplace continue and that we are able to increase the support of all people with families at any age in the workplace.

No one likes change. You’ve probably heard the quote, attributable to everyone from John C. Maxwell to Gandhi: “Change is inevitable. Growth is optional.” The message: change is hard, people need help adjusting to it, and with it come opportunities.

We are hard-wired to find change threatening, for obvious reasons. Change represents the unknown. We might have to learn new skills or see things differently. Perhaps change will require us to unlearn old behaviors. It knocks us off-kilter, and we don’t like to feel out of balance.

There are changes we need to adapt to on a daily basis. Your colleague is fired and you have to pick up the slack. Someone cancels an appointment. These last-minute disruptions require you to shift gears and figure out how you’re going to handle the situation at hand. Though seemingly minor, even these changes may upset your internal sense of stability and tap into your fears or insecurities. If you have trouble handling these kinds of changes, ask yourself why, and review the suggestions below.

Then there are the monumental life changes: pregnancy, childbirth, divorce, empty nesting, job loss, a move, or the overwhelming loss of a loved one. A change like that can feel prodigious, like something you can’t recover from.

Change is inevitable. Coping means balancing the reactive with the proactive, being present while processing what’s happened. I advocate for being in “the now,” not the past or future, but that is difficult when you are faced with a big life change. You might need to let go of something from your past, or the fantasy of what might have been. You have to tap into how you feel about what‘s happening. Often, none of this is welcomed or easy, especially because as women we tend to care for others first and don’t take time to understand how experiences have affected our lives and hearts. We either slap an emotional band-aid on and move full throttle into “what’s next” or we grieve so intensely that we can’t pull ourselves out of it.

With change, you’ll likely have concerns (or fears) about what seems an uncertain future, and legitimately so. Change means that life will be different in some way. Rather than shove down your concerns, take a good look at them.

We aren’t given tools to deal with change. Instead, we’re taught to be reactive rather than proactive. We believe we have no control over how we feel, as if our emotions come out of left field. In fact we do have the ability to decide how we feel, but we’ve been programmed to react in certain ways for a very long time.

Emotions don’t come in a vacuum; they come with a history. No one knows what it’s like to be you, to have had the life experiences you’ve had that created your particular unconscious beliefs, and sense of the past or future. Transitions are a good opportunity to reengage with your sense of self, investigate what stops you from moving forward, and/or create something new.

Taking control of your life is an inside job. It is a good idea to get support, but ultimately how you handle a transition is up to you. It can increase your confidence, create learning, and even help “rewire” old thought patterns that are unhelpful.

During a transition, I recommend the following:

• Find some alone time to examine what you’re thinking and feeling.
• If you don’t have to make quick decisions, don’t. Honor the transition.
• Do a head and heart check. Ask: “How do I feel changed by this? What is the best
• outcome? What can I do to make this easier?”
• Try to find an empowered and/or optimistic twist to what’s happened.
• Embrace yourself and practice good self-care.
• Recall how you’ve handled transitions in the past. What worked, what didn’t?

Taking time with the questions above will make it less likely that buried emotions will arise with a vengeance later on. You can get a grip on what is real versus perceived fear. Remember, allow yourself to grieve for the past but make empowered plans for a new future

Benzodiazepines are a class of drugs often prescribed to ease the anxiety and/or the insomnia associated with chronic pain. They include familiar names such as Xanax, Valium, Ativan and Klonopin. Unfortunately, recently published research has found that older patients prescribed these drugs are at a higher risk of developing Alzheimer’s disease, the risk becoming significantly higher with the greater use of these medications.

Interestingly, many of these drugs are used to treat elderly patients suffering from agitation and anxiety—symptoms which can themselves be early manifestations of what could eventually be Alzheimer’s dementia. Researchers set out to study the intriguing hypothesis that perhaps these drugs were not so much treating anxious patients, but instead creating demented patients.

The study, as described in last month’s issue of the “British Medical Journal,” compared the pattern of benzodiazepine use in 1,796 elderly people diagnosed with Alzheimer's disease with that of 7,184 similar people who had no such diagnosis. Obviously, this sort of observational study design cannot definitively establish that more intensive use of benzodiazepines causes Alzheimer's disease. Nevertheless, it raises interesting issues that need to be explored with a more robust scientific method.

The study participants were individuals over 66 years of age. Those who took low-dose benzodiazepines, or who took only occasional high dosages, did not have their Alzheimer's risk increase for the five years they were studied after having been initiated on these agents. In contrast, those who frequently took long-acting benzodiazepines, who frequently took high doses, or who took any such drugs regularly over several months, suffered a more disturbing fate: Specifically, those who took the cumulative equivalent of daily doses for three to six months over a five-year period were roughly 32% more likely than those who took no benzodiazepines to develop Alzheimer's. And those who took the cumulative equivalent of a full daily dose for more than six months were 84% more likely to do so.

It is already acknowledged by the thought leaders in the medical community that benzodiazepines are not meant for long-term use, and should not be taken steadily for more than three months. But a glance at the refill patterns of most patients reveals that these drugs are used on a chronic basis, for years and years. In addition to their cognitive adverse effects, benzodiazepines are also implicated in the national epidemic of opioid pain medication overdoses and fatalities that result from mixing them with alcohol and opioid drugs.

A nice cup of chamomile tea is sounding pretty good right about now.

One of my favorite shows on television is Nathan for You. Hosted by the deadpan Canadian comic, Nathan Felder, the show documents Nathan’s exploits as he attempts to help struggling small business owners using gimmicky ideas. Furthermore, Nathan works effortlessly with his crew and spends whatever money he needs to in order to make an idea happen or find a comic out. (Remember "Nathan for You" is a Comedy Central show with a budget.) Some of my favorite things Nathan has done include trying to get a pregnant woman to birth in the back of a taxi with the help of a midwife (who creates a sterile environment), getting a frozen yogurt shop to sell a “poo” flavor which Nathan then creates, and, of course, opening a “Dumb Starbucks.”  Anyway, I sometimes try to think of an idea that would work for "Nathan for You." And I think that I thought of a good one: helping a struggling sperm bank drum up business by advertising that “all sperm is Ebola virus free.”

If you haven’t already heard, Ebola is scaring everybody. (Especially, when people with Ebola are getting on airplanes.) Ebola is a contagious and painful disease which causes viral hemorrhagic fever—bleeding, high fever, shock and even death. As is the case with countless other journalists, I recently wrote about Ebola. While doing my research, I realized that in addition to all other body fluids, Ebola is also found in semen.

So, somebody out there might develop Ebola thanks to sex. But the chances of developing Ebola on account of semen alone is remote. First, people don’t interact with each other using the sole currency of semen. Before receiving semen, a person would likely interact with an infected partner by kissing and so forth. Moreover, it’s highly unlikely that a person with symptomatic Ebola would feel like having sex.

Any thoughts?

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Elizabeth is artsy, not really an artist, just artsy. She likes to decorate, make jewelry, appreciate nature. She loses track of time. She says she suffers from depression but doesn’t believe in taking medication. She’s 50 and never earned more than $20,000 a year and has been unemployed or making near (or even below) minimum wage for most of her life. She’s now been unemployed for more than a year and her unemployment checks have just stopped.

David graduated from Harvard Summa Cum Laude in history but has a prickly, know-it-all personality and a short temper. He had 14 jobs in 18 years, and now, with all that on his resume, at age 40 with no career progression to speak of, he’s been unemployed for two years.

Ted is an immigrant who was a nurse in Poland. His nursing license is not recognized here and he can’t afford to go to a U.S. nursing school even if he could get in, which is doubtful because of his poor English. He also is an inveterate procrastinator—He just can’t make himself do the things he needs to do, which he attributes only in part to his smoking pot a few times a week. He has not held a paying job in 18 months and currently volunteers at his church. His parents, back in Poland, are supporting him.

There are many other types of economic misfits: those with low intelligence, chronic unreliability, mental disease, physical disability, criminal behavior, and people who refuse to take a job other than a highly desirable one, which hundreds of people typically apply, for example, journalist or activist.

What might economic misfits do?

Some people simply won’t or can’t find desirable paid work throughout their lifetime. What might they do?

• Take a less desirable job. They might want to remember that all ethical work is worthy work, and compared with more desirable work, it’s much easier to find a job as a security guard, dishwasher, housekeeper, gas station attendant, night clerk at a motel, farm worker, the underrated letter carrier job, etc. Even if you have to work at a fast-food restaurant or as an iron worker, you may find that more cosmically just than not working and letting other people work to pay for your expenses. Sad that you can’t do what you love? Like most people, do it is as hobby.

• Do worthy unpaid work. If you feel you must rely on a parent, spouse, or society to support you, you have a particular obligation to do volunteer work full-time. While almost all volunteer work has value, you may do more good if you look for opportunities with ripple effect: tutor rather than hospice volunteer, health educator than soup kitchen worker, political activist (Left, Center, or Right) than dog-pound cage cleaner, etc. In all interactions, in and outside of your volunteer work, your job is to be as kind as possible—That may be easier to do if you remember that the world is supporting you; you have an obligation to support it.
  

What might society do for economic misfits?

• Assistance Army. The government, for-profit, and non-profits sectors should team up to create an Assistance Army. Each sector would create pro-social jobs that are doable by a wide range of people: teacher’s aide, park rehabilitator, graffiti remover, hospital volunteer, customer service rep, etc. Additionally, all the sectors would mount a PR campaign to encourage individuals to hire personal helpers: new mom aides, homework helpers for school-age kids, housecleaners, personal assistants, tech tutors, elder helpers, gardeners, etc.

• The basics for all. Even if someone doesn’t make the lifelong effort to find and retain employment, it seems that every human being is entitled to basic food, shelter, clothing, and health care. If kept basic, I believe it will not demotivate people from working. How might basic be defined? Food and shelter might be equivalent to what college students pay a fortune for: dormitory-style with roommates and food served in a cafeteria. Clothing might come from thrift stores such as the Salvation Army and Goodwill. Health care could consist of access to basic prevention and treatment provided primarily by physician assistants at clinics.
  

• Replace derision with generosity.  After having been career counselor to 4,500 clients over the past 29 years, I’ve come to believe that some people just can’t be expected to find decent work throughout their lifetimes. Instead of resenting them and thinking that our giving them a pass will encourage sloth, we should feel grateful we’re not like that and replace our derision with a measure of generosity.

Marty Nemko's bio is in Wikipedia.

One of the strangest and rarest mental disorders that has been studied academically is Cotard’s Syndrome (CS), and also known as the Cotard Delusion, the Nihilistic Delusion, and the Walking Corpse Syndrome, CS is where individuals hold the delusional belief that they are dead (figuratively or literally) and do not exist. Alternative versions of CS involve the individual believing they are putrefying and/or have lost their blood and/or internal organs. In even rarer instances the condition may include delusions of immortality. Unsurprisingly, CS is often found in psychotic individuals with schizophrenia but has also presented itself following adverse reactions to the anti-viral drug acyclovir (typically used in the treatment of herpes simplex virus). Some research has also indicated that individuals with impaired renal function are also at a higher risk of displaying CS symptoms.

CS is named after the 19th century French neurologist Jules Cotard who first described the condition in 1880. Cotard named the disorder the ‘negation delerium’ (le délire de négation). The severity of the disorder can differ between individuals (i.e., mild to severe). The characteristics of CS include despair and self-loathing at one end through to intense delusions and chronic depression at the other. The original case described by Cotard was a female given the pseudonym ‘Mademoiselle X’. She eventually died of starvation (because she believed she didn’t need to eat and denied that some parts of her body even existed) and believed she was eternally damned.

According to Yamada and colleagues in a 1999 issue of Acta Psychiatrica Scandinavica, CS has three distinct stages (i.e., germination, blooming and chronic). The first (germination) stage comprises psychotic depression and hypochondria. The second (blooming) stage comprises the full development of the syndrome and the delusions of negation. In the final (chronic) stage comprises severe delusions and chronic depression, and leads to a completely distorted view of the world in which they live. They also become socially withdrawn, completely neglect their hygiene, and cannot make sense of reality. As far back as 1921, Tissot described two components of the syndrome - an affective component associated with anxiety and a cognitive component associated with the presence of delusion. Here are a couple of examples from the clinical literature.

• Example 1: In a 1996 book chapter, Dr. A.W. Young and Dr. K.M. Leafhead reported a case of CS in a Scottish man who suffered brain injury following a motorcycling accident. Following his discharge from hospital, he was taken to South Africa by his mother and became convinced that he had died of septicaemia or AIDS and had gone to hell.

• Example 2: A case study reported by Dr. D.N. Mendhekar and Dr. N. Gupta in a 2005 issue of the Indian Journal of Pediatrics described CS in a 14-year-old male epileptic. He had a history of depression, social withdrawal, talking about death, and disturbed biological function. His CS episodes occurred around twice a year (lasting 1-3 months each time). During each affected episode, the child believed that he and everyone around was dead.

Recently, Hans Debruyne and colleagues wrote an excellent review of CS in a 2011 issue of Mind and Brain, and wrote what they believed is a “classical description” of CS:

“In its early stages, Cotard’s syndrome is characterized by a vague feeling of anxiety, with a varying time span from weeks to years. This anxious state gradually augments and can result in nihilistic delusions where denial of life or denial of body parts are the prominent features. The patient loses sense of reality. Despite the delusion of being dead, these patients show an increased tendency to automutilation or suicidal behavior. Additional symptoms may include analgesia and mutism. The core symptoms always reflect a preoccupation with guilt, despair, and death”.

In the same 2011 review, the authors examined all the epidemiological studies and summarized the findings:

“The prevalence and incidence of this rare syndrome is not known. Only one study reported on prevalence in a selected psychogeriatric population in Hong Kong. In 2 out of 349 patients, Cotard’s syndrome was diagnosed suggesting a prevalence of 0.57% in this population. A prevalence of 3.2% was reached when severely depressed elderly were included. A recent study found 0.62% (n=3) of patients in a Mexican sample (screened over a 2-year period) of primary psychiatric patients having Cotard’s syndrome. Using the same methodology they found also 0.11% (n=1) having Cotard’s syndrome in a sample of neurological patients with mental disturbances”.

In a 1995 issue of Acta Psychiatrica Scandinavica, Dr. G.E Berios and Dr. R. Luque carried out a statistical analysis of 100 cases of CS. They reported no differences between men and women with CS, and age appeared to increase the likelihood of someone developing CS. In relation to affective disorders and mood state, the authors reported that CS sufferers experienced depression (89%), anxiety (65%) and guilt (63%). In relation to delusions, CS sufferers experienced hypochondriacal delusions (58%) and delusions of immortality (55%). The most common nihilistic delusions concerned the body (86%) and existence (69%). The authors also carried out exploratory factor analysis and reported that the factors appeared to suggest three types of CS (i.e., Psychotic Depression Type; Cotard Type I; and Cotard Type II) and that each type may need to be treated differently and have different therapeutic implications.

• The Psychotic Depression type includes individuals with melancholia and a few nihilistic delusions.

• The Cotard Type I includes individuals with no depression or other disease and comprises a “pure” CS whose nosology is closer to delusional disorders (rather than the affective disorders).

• The Cotard Type II includes individuals with anxiety, depression and auditory hallucinations and comprise a mixed group.

Neurologically, CS is thought to be related to the Capgras Syndrome (i.e., a disorder in which an individual has the delusion that someone close to them – partner, friend, or family member – has been replaced by an identical-looking imposter). Both syndromes are thought to originate from a disconnection between the areas of the brain that recognize faces and the areas that associate emotional content with such facial recognition. This can lead to feelings of derealization (i.e., an alteration in experience or perception of the external world so that it seems unreal). Brain scans show that those displaying CS often have lesions in the parietal lobe and greater brain atrophy than those in control groups. There are several reports of successful treatment in the psychiatric literature with ant-depressants, anti-psychotics, and various mood stabilizers. Therapeutic interventions such as electro-convulsive therapy have also been used to positive effect. In their 2011 review in Mind and Brain, Debruyne and colleagues concluded:

“Despite that Cotard’s syndrome was first described more than a century ago, literature on this topic remains restricted to case reports. Although the syndrome is rare, more larger scale research is needed to further clarify the pathophysiologic underpinnings of the disease and its relation to other delusions of misidentification such as Capgras syndrome”.

References and further reading

Berrios G.E. & Luque R. (1995) Cotard's delusion or syndrome? Comprehensive Psychiatry, 36, 218-223.

Berrios G.E. & Luque R. (1995) Cotard Syndrome: clinical analysis of 100 cases. Acta Psychiatrica Scandinavica, 91, 185-188. 

Berrios G.E. & Luque R. (1999) Cotard's 'On hypochondriacal delusions in a severe form of anxious melancholia'. History of Psychiatry, 10, 269-278.

Cohen, D. & Consoli, A. (2006). Production of supernatural beliefs during Cotard's syndrome, a rare psychotic depression. Behavioral and Brain Sciences, 29, 468-470.

Debruyne H, Portzky M, Peremans, K. & Audenaert K (2011). Cotard’s syndrome. Mind and Brain, 2, 67-72.

Debruyne H, Portzky M, Van den Eynde F. & Audenaert K (2009). Cotard’s syndrome: a review. Current Psychiatry Reports, 11, 197-202.

Mendhekar, D. N., & Gupta, N. (2005). Recurrent postictal depression with Cotard delusion. Indian Journal of Pediatrics, 72, 6, 529-31.

Pearn, J. & Gardner-Thorpe, C (2002). Jules Cotard (1840-1889) His life and the unique syndrome that bears his name. Neurology, 58,1400–3.

Tissot F. (1921). De lire des negations termine par guerison. Cosiderations sur l’hypochondrie et la melancholie. Ann Med Psychol, 79, 321-328.

Yamada, K., Katsuragi, S. & Fujii, I. (1999). A case study of Cotard’s syndrome: stages and diagnosis. Acta Psychiatrica Scandinavica, 100, 396-399. 

Young, A.W., Robertson, I.H., Hellawell, D.J., de, P.K.W., & Pentland, B. (1992). Cotard delusion after brain injury. Psychological Medicine, 22, 799-804.

Young, A.W. & Leafhead, K.M. (1996) Betwixt life and death: Case studies of the Cotard Delusion. In P.W. Halligan & J.C. Marshall. (Eds.), Method in Madness: Case studies in Cognitive Neuropsychiatry). Hove: Psychology Press.

What do we know about the psychological factors that are likely to determine how fearful or worried you become about the current Ebola outbreak? It is a topic that certainly commands a significant amount of news time, and it is – of course – an infectious disease that to date has no effective treatment. There are good reasons why people who are at high risk of contracting Ebola should be cautious, but why do so many other people who are at very low risk of developing Ebola also fear the disease– often to the point of this fear being debilitating and distressing? Here are a few psychological processes that we know can influence the level at which you might fear a potential threat such as Ebola – all of which may contribute individually to raising fear levels.

 1.         Evaluation of risk: There is no doubt that most people are very bad at objectively judging risk, and many people are prone to simply overestimate the risk of bad things happening – especially to themselves. This often happens in mental health problems such as obsessive-compulsive disorder (OCD), where sufferers develop complex rituals designed to neutralize what they see as a high risk of contamination (in compulsive washing) or a high risk of danger (in compulsive checking). A recent study in Ontario, Canada, found that 4 out of 10 respondents worried that an Ebola emergency on the other side of the world could soon pose a threat to themselves. So why do some people develop such exaggerated assessments of risk? One reason is that they tend to perceive situations as dangerous until proven safe, whereas many others of us will tend to see situations as safe until proven dangerous! Most people are agreed that currently the risk of being infected with Ebola outside of West Africa is very low.  But for someone who perceives situations as dangerous until proven safe, the sense of risk for them will be disproportionately high, causing anxiety and worry – a fear that may well persist until an effective treatment is found.

 2.         Disgust sensitivity: One thing we know about fear of contamination is that it can be driven by the individual’s level of what we call disgust sensitivity. Disgust is a food-rejection emotion that we’ve all experienced when we encounter things like vomit, feces, or mucus. The purpose of this emotion is to prevent the spread of disease and illness through the ingestion of products that may be vehicles for disease, such as feces and mucus. However, people differ in their sensitivity to disgusting stimuli. For example, we know that people with contamination fears tend to have high sensitivity to disgusting objects (i.e. they react more strongly to things like feces and mucus). One implication of this is that people with high disgust sensitivity levels will be more fearful of contamination, and as a result will be more fearful of the risks associated with Ebola.

 3.         Negative Mood: We know that experiencing negative moods, such as anxiety or depression, makes potential threats seem worse than they are, so if you’re someone currently experiencing chronic anxiety or depression then you will be more likely to view Ebola as a threat. This is because negative moods significantly affect the way you process information. They cause you to unconsciously attend to threatening things, selectively retrieve negative or threatening information from memory, and interpret potentially ambiguous events as threatening rather than benign. In the context of Ebola, negative moods are likely to tip the individual to selectively attending to threatening information about Ebola, retrieving negative information about Ebola, and interpreting information about Ebola as personally threatening. All of this is grist to the mill of Ebola fear.

 4.         The Invisible Enemy: The problem with germs or viruses is that you can’t see them with the naked eye, so it’s very difficult to estimate how much of a threat a particular situation might pose (such as travelling in on airplane or even working as a health care worker in an isolation ward). This is particularly challenging for people who consider situations dangerous until proven safe, because how would you ever know you were safe if you can’t see the virus? This is a dilemma for many people who suffer debilitating OCD contamination fears, and is a factor that often makes the problem difficult to treat and recover from. Of course, a similar logic can also be applied to fear of Ebola.

 5.         Negative News: I’ve already written before in this blog about the psychological effects of negative news, and certainly one factor that will undoubtedly fuel Ebola fears is the constant exposure to news bulletins about the disease. It’s not so much the mere exposure to news about Ebola that might fuel fear, but the degree to which individual bulletins highlight the fears and risks surrounding Ebola, and in particular how those bulletins try to convey these fears and risks in an overly emotional way. Because Ebola is becoming a long running news story, the media often need to create more and more sensational approaches to convey this story in order to maintain long term public interest in it – this creates emotional reactions in the viewer or listener which are likely to bias the individual towards viewing Ebola as a threat, and so begin to evoke fear and worry.

 These are just some of the psychological processes that will influence fear of Ebola, and there are, of course, many others. But it is interesting that, as a threat to public health, the current Ebola outbreak possesses many of the features that are likely to bring these psychological factors into play – it is a disease, and so will interact with existing disgust sensitivities; it is an ‘invisible enemy’ which makes proving that you are safe very difficult; and it is associated with regular news broadcasts with ever-increasing emotional content.

Note:  This post was written by Steven Jackson.

Not long ago, on an ordinary school day in Japan, a team of researchers crammed themselves into a first-grade classroom. They passed out art supplies to the students, along with some simple instructions: Draw a landscape, including at least a house, a tree, a person, and a horizon. The children had 30 minutes to complete their drawings.

Meanwhile, on the other side of the world, the same scene played out in a Canadian classroom. The teacher halted the lesson and the children dutifully set to work on their landscapes. Exactly 30 minutes later, the researchers gathered the artwork and left. After the classroom visit, they analyzed the drawings with an eye for one detail: Where was the horizon line? They repeated the artwork assignment for students in grades 2 through 6, always carefully measuring the placement of the horizon on the page.

These scientists were not the first to be fascinated by horizon lines. Several years ago, a team of cross-cultural psychologists, led by Takahiko Masuda, analyzed hundreds of paintings from East Asian and Western cultures between 1500 and 1900. They found that, in landscape art, East Asian paintings consistently had higher horizons.[1]

Why do psychologists care about horizon lines in art? To answer that question, we need some context.

Research over the last two decades has revealed systematic cultural differences in cognitive processes across cultures—and some of the most striking differences are between adults from Western and East Asian cultures. Westerners tend to think more analytically, while East Asians think more holistically. Analytic thinking is marked by logical reasoning, a belief that individuals and their attributes are the primary cause of events in the world, and a focus on objects in the foreground of a visual scene. Holistic thinking, on the other hand, is characterized by dialectical reasoning, a belief that events are caused by external forces beyond the control of individuals, and a focus on the background elements of a visual scene.

This is where art comes in. The placement of the horizon in a piece of art tells us a lot about the culture in which that art was made. If the horizon is high on the page, the field of information is deep, and there’s ample room for contextual details in the frame. This kind of visual layout reflects a holistic cognitive style, which is more common in East Asian cultures. If the horizon is low on the page, there’s less background space in the frame, and more of the page is taken up by one or two objects in the foreground. This kind of visual layout reflects the analytic style that is more common among Westerners.

When the same researchers who analyzed all those classic paintings asked adults to draw landscapes, they found that East Asians tended to draw their horizon lines higher than Westerners—about 19% higher, to be precise.

But there’s a problem here: Most of the cross-cultural research on cognitive style has used young adults as subjects. As a result, we don’t really know how early in the lifespan these differences emerge. That’s why the researchers were collecting art from grade-schoolers in Japan and Canada. They wanted to know if these cognitive styles are learned later in life, or if they are present from a very young age.

When they analyzed the children’s artwork, they got their answer. Starting in the second grade, Canadian children drew their horizon lines significantly lower than Japanese children did. (First-graders in both countries didn’t understand the concept of the horizon at all; their lines were all over the place.) To ensure that drawing ability did not influence the results, the researchers conducted a second study in which the kids used pre-made collage items to create a landscape.

In both the drawing and the collage tasks, the results were the same. Once children understand what a horizon is and how it relates to perspective, they begin to make art that is consistent with their culture: Japanese kids make art that is more context-rich, while Canadian kids make art that is more focused on singular objects in the foreground.

These studies remind us that works of art are more than just pretty pictures. They’re cultural products that reveal diverse ways of thinking and moving through the world.

Sources:

Masuda, T., Gonzales, R., Kwan, L., & Nisbett, R.E. (2008). Culture and aesthetic preference: Comparing the attention to context of East Asians and Americans. Personality and Social Psychology Bulletin, 34(9), 1260-1275.

Senzaki, S., Masuda, T., & Nand, K. (2014). Holistic versus analytic expressions in artworks: Cross-cultural differences and similarities in drawings and collages by Canadian and Japanese school-age children. Journal of Cross-Cultural Psychology,45(8), 1297-1316.

[1] By “East Asian,” cross-cultural psychologists usually mean Japan, China, and Korea. “Western” usually means the United States, Canada, and the United Kingdom.

An Empathy Gap?

In my last post, I discussed research on the social isolation that wealth creates, and what this means in particular for the children of the wealthy.

A growing body of research indicates that the wealthy have more difficulty reading other people's emotions and difficulty understanding the fears, hopes, and problems of people different from them. After all, when you find that money and power can leverage problems, it is less important that you understand where other people are coming from or how to read social cues. This becomes a problem for us all, then. The power and influence that the wealthy wield in this society is not tempered by an understanding of the difficulties that the rest of the society face.

Yet children from affluent families face complicated pressures that can distort their sense of self, particularly in the schools. One independent school teacher observed that, “I hate to lump the wealthy kids I teach together, but many of them struggle with a few core dynamics.” This teacher pointed out that many children from wealthy families feel their life is already defined: they face pressure to achieve the same level and kind of success that their (often) high-power, highly successful parents found in school-- to get into the same “prestigious” colleges, etc.-- and they are burdened, too early, with a resume-building focus on the things they do. Secondly, many of them struggle to find happiness because “a lot of the little wins - such as buying a first car - are taken from them.” An example: “one kid I work with recently admitted that his parents’ personal assistant actually wrote his senior thesis and college admission essay...”

Can We Empathize with the Wealthy?

It’s tempting to roll our eyes when we think about the emotional problems of the wealthy. First World problems, we may scoff. Yet to do so is to ignore a real social challenge.

We live in a time of an increasing divide between the very wealthy and the rest of us. The opportunities for envy and projection increase as the divide does. As one psychiatrist observes: " For most of us, empathy directed toward the less fortunate comes easily. But ultimately empathy must transcend economic class. If we cannot approach the wealthy with empathy about their situation and unique problems, we cannot engage them in constructive conversation about this divide. Their isolation and exclusion from the dialogue will only add to polarization and hostility." [i]

How do we encourage empathy and a curiosity about the world in the children of the wealthy? This coming school year (2015) looks to be the first year in which the public school population of this country will have a majority non-white composition. How do we prepare the children of the wealthy to deal with the changing demographics of this country? After all, we are all unprepared for the changes of adulthood and the changes we face socially in this country. The children of the wealthy need the same experience of being heard and listened to, to feel and understand the importance of being heard and listened to, as anyone else.

How Teachers Can Make A Difference

While there needs be many levels of response, from social policy to individual interactions, I want to focus on the important micro-, everyday level—in particular, on the difference that teachers can make in the emotional development of their students, wealthy and not.

So much of our attention is focused on the teaching of cognitive skills in contemporary education that we can forget that good teaching is actually founded on a caring relationship with students. Research shows over and over that teachers who make a difference are good at instruction and also are able to form a strong relationship with their students. We need both in teachers: instructional skills and relational skills. [ii]Good teaching fosters emotional development, helping students understand how the social world works and what it means to be a human being.

The teachers of the wealthy are key players in this drama of social change, with opportunities taking place in classrooms every day. What do these moments look like?

First, it’s important for teachers to recognize that kids who look like they “have everything” may not in fact have what they most need to succeed in life. Don’t assume a kid is “doing fine” just because s/he seems to be highly achieving. Be attentive to moments of challenge, even failure, in student’s lives and take a moment to be curious with them about how they are doing, what they are feeling, whether they want to talk about what it means to be themselves.

A colleague who works with children of wealth described the time an eleventh grader sat in her office in tears because her parents had just sold one of her four horses. She only had three left and she was hurt and angry. Her parents’ had broken a promise—that if she showed she could take care of her horses, they would allow her to explore her passion for riding She had done so, keeping her part of the bargain while they’d not kept theirs. And she was sad: she missed the horse. My friend struggled with her judgment of this child’s entitlement and impulse to dismiss the girl’s feelings (how many horses are enough?)However she was able to realize that the girl was talking about a deeper struggle: that parents make promises and don’t keep them. That we lose things in life that we love very much. My friend could see that the girl felt betrayed and hurt by her parents—something a child might feel regardless of the income level of their parents. The issue was how to help the girl deal with her feelings of loss and injury—that her voice counts too, and that her hurt is worth hearing about and attending to.

Ironically, children of the wealthy may have little experience in feeling listened to and heard by an adult. If their futures are pre-planned, if everyone around them is busy, who actually is listening? Teachers have the opportunity to create conversations that provide an opportunity—sometimes for the first time—for such students to experience their own perspective, their own feelings, their own sense of choice and self-hood. So, for example, consider the teacher whose student told him that his parent’s personal assistant wrote his college application essay. The teacher told me that “at first I was tempted to respond by offering to broker a conversation between the student and the parents, or to reach out to the parents directly.” That’s not what he did though. Instead, he began a conversation with the student that focused on how the student felt about what happened and why it happened. “We discussed what might be motivating his parents to handle things that way. The student ultimately commented that he felt like the outcomes of his life was way more important to his parents than how those outcomes were reached, that he wasn’t allowed to fail, ever, because his parents would always step in and fix things if he got in a pinch! I got a strong sense that the student felt like he was just floating downstream, waiting to hit some moment in his life when he started ACTUALLY living. So, we chatted about what he could do here. One thing the student proposed was to be more proactive, to write the essays, apply, etc., before his parents had a chance to step in.”

In other words, the teacher was listening to the student, raising the important question of the student’s own perspective on what happened and what—if anything-- the student wanted to do about it. The teacher didn’t become the proactive “fixer,” taking away from the student the possibility of developing his own sense of choice and responsibility. (Which would have replicated the parents’ behavior.) Instead, the teacher served as the trustworthy listener who took seriously the dilemma of the student’s life and was truly interested in helping the student develop a response that felt rooted in his own feelings and experience.

And perhaps, in helping a child of privilege understand their own emotional life, and to begin to understand how relationships heal, such lessons will extend to their understanding of all people, regardless of their material wealth.

Schools need to do this for all students, of course, and in an upcoming post I’ll talk about what the role of teachers and schools is in truly “educating” students, regardless of income level of their families.

Dr. Sam Osherson is author of The Stethoscope Cure, a novel about psychotherapy and the Vietnam war. He is a Professor of Psychology at the Fielding Graduate University.

[i] Stangler, R., Comment, “Dialogue With The Wealthy,” NY Times, Feb, 24, 2014

[ii] http://www.apa.org/education/k12/relationships.aspx

An embalmer was taking a body into what he believed was an empty building. He wheeled the corpse through one room, and since there was sufficient light to see, he decided not to bother with the light switch. Then he noticed movement at the far end of the room so he stopped and peered down that way. It looked like someone was watching him – possibly two or three people.

Walking back to the light switch, he flicked it on and caught a glimpse of someone disappearing into the next room. That was the viewing room. No one was supposed to be in there at this time of night. Thinking it might be kids who’d somehow gotten into the locked building, he went to investigate. No one was there. He checked the only other door into the room and found it locked. Now he was really mystified. He knew he'd seen someone come in here, yet he couldn't find anyone. 

He went ahead and finished his task. After checking again to ensure the building was empty, he locked up. The next day he mentioned his strange experience to someone who worked there and she turned pale. "I've seen them, too," she whispered. "They just watch me and then they're gone."

The person who told me this story did so with a measure of reluctance. "I don't believe in ghosts, but..."  He wanted to assure me that he was a levelheaded man with no interest in the supernatural. But this had happened, he insisted. And he wanted to know what I thought. He didn’t believe, but then again….

I hear this phrase all the time. Whenever I travel, I ask about ghost stories. I like to collect different types of tales, especially from other countries. Even my own neck of the woods offers distinct tales from the Moravian time period unlike any I’ve heard elsewhere.

For example, in Bethlehem Ghosts, I included der Ausleger, the phantom undertaker who'd enter people’s homes or yards to drink the water they’d used to wash down the body of a deceased relative. (They were so disgusted by this spooky thing’s behavior that the entire community took up the ritual of tossing all death water into the cemetery. He could go drink it there!)

As I collect these tales, I’m always amused how often people qualify their experience of what they're pretty sure was a ghost with the phrase, “I don’t believe in ghosts, but…” They then proceed to tell the tale that indicates they clearly do believe in their experience and their interpretation of it.

In fact, there are sufficient numbers of these tales framed within the assurance of rational normalcy that I could use this title for a reality TV show. Maybe I should propose it!

Often, those who insist, “I don’t believe in ghosts, but…” are either living in the place where they experienced the alleged entity or they’re employed there. Thus, I can understand the qualifier. In the former instance, they want to reassure themselves. It's just a buffer between them and their own anxiety. In the latter, they want to ensure their future employment.

And there certainly are those people who are just embarrassed that such a thing has happened to them!

I’m most interested in those who tell me about experiences in a place they've visited, and they have no psychological investment in it one way or the other. Yet, they still want to tell it ... within the framework, of course, that they are “normal” individuals.

Partly for this reason, I go to Gettysburg during the Halloween season to sign books like Haunted Crime Scenes and Blood and Ghosts. As my co-author Mark Nesbitt and I sit at the table, people come in to tell us what they experienced in town or on the battlefield. (That’s how Mark has managed to write so many Ghosts of Gettysburg books!)

Quite often, they will first state, “I don’t believe in ghosts, but….”  We just nod, smile, and listen.

There is “No Thank you” and then there is “I said No!” How you say no to someone will certainly be determined by the situation and the person hearing it. In refusing a second helping of some less than delicious food a simple “No thank you” delivered with a smile is sufficient. If some goon is bothering you at a bar a far more forceful statement, certainly without the smile, is what’s called for.

There are many other circumstances in between where you want to let whomever is petitioning you know that you are refusing but you don’t want to insult him or her, neither do you want to be coaxed into giving in out of exasperation.

A criticism I have heard many times, particularly of women, is that the person refusing doesn’t sound like she means it. She’s smiling in a way that appears flirtatious or her inflection sounds more like a question than a declaration. (If you’re familiar with California “upspeak” you know what I mean.) That sounds like the person speaking is unsure of her or his position and seems to beg the asker to just try harder and the request will be granted. The last thing you want is to encourage is pestering.

So let us assume that you are saying no to someone who wants something from you – anything from a date to asking you to serve on a committee, a donation to a cause, or an invitation to an event you want to miss. The people asking have got to hear that no means no and not maybe but you don’t necessarily want them to go away angry at you for refusing. Disappointment can’t be helped. Everybody wants what they want. The situation here is that something is wanted from you and you are not willing to give it. So, some tips on refusing without seeming like an ogre:

1. Say what you have to say with a pleasant expression on your face. If you can summon “rueful” all the better. If you are being asked over the phone try to put that rueful expression into your voice.

2. If appropriate to you and the person asking, a friendly touch like a hand on the arm will soften the rejection. If you are not a person who is used to touching others casually this might be a good time for you to try it out. It really does make hearing “no” easier.

3. Offer no excuses or explanations. “I’m so sorry but I can’t” is all that’s necessary. If the other person is rude enough to persist or ask for reasons, just repeat what you said.

4. If you don’t want to be asked again in the future stifle the urge to add “Not just now” or “Perhaps some other time.”

5. Wishing the other person well, which also softens a refusal, is nice to do. “I hope you find someone to take over that job” or “Have a lovely event” or some such is gracious without in any way backing off your refusal.

Being able to say no is a learnable skill. It gets easier the more you practice it and it is one of the most useful skills a person can acquire. Now, aren’t you eager for the opportunity to use it?

The tall, fit military officer wearing a crisp formal uniform with shining insignias atop his shoulders and an array of colorful ribbons on his chest walks into a room when another person calls out “Attention!” Everyone immediately stops what they’re doing and stands erect. How would it feel to experience that kind of behavior from others? Even if they didn’t like you, they’d have to stand and respect your authority.

A number of studies show that people treat people differently based on certain external trappings—skin color, clothing, height, neighborhood, type of car driven, wealth, social acceptance of others (popularity), and other external components like job status and rank. Perhaps that is why so many people, especially in the U.S. culture, seek out public displays of materialism (aka conspicuous consumption). They want power and respect. Gang members take it one step further and arm themselves with excessive weaponry in order to secure social standing and earn respect.

This post, however, is not about any of these material trappings. It’s about the inside—adjusting the ‘core self’ so that respect from others becomes automatic and genuine based on who you are and not what you have or look like.

Another famous word for ‘core self’ that gets some confusion is ego. The Greek word for ego actually means “I” and simply refers to a person’s core self. Freud added the concepts of id and superego to address the continuum extremes on each side of the ego that act like a child (id) or a highly functioning parent (superego). Many people think the ego is a bad thing and refer to dysfunctional behaviors as the ego. Many Spiritual teachers discuss rising above the ego. Perhaps what they are really trying to articulate in psychological terminology is to rise above the detriments brought on from a weak ego and to actually cultivate a healthy ego.

Lack of respect resides in a weak ego. This is because people with weak egos often compensate with major ego defenses (denial, distortion, compensation, projection, rationalization, acting out, etc.). They also tend to confront more ego defensive behaviors from others, so it becomes a vicious feedback loop of defensive behaviors.

Weak ego-strength often stems from unmet infant and childhood needs, some form of trauma, abuse or abandonment, and other interruptions to the normal lifespan development stages.

Let’s take a look at some common consequences of weak ego-strength:

• Living defensively tends to put people in a fight/flight/freeze mode and the brain cannot learn new things or emotionally reflect in this physiological aroused state

• Difficulty concentrating

• Solutions to problems seem insurmountable, so escape becomes the only solution (either through addiction, dissociation, etc.)

• Thinking becomes all or nothing as it is mired in fear and anxiety

• Fear of others becomes heightened

• Demands for respect and desires of grandiosity increase

• Feelings of worthlessness, futility and hopelessness take over

• Expectations become unrealistic

The reaction to these behaviors is often to smash the ego, yet the ego is already smashed. It’s like a fish flopping on the beach that needs healing and to be gently placed back into the ocean. Thus, any self-flagellation only serves to increase the ego-defenses. Healing happens when the ego (self) can be seen and heard. When feelings can flow. When self-care can occur. When self-acceptance can be achieved. When self-love becomes the norm.

Here’s what a healthy ego looks like:

• Resilient

• Loving and empathetic

• Doesn’t take things personally

• Can see their part and contributions to problems

• Genuine joy with self (radical self-acceptance)

• Creative

• Open to new ideas and solutions; always learning

• Can fully listen to others while also being able to communicate

• Differentiates needs from wants

• Pursues goals while easily delaying gratification

• Communicates clearly (not passively or aggressively)

• Can confront conflict with patience and understanding of other point of views in order to repair

• Has an inner sense of personal power and autonomy

If your ego could use some healing and repair, start by finding and talking to someone safe where you can be safe to be the vulnerable you. Give birth to your core self and try to recognize when you are telling yourself to be different in order to fit in. Journal. Feel your feelings. Love yourself. If you have a host of troubled memories, don’t stuff them. Write about them. Paint your feelings. Honor your tears instead of trying to hide them (some cultures have little tear jars to collect the tears of grief as a way to heal and honor the loss). Love yourself one day at a time. The more you feel, the more you heal…and the more you become your real self. The healthy you. The one—that paradoxically—will earn more genuine respect from others. (Yet you won’t care then because you won’t be focused on what others think; you’ll just be happy being you. The same thing applies to love. Once you stop looking for it and start truly loving yourself, a healthy and respectful loving relationship will emerge.)

Dear Dr. G.

The time that I've dreaded has just arrived. My 12 year old daughter has asked me when she can start dating. I wasn't allowed to date until I was 18 because I had very strict parents. I didn't sneak around and date either because I didn't want to get into trouble with my parents. Let's just say that I was sort of a goody two shoes and didn't want to upset my parents.

Fast forward to 2014. I am now a mother of a 12 year old daughter and a 10 year old son. Last week the 12 year old asked when she can start dating. I was shocked that she would even think about the concept of dating at such a young age. My husband and I have been discussing the answer to our daughter's question and we just don't know the right answer. I don't want to be overly protective and strict like my parents were but I also don't want to be too permissive. By the way, my husband was a late bloomer and started dating at 19.

Please help.

A Confused Mother

Dear Mother,

I completely understand why you are confused. First, the definition of dating is different these days than it was when you and your husband were younger. In the past, a young man, usually a teenage boy, would come to a teenage girl's house and take her on an actual date which might include something like a movie AND a curfew. The definition of dating has changed these days. Middle schoolers sometimes say they are dating when actually all they are doing is texting or even communicating via Facebook or in some other electronic manner. Teens in high school may define dating as being exclusive with each other physically which means that they don't "hook-up" with anyone else. Yet other teens do go on dates with each other that are somewhat more formal where one member of the couple picks up the other one in a car for an afternoon or evening together that has been pre-planned.

The first order of business with your kids should be to ask them to define what they mean by dating. If they are referring to actually spending time alone with their date then I have to say that around the age of 16 seems to be the magic number. And, you must make it clear what your rules and expectations are other than age. You and your husband need to address the following:

1. Curfews

2. Issues Around Sexuality

3. Whether or Not They Are Permitted to Drive With The Date

4. Making Good Choices

5. Use of Alcohol & Drugs on Dates

6. Not Forgetting to Maintain Friendships While Dating

AND

7. Keeping You Informed About Their Whereabouts & Changes in Plans

Having said all of the above I must tell you that I think that dating serves a very important purpose. Teens learn to negotiate their feelings and relationships while they are still young and under your roof. As we all know, relationships and healthy dating take a lot of practice and trial and error. Make sure to act interested but not too interested in your teen's dating life with the hope that they will open up to you if they run into difficulties. Good luck with this tricky but important issue.

Dr. G.

See my website for more articles like this:

http://drbarbaragreenberg.com/

Get it in writing! ~ The book of trust

Suppose you are applying for a job and the company offers you 100k with a certain probability that they will add a bonus of 10k. You consider the 100k offer low and the 110k offer acceptable. Following the 11th commandment in the Book of Trust, you try to get the high offer in writing. The company balks. They point out that they just don’t know yet if they have the necessary funds, but they are rather ‘confident’ that they will. They want you to sign, committing yourself to accepting the low offer without making a commitment on their part to deliver the promised, if probabilistic, bonus. You realize that that once you sign, you have played all your cards, and the company is free to claim the extra 10k that are now lying on the table.

Game theory can help to make sense of this situation. Let us boil down the available strategy space to 2 per player. The company (the buyer) has a choice between making a low offer and making a high offer. You (the seller) have a choice between accepting an offer and rejecting it. Suppose – for simplicity – that you and the company select your strategies in private and at the same time. There are 4 possible results, and they are valued differently by the company and by you. The matrix shows these preferences: higher number mean greater value, and the numbers to the left of the comma within each cell refer to the valuation by the row player (the buyer), while the numbers to the right refer to the valuation by the column player (you).

The buyer would be happiest with making a low offer and having it accepted (4). The worst scenario is to make a high offer and have it rejected (1). In between, there is the possibility of having a high offer accepted (3) and a low offer rejected (2). I am assuming here that the latter is more aversive to the buyer, and this turns out to be critical (as we will see). You, the seller, would be happiest with receiving a high offer and accepting it (4) and saddest with accepting a low offer (1). In between, there is your choice to decline an offer, and I am assuming that it is more aversive to reject a high offer (1) than it is to reject a low offer (2) – because the former opens you up for regret. The ranking of these last two outcomes does not matter for the present argument.

To review, the buyer’s primary interest is to get you to accept an offer ([4 + 3] > [2 + 1]), and his secondary interest is to make a low offer. Making a low offer is a dominating strategy. Whatever you do, the company is better off making a low offer (4 > 3 if you accept and 2 > 1 if you reject). You can, in other words, expect them to make a low offer. Your primary interest is to receive a high offer ([4 + 2] > [3 + 1]). Your secondary interest is to match the buyer’s move. If he makes a high offer, you accept (3,4); if he makes a low offer, you decline (2,3).

We already know that the buyer will make a low offer and that you will reject it. The outcome, 2 for him and 3 for you, is an equilibrium state. Neither you nor the buyer can improve your outcome by unilaterally switching strategy. This is too bad, and it is worse for the buyer, who receives the second most aversive outcome, than for you, who receives the second best. And herein lies your chance.

Unless the buyer is myopic, he will realize that a unilateral switch to a high offer will be met by you with acceptance. The game will not end in the high offer/reject cell [1,2] unless you are spiteful. The final outcome is the second best for the seller (3) and the best for you (4), which means an improvement for each of you over the earlier equilibrium state of low offer/rejection (2,3). Alas, the new state of high offer/acceptance (3,4) is not an equilibrium. The buyer now has an incentive to renege and switch back to a low offer (“Oh, we couldn't find the funds to pay for the bonus after all”). This is where a stopping rule would help. Once an agreement is reached that has improved the outcomes of both parties, no further switching ought to be allowed. Unless the buyer is myopic, though, no formal stopping rule may be necessary. A seller who considers switching from high to low should be able to foresee that you will counter with rejection, turning 4,1 into 2,3. Once there, the buyer has lost credibility that any further switching will stop at 3,4.

Now return to the assumption that the buyer would rather make a high offer and get a deal (3) than having a low offer rejected (2) and reverse it. Again, the game would begin with the equilibrium of low offer/rejection (3,3), but there would be no incentive for the buyer to switch to the higher offer. A switch could only turn 3,3 into 2,4. There would only a redistribution in your favor at the buyer’s cost. He could not want that.

At this point, you might ask whether there is any way of knowing whether the original assumption holds (that the buyer would rather see a high offer accepted than a low offer rejected) or whether the reverse is true. If there was no way to tell which assumption holds, your efforts at negotiation would be grounded in nothing. Let us not be so pessimistic. I think the assumption that the buyer prefers a high offer accepted over a low offer declined is justified on the following grounds. First, the buyer already signaled the possibility of a high offer. This could be a bad-faith tactic, however, and it is therefore not sufficient. Second, if we assumed that the buyer prefers a rejected low offer over an accepted high offer, we would be saying that the buyer has only one overriding interest: to make a low offer (4 > 2 and 3 > 1). This buyer would have no secondary interest in getting you to accept an offer (4 + 1 = 3 + 2). In other words, a buyer with this set of preferences would not really be negotiating at all, and his initial signal that there probably will be a high offer after you accepted the low one could only be considered sent in bad faith. Whatever the case may be, whether the buyer – as originally assumed – prefers an accepted high offer over a rejected low one or not does not affect your outcome at equilibrium. Rejecting a low offer is still the second best outcome for you. The rest is a game played inside the buyer’s mind.

Yelling at your kids just makes you a “poster adult” for temper tantrums. Doing this unfortunately also gives your kids the message that you are not in control. Defiant children and teens especially already believe that they are equal or above adults in authority. The last thing you want to do is fuel this perception. It is also crucial to understand that kids feel unsafe when they perceive that their parents shave no control.

In my book, 10 Days to a Less Defiant Child, I describe this messy, coercive cycle: When you yell your children will likely either yell back or act out in some other negative way. As a result, you yell more. Then, they yell louder or act out further. Fighting just ensues and nothing gets resolved. Yelling is obviously counter-productive and can easily become a downward spiral.

Bearing this in mind, so many parents still continue to yell. Many parents end up in my office expressing that they feel frustrated and upset after they yell. They also share feelings of guilt over the way they handled challenging situations. They say they will work harder not to yell, but they realize that working harder is not the same as working smarter. Fortunately, there is a way out of this messy, emotionally laden power struggle:

Keep the following in mind to work smarter at yelling less:

Tune in to the situation - Reflect about what is causing you to yell at your kids in the first place. Is it fighting? Are they leaving their toys all over the house? What is stressing you out? Identify it and evaluate what can be done to make the situation less stressful.

Promise yourself to stop yelling - I know the idea of making a promise to yourself to stop yelling may sound overly simple and possibly fruitless. If, however, you really commit to staying mindful of your goal to not yell, you will more likely succeed. Changing behaviors all begins with making yourself accountable with firm, positive intentions.

Speak quietly - It may sound outrageously counter-intutive, but when you get upset, speak quietly. By speaking in calm tones, children have no choice but to stop and pay close attention to what you're saying. You remain calm, the child remains calm, and everyone learns how to listen to one another.

Manage your expectations - If you don't want to yell, make it easier not to do so. Working smarter really does go a lot further than just trying harder. So if you're always yelling at the kids to put their toys away, put a limit on how many they can have out. Make it easier to not yell and you'll reduce the amount you do.

Don’t take it all so personally - If you stop and think about it, most of the time you yell at your child, it’s because you are taking her behaviors too personally. Realize that your child, even if trying to provoke you, is really behaving in this manner because of her own struggles, not yours. Remembering this will help you not get so frustrated and your risk of yelling will be much lower.

Take a time out - When all else fails, do what you can to walk away from an exasperating situation. In the case of overheating emotions, it makes sense to go slower versus faster. When your kids are driving you nuts and you feel you're about to lose it, step outside, phone the babysitter, or just even take some deep breaths.

Stop comparing and be grateful - Comparing yourself to other parents or your child to others just puts you on the expressway to misery. Keep an attitude of gratitude and you will feel more content and have more self-control. Remember that there are many parents out there with children who are not as heathy or as fortunate as yours and would love to trade places with you--without any yelling or protest. 

Dr. Jeffrey Bernstein is a psychologist, personal and executive coach, and motivational speaker in the greater Philadelphia area. He has been on the Today Show, National Public Radio, and has written four popular books, including 10 Days to a Less Defiant Child and Liking The Child You Love.

You can also follow Dr. Jeff on Twitter.