Category Archives: Family Dynamics

Coaching Toward Better Family Relationships

Posted on March 5, 2015 by mixomocha

This week’s offering is a guest post by Ronald B Cohen, MD, a Psychiatrist and Marriage and Family Therapist from Great Neck, NY. Dr. Cohen is a Fellow of the American Psychiatric Association and an Affiliate Member of the American Academy of Marital and Family Therapy.

In 2001, Betty Carter & Monica McGoldrick two of the most-respected authors, teachers, and clinicians in the field of family therapy, published Advances in Coaching: Family Therapy with One Person, detailing 25 years of research into the theory and techniques of “coaching” individuals to change themselves in the context of their family of origin. The technical term “coaching” refers to preparing and acting for change in the individual’s natural system of relationships.

In contradistinction to traditional individual therapy, coaching focuses on real world behavior with significant others rather than the in-session therapeutic relationship. It is not the interaction with the therapist but rather the individual’s relationships with their family of origin that is of utmost value. Although this approach is regarded as one of the major modes of intervention in family therapy, the actual methods and techniques are not widely understood nor often implemented effectively. Techniques for helping individuals deal with difficult family relationships are not widely known by most individual therapists.

The goal of coaching is to help individuals proactively define themselves in relationship to others in their families without emotionally cutting off or giving in. The process of change is built upon ownership of one’s emotional reactions to old triggers and interactions. Coaching, or family therapy with one person, offers individuals a process for making change in their relationships even without the participation of other family members.

As a therapeutic coach, I help people plan and strategize. I begin by training individuals to become observers and researchers of their role in their family‘s patterns of behavior, what the anthropologists refer to as being a “participant observer”. The information and interactions are then reviewed and we talk about what kind of responses they got, what worked and what didn’t, and where they got stuck. Then we plan what they might do different next time in order to get a response that is more in line with what they are looking for.

The process then moves to helping individuals bring their behavior more in line with their deepest beliefs, even if this means upsetting family members by disobeying family “rules.” An important part of the coaching process is to help people develop realistic expectations when moving toward changing their part in the family dance. This includes being prepared to respond productively even if unfortunately the other person reacts unfavorably.

Coaching teaches the possibility of dealing with differences without losing connection, which is one of the primary developmental tasks for a young adult. If you are tied up with all of the stuff and rules and roles of your family of origin, it is really hard to figure out who you are and what you want to do with your life.

Coaching is “differentiation in action,” guiding people through a process of changing their own participation in unsatisfying family relationship patterns. It is a conscientiously thought through approach to establishing a unique one-to-one relationship with every individual in the family system.

This post was written by Ronald B Cohen, MD, a Psychiatrist and Marriage and Family Therapist from Great Neck, NY. Dr. Cohen is a Fellow of the American Psychiatric Association and an Affiliate Member of the American Academy of Marital and Family Therapy. As a consultant specialist, Dr. Cohen provides clinical supervision, and confers with individual therapists and other health care professionals and organizations to help them consider how adding family therapy sessions to the treatment program is both restorative and proactive as improvement is long lasting.

Dr. Ronald B. Cohen graduated summa cum laude, from Brandeis University and The Albert Einstein College of Medicine. In addition to his psychiatric residency training, Dr. Cohen was educated at the Psychiatric Epidemiology Program of the Columbia University Joseph L. Mailman School of Public Health. Subsequently Dr. Cohen completed the four-year core postgraduate training program in Family Systems Theory and Therapy at The Family Institute of Westchester

Please feel free to comment, request more information and/or schedule an initial consultation contact Dr Cohen at: http://www.familyfocusedsolutions.com/contact/

Or email him at:

RBCohenMD@FamilyFocusedSolutions.com

 

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Performance Addiction: If I do this, then will I finally be happy?

Posted on February 12, 2015 by Melissa Killeen
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Melissa Killeen

Performance Addiction

As a recovery coach it is hard to surprise me with an addiction of which I am not familiar. Yet, I had never heard of Performance Addiction. Well as Gandhi said “it is healthy to be reminded that the strongest might weaken and the wisest might err.”

I was introduced to the concept by Dr Arthur Ciaramicoli, professor at the Harvard Medical School in Cambridge Massachusetts and author of Performance Addiction: The Dangerous New Syndrome and How to Stop it from Ruining Your Life. His book describes in depth  the compulsive ride the over achiever, or the type “A” personality experiences. It is the rollercoaster many of my clients are riding.

Dr Ciaramicoli explains, in a big way, how perfectionism comes into play in performance addiction. Psychologist Robert Stanley and his graduate assistant, Doug Johnson, developed an Almost Perfect Scale to measure the components of perfectionism. Stanley reports that setting standards for perfect performance is desired, reasonable, and after all, is basic to the pursuit of happiness and the American dream. However, Stanley’s work suggests it is our perception of perfectionism that can run amok. The elusive desire to appropriately pursue high standards is adaptive, meaning it is considered healthy perfectionism and is present in many of us. What performance addiction is all about is the pursuit of high standards in order to hide our imperfections or inferiority, which is considered maladaptive perfectionism, or a rather unhealthy pursuit. With performance addiction, when you don’t reach your goal, what happens? You believe you are inferior and that belief turns into a whole bunch of disapproving thoughts, depression, negative self-esteem and unhappiness.

Return to the scene of the crime.

Dr Ciaramicoli invites his readers to return to the “scene of the crime” or where was this performance seed was planted? Where does this belief that if you try harder you will be rewarded by love and happiness begin? The seed is usually found in our families, experiences in our youth, and our schooling.

How many of us grew up in a household where our performance was compared to our worthiness? Did your parents elevate you by bragging to neighbors or by giving you money if you got all A’s on your report card? Did they negate you if you did not make a goal at the soccer game, or get nominated to the honor society? Were they hypercritical of every move you made? The seeds of maladaptive perfectionism were often sown in the home. Some of us marry into it. When two people who grew up in highly perfectionistic households marry, the two play out their maladaptive perfectionism to such a high degree that the level of evaluation and pinnacles of judgment can cause nose bleeds. Yes, things get done, professions may flourish but there is little intimacy, enjoyment or meaningful spontaneity in their lives.

If I do this, then will I finally be happy?

Growing up and doing better than your parents was basically a depression era mind set. Yet today, three out of four kids go to college “to make more money.” A study by UCLA and the American Council on Education completed in 1998 listed the objectives desired after graduating: 74 percent of the students ranked “being very well off” higher than developing a meaningful philosophy on life, helping others or raising a family. The seeds of performance addiction have been sown. After all, isn’t making more money the perfect goal?

Ed Deiner, positive psychologist from the University of Illinois surveyed 100 people from Forbes list of Richest Americans. He found that the happiness quotient was only slightly higher for the richy-rich than the average Joe. But the elusive thought of “maybe if I do it better, work at it harder, I will be rewarded financially and then, I will finally be happy” is firmly planted in everyone’s brain. Especially in the performance addict’s head.

Performance addiction is not just evident in the workplace, it effects love interests as well. In the book General Theory of Love, three psychiatrists have answered the age-old question of “How do I pick a partner?” Thomas Lewis, MD, Fari Amini, MD, and Richard Lannon, MD, explain that emotional attachments are deeply rooted in our early life experiences. Emotional attachments cannot be directed or rationalized. However, these doctors have seen there is a link between the emotional attachments that were vital to our childhood survival and the same attachments that influence our selection of a mate when we are adults. They use the example of a child being dependent on his mother. Whether or not the mother is beautiful, smart or an ax murderer, the child grows to love the emotional patterns he has linked to his mother. So when he is an adult and meets a potential mate who has the same characteristics as his mother, BAMM! He is entranced, feels he belongs with this person, and falls in love.

None of us falls in love with another person. We fall in love with an image.

Ciaramicoli goes into great depth about “Image Love.” The image of “what or who” we think that person we have fallen in love with is. But the reality is; they are not who we think they are. We idealize these lovers into an image of our mother, father, rich woman, smart man, independent woman, athletic man, whatever our mind makes up will be the perfect person for us. We create an image in our brains that this is our true love. But it is really based on our past. Performance addicts are especially prone to this. They have goals in mind for their partner, images that their partners must fit into. Such as their parents must love this person (sometimes this is more important, than the performance addict actually loving this person), this person has to have a certain body type, have a high sexual performance rating or believe in a certain religion. In essence the performance addict is creating a love image of their mate, before he/she even walks in the door on their first date.

Performance addiction is constantly evaluating and the addict’s emotional capital is based on the outcome of that judgment. It gets even more complicated when sex gets into the picture, but that is another blog post, entirely. Again, our shrinks from the book General Theory of Love classify being in love as different from loving. The first distinction between these two is time. Taking the time to get to know the other person. Going through that incredible Dopamine-filled period of infatuation and truly getting to know the other person. Thomas Lewis, Fari Amini and Richard Lannon, say that being in love requires a brief acquaintance, a spark, some chemistry, a few dates or maybe a roll in the hay. However, loving requires time, intimacy, and a prolonged surveillance of another person’s soul. Of course as a performance addict it is hard to move from in love to loving, because one has to move from a relationship that is sexually exciting, passionate, alive with attraction, tons of verbal acceptance and compliments to, well, let’s call it boring, normal relationship stuff, truly mediocre life experiences. Such as waking up late, running out the door eating cornflakes, passing gas under the covers or deciding who is going to vacuum the living room.

I can’t even use the word mediocre, it’s terrifying.

A performance addict hates the thought of being average in anything they do. Their mood goes up and down depending on how their performance is rated by others. They are labeling others based on their projected imperfections. Being better than is preferred to being less than, white collar over blue collar, college educated over a high school education, exceptional over mediocre. Whether it is in the workplace, the bedroom or at home, performance addiction is tremendously damaging to relationships. As Dr. Ciaramicoli stated, the scene of the crime started with the family. How do you think the performance addict learned their behaviors? Most likely from another performance addict.

The parent trap.

Besides teaching a performance addict-in-training how to be better than the Jones’ next door, how many times is the child used by the parent-performance-addict first? How does a parent-performance-addict use their children to bolster their self-worth? Does the TV show Dance Moms ring a bell? Have you heard a father brag about his son making the varsity team? Or a mom criticizing her daughter for dying her hair purple? How about a parent who yells and screams at their kids at a little league game? Of course the media has us convinced that every Jewish mother wants her son to grow up to be a doctor. How about in small business? In every family-run business the child is expected to take over the enterprise. What if they don’t want to? It is tough to break this cycle.

All of us need to push away the illusions we have lived with for the majority of our lives. The illusions that money can buy happiness, that true fulfillment comes with business success, we have to take over the business to please Dad or if we are thin, rich or young enough, we can find love.

People who are experiencing these secret compulsions to succeed at any cost are thrown off the merry-go-round every time something changes. Their desire to control, be perfect, too find happiness is their path and they will not accept anything less. Their performance addiction is a defense against feelings of fear and inferiority. These addicts depend wholly on exterior measurements of value, big house, fancy clothes, corner office rather than exposing their vulnerabilities by video taping their daughter with Down Syndrome and putting it on YouTube.

Performance addiction permeates our culture, work, home, church and school. But if we are equipped to treat ourselves as individuals we hold in high regard, if we have deeper respect for ourselves as evidenced by taking care of ourselves, loving our spouses and caring for our family, we can change. Performance addiction can be worked on, healed and then set aside.

Arthur P. Ciaramicoli, Ed.D., Ph.D., is a licensed clinical psychologist who has been treating clients for more than 35 years. Dr. Ciaramicoli is the SoundMindz Chief Medical Officer, and has been on the faculty of Harvard Medical School for several years. In addition to treating patients, Dr. Ciaramicoli has lectured at Harvard Health Services, Boston College Counseling Center, the Space Telescope Science Institute in Baltimore as well is also a seasoned media expert, appearing on CNN, Fox News, Comcast TV, Good Morning America Weekend, The O’Reilly Report, and other shows. Dr. Ciaramicoli is the author of The Curse of the Capable: The Hidden Challenges to a Balanced, Healthy, High Achieving Life (Wiley, 2010), Performance Addiction: The Dangerous New Syndrome and How to Stop It from Ruining Your Life (Wiley 2004) and The Power of Empathy: A Practical Guide to Creating Intimacy, Self-Understanding, and Lasting Love (Dutton 2000). His newsletter, blog comments and contact information are available at this web site, http://www.BalanceYourSuccess.com. You can follow his daily insights at www.twitter.com/docapc.

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Angry Birds—Part 2- The conflict between a young adult and her mother in recovery

Posted on August 22, 2014 by Melissa Killeen
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Melissa Killeen

In my last post, I touched on the subject of how a mother in recovery can cope with the conflict and rage her 21-year-old young adult daughter expressed during a family holiday get-together. In this post, I am exploring the difficulty parents of emerging adults have coping with their separation. I must admit that I am a parent of an emerging adult, a 25-year-old son, so as you read this post, you will see I use the term “we” quite often, we meaning parents like me. Laurence Steinberg, a psychologist at Temple University, is one of the country’s foremost authorities on the transitions of young adults. Based on a longitudinal study he conducted of more than 200 families, he found forty percent of his parent sample suffered a decline in their mental health once their first child entered adolescence and young adulthood. Parents reported feelings of rejection and low self-worth; a decline in their sex lives; and increases in physical symptoms of distress. It may be tempting to dismiss these findings as by-products of a midlife crisis rather than the presence of young adults in the house. But Steinberg’s results don’t seem to suggest it. Steinberg’s research was better able to predict what the parent was going through psychologically, by looking at the age of his or her child, rather than by knowing the parent’s age.

Young adults who are attempting to launch are especially rough on parents who don’t have an outside interest, whether it’s a job they love or a hobby to absorb their attention. Parents who have been planning that perfect wedding or expect their child will be a doctor or a Nobel laureate, since the kid’s bar (bat) mitzvah, need to stop that. It is time to separate what they ‘make up in their heads’ with the reality of the situation. I may over emphasize this a tad, but for every parent there is this overarching desire for their kids to fulfil the American Dream: to do better than their parents. Today, post the Great Recession, this may be a bit difficult to achieve for most 20 to 30 something’s. It also raises the bar for these launching young adults who already have too many goals to realize during this decade. These goals include: separating from their family, leaving the childhood home, attending college, finding a job, moving into a new home, excelling in that job and finding a mate.

There are more responsibilities laid at the feet of a 20-30 year old in this decade of emerging adulthood than in any other decade preceding or following this age. A person might expect that sitting, chilling out and playing a video game can take some pressure off of the emerging adult, wouldn’t you think? Knowledge that wasn’t around twenty years ago, when most parents were rocking out to The Police or Nirvana, attests that the prefrontal cortex, the part of the brain that governs so much of our higher executive function—including the ability to reason and control our impulses—is still undergoing structural changes up until the age of 25. Complicating matters more, dopamine, the hormone that signals pleasure, is very active in young adults, which is why they assign a greater value to the reward they get from taking risks than older adults do. Of course, in the face of observing such risk taking, our first parental response is to step in, control and make things right.

As their parents, we see these risky choices based on youth and stupidity rather the researched-based facts of being part of a developmental process. It’s precarious being someone’s prefrontal cortex by proxy. Yet modern culture tells us that that’s one of the primary responsibilities of being a parent. In addition to decisions by proxy, we carry unresolved problems from our past with us into our current situations. At times of disagreement or unexpected crises, conflict and dysregulation arise. Wikipedia describes manifestations of emotional dysregulation as angry outbursts such as yelling, destroying or throwing objects, aggression towards others, and use of all capital letters in text messages (I added that last entry). Regarding the mother and daughter issue referred to in the my last blog, I went to my “go to guy”, Bowen Family Systems psychiatrist, Ronald Cohen and he offered these questions:

(1) What can you do to help resolve the conflict, reduce stress and anxiety, improve communication, and promote active problem solving and healing?

(2) How do you maintain both your autonomy and the connections with the emotionally important person in your  life?

(3) Which behaviors will help make things better no matter what the emerging adult does?

(4) How do you deal with differences without losing connection?

The end-goal is differentiation of self,  the capacity for the individual to function autonomously by making their own choices, while remaining emotionally connected to family. For the for my client, the recovering mother and for the emerging adult, her daughter, this is a goal they both can agree on. This goal will allow the daughter to engage the process of partially freeing herself from the emotional entrapment of her mother. Differentiation can release the mother from her care giver role and all of her past roles as a parent of a young child that are no longer required. In doing so, the young adult daughter may recognize that running away from her mother won’t achieve liberty, but in fact by running away, she will become as emotionally dependent as the emerging adult who never leaves home. More will follow with next week’s post.

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