Category Archives: Happiness

Surprise! Today is mostly the same as yesterday…

Surprise! For most of us, today is mostly the same as yesterday!

Huh?

Well, maybe I am letting a pinch of my grew-up-in-Jersey show, with an unhealthy indulgence in sarcasm…but I have a point.

Why are so many people surprised when every day, so much is the same?

Why do some sources tell us the “average American woman” tries on four or five outfits before leaving for work? Is it really possible this hypothetical average woman is perpetually surprised by the obligation to wear something besides yoga pants and a slept-in t-shirt? Imagine: “D’oh! Get dressed again???? What the…?” It’s much more likely that what-to-wear becomes, under pressure, an emotional decision (what do I feel like wearing) instead of a practical one. The cool, calm decision on Sunday (what makes sense based on the demands of each day of the week) turns into a workday morning emotion-fest for people who get caught up in “I feel fat” or “I look terrible.”

It’s not just about prepping for the non-surprising workday.

Why is anyone over the age of twelve stymied by the multiplication of dishes in the sink, the need to do laundry, or the fact that garbage cans get full? Worse yet, why are so many couples arguing, night after night, about “what to do about dinner,” as if the need to eat sometime between finishing lunch and going to bed caught them unawares?

I try not to be surprised by the every-day. Maybe I am flattering myself by mincing words here: I am dismayed that Darcy the twelve-year-old cat has once again thrown up in the middle of a wood floor. I am, regrettably, not surprised.

The school year is beginning here in West-Central Florida, and so families all over are waking up to unpleasant (non)surprises: pack lunches? Matching socks? Complying with uniform rules? What??? I am right there with you, folks, amazed that it is once again time to get into the autumn routine.

For me, that includes packing a week’s worth of lunches and ironing a week’s worth of clothes on the weekend. Crazy, right? Until you imagine it taking two minutes to get dressed for work and a few seconds to grab a lunch out of the fridge, instead of trying to figure out what to wear, heat up the iron or touch up shoes, wash fruit and veggies, etc., while the work day morning clock’s ticking. I have it figured out: less than 30 minutes total for all clothes- and lunch-prep on Sunday or cope with 15 minutes or more five times a week. I am saving myself, at minimum, 45 minutes

Emotions are what get in the way for families bickering about “what to do about dinner,” or “how are we going to get the laundry/kitchen/pet duties done.” People are tired, they are hungry, they are stressed out from the day. Tired, hungry, stressed people are not as good at negotiating and decision-making, whether at home or work. Instead of wishing you could come home, magically downshift to a Zen-like mindful state and engage in creative cookery and Pinterest-worthy home maintenance, why not just plan to deal with reality?

The reality is, you will be tired, you will be stressed, and you will wish you had something easy, tasty and nutritious. You will not want to spend a half-week’s worth of grocery money on takeout because the dinner hour caught you by surprise.

The 1990s bestsellers by Elaine St. James (Simplify Your Life, Living the Simple Life, etc.) included very down-to-earth, helpful tips: have a weekly menu that rarely varies. It keeps life simple. That doesn’t mean you can’t have wonderful, complicated meals, but it does mean that you can also plan for: Ugh, it’s been a 14-hour day door-to-door and that homemade soup from the freezer/half a lasagna/whatever ready to go and bag of salad are going to taste really, really good…in about five minutes, instead of spending a half-hour bickering, grumbling, and absent-mindedly eating a half-bag of chips while you try to figure out what to do.

Slices of the culture are having a virtual love affair with simplifying, decluttering, etc. How about decluttering and simplifying the routines of life, the predictable little tasks that are the same each day, so you have more time and mental energy for the things you’d rather do?

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Reports, Commands and Rules

Many years ago, on the first day of class in the graduate-level course on Abnormal Psychology, our instructor held up the then-current version of the DSM (Diagnostic and Statistical Manual of Mental Disorders) and said,

“Always remember…you never know what flick is playing in someone else’s head.”

Words of wisdom: much goes awry because we forget that simple fact.

Honestly, don’t you ever wonder if some people are actually going out of their way to deliberately misinterpret what is said?

Have you never sat in slack-jawed wonder at the psychological gymnastics required to wrest a particular interpretation from something that meant nothing of the kind, as you witnessed someone gallop away, flush with a gross (and possibly deliberate) misunderstanding?

Sometimes, there may be bad intentions, or at least the intention, all along, to make some point, whether or not it makes any sense in context. We see this often in every level of politics. Commentator Smith had a well-rehearsed point to be made during the allotted few minutes on-air and by golly, Smith is going to find a way to interject it even if it makes no sense in context. Smith hopes that the point thus calculatingly made is so clever, so memorable, that it will be the “take-away” point for most listeners, even though, within the transcript, it seems arbitrary at best.

Among the well-intentioned, the problem may sometimes be a lack of clarity…more often, I think, it is a lack of clarification.

In family therapy and family systems theory, we refer to a metacommunication concept called “Report and Command.” The “report” is what someone actually says. The “command” is the meaning of that statement to them. It is the hidden expectation. In a final exam question for a family therapy course, I give the following example:

Matthew states, “Susan never makes my favorite meal anymore.” From a metacommunication perspective, “Susan never makes my favorite meal anymore,” is the report. The command portion might be:

  1. “I feel hurt because she doesn’t care to do this for me anymore.”
  2. “…And she should make my favorite meal.”
  3. “because she knows I’m supposed to watch my cholesterol.”
  4. There is no command in this communication

Students are expected to pick an answer and defend it briefly. There are multiple “right” answers. It is telling that, given the statement, “Susan never makes my favorite meal anymore,” more than half the students regularly assume that the command – the hidden meaning – is b, “And she should…” rather than the plaintive option, a, or even the matter-of-fact and somewhat complimentary c. The choice of b, of going negative, tells them, and me, a lot about how they make assumptions about what people might mean, and points out the risk of assuming rather than clarifying the deeper meaning of even seemingly mundane remarks. Here, then, if Matthew is passively expressing hurt at his wife’s apparent disinterest in nurturing him, and Susan instead “hears” a chauvinistic, boorish demand that she slave over a hot stove, well, I may have an appointment open, week from Tuesday, at 6 PM.

Another recent example: a friend observed a parent telling a child engrossed in a video game that the child’s sporting event was to begin in 10 minutes. To only the parent’s surprise, this barely nudged a response from the child. The parent actually said, “Hey, your race starts in 10 minutes.” The parent believes he communicated, “Hey, dude, we gotta get going NOW so you can be in position for the race in less than 10 minutes.” Dad made a vague observation about time that meant nothing to a child and the child took it literally: Dad is updating me on the passage of time. I leave to your imagination the subsequent exercise in frustration for Daddy and his swimmer.

Some people claim they don’t have a lot of expectations. Nonsense. Of course they do. They expect the lights to go on when they flip a switch, though for the most part they know not how it happens. They expect politicians to magically create more jobs and higher wages. They expect their spouse to read their mind when they make that little throat-clearing noise and bulge their eyeballs at dinner with extended family or friends. They expect their loved ones to know what they might want for their birthday. We all have lots of other day-to-day subtle expectations, without which we couldn’t get through the business of living. There really isn’t time in a day to treat every iota of experience as a new and undiscovered country. Some things have to be on autopilot (which implies expectations, however buried they may be).

If you are happily married, you expect your spouse to come home; you expect compassion; you expect at least well-feigned interest in much of what you say. You probably have a reasonable expectation that certain tasks will be done and that you will be warned before in-laws or ne’er-do-well friends, down on their luck, take up residence on the couch. If, to your surprise, perpetually unreliable Cousin Pete has been invited for an extended and slovenly stay, you might reasonably say to your spouse, through gritted teeth in a whisper in the kitchen, “I had no idea your Cousin Peter was coming to visit,” (report) with the unsaid (command), “…and I am perfectly right to expect that you would have asked before letting him set foot in our house.” “But honey,” your spouse might say, “Pete’s family.”

Ah, the family card. Now we move from Reports and Commands to Rules.

Everyone has rules. Some rules are overt: my husband has asserted that I am not permitted to give up chocolate for Lent. This is one of a few rules in our house. Have I mentioned his strong survival instinct?

Most rules are not even verbalized; they are taken for granted, as if a law of nature. In the example of your spouse’s unwelcome cousin Pete, “family are allowed to be here without either of us consulting the other,” is apparently the inviter’s rule. You might be thinking, “Yeah, well, maybe a nice family member but not stinky, rude, mooching Cousin Pete,” or, “for dinner, maybe, but to sleep on my couch for some indefinite period of time, no!,” but, you see, that is an entirely different rule.

A lot of clashes arise because people have not clarified their expectations and their rules, both to themselves and to others; and because they speak in terms that they believe are perfectly clear when actually they are not clear at all. Next time you find yourself in a gross misunderstanding with someone you love, perhaps it would be worth revisiting whether you actually communicated what you thought in the privacy of your head…and to ask more questions about what someone means before you assume that what you heard is what they intended you to understand.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Wrestling with OCD

If you have suffered with Obsessive Compulsive Disorder (OCD), or know someone who has, you are probably familiar with those distressing, intrusive thoughts that create so much anxiety. Traditional psychoanalysis used to focus on the content of those thoughts and seek to uncover the deep, buried wounds and wishes that led to these strange, seemingly alien notions. Thus the woman who was obsessed with the fear that her child would get hurt walking to school might be analyzed and advised that she seems to have a deep resentment against the child and all the responsibilities of motherhood and the worry is really an expression of an unconscious wish to be rid of the child. Talk about a guilt trip…!

Modern research and practice in treating OCD tends more towards the notion that everyone’s brain generates random and sometimes pretty crazy-sounding thoughts. Thus, the treatment is much less about wrestling with the particular content of the OCD thoughts and more about learning to compassionately notice that thought happening among all the other thoughts firing off like popcorn in the typical brain, use strategies to calm down the anxious physical reaction to the thought and refocus, gently and purposefully, on what one would rather think about at that moment in time. It stops becoming “Don’t think about X,” (try that: right now, I forbid you to think about pizza. Ha – how long did it take to imagine a pizza?). Instead, it becomes, “Yup, there’s that thought about X…and now I will take a deep breath and refocus on what I was doing/what’s going on right here and now.”

This is what mindfulness, stress management and cognitive-behavioral therapy can do, together, to help with OCD. The brain changes in response to choosing these behaviors, and the degree of physical distress decreases throughout the whole body.

If you are suffering with OCD, this kind of very well-researched approach may be what you need. Please contact a professional in your area if you think this might be helpful for you.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Cut Them Some Slack

Doing unto others as we would have done for ourselves…well, there is one thing that most people tend to do for themselves that they are often slow, reluctant and resistant to do for others: cut them some slack. Consider the historical narrative on this:

Jesus of Nazareth: “Why do you notice the splinter in your brother’s eye but not perceive the wooden beam in your own?” (Luke, 6:41, NAB)

Soren Kierkegaard: “Most people are subjective towards themselves and objective towards others, frightfully objective sometimes – but the task is precisely to be objective towards oneself and subjective towards all others.” (Works of Love)

CS Lewis: “…It is no good passing this over with some vague, general admission such as, ‘of course, I know I have my faults.’ It is important to realize that there is some really fatal flaw in you: something which gives the others just that same feeling of despair which their flaws give you. And it is almost certainly something you don’t know about…” (Essay: The Trouble with “X”, from God in the Dock)

Psychologically, of course, it makes sense: we, after all, know what we intend to do/say; we have deep awareness of all the people and events that obstruct our good intentions. Meanwhile, we have no clue – or concertedly avoid taking notice of clues we trip over – about whatever obstacles and heartaches might underlie others’ disappointing and often frustrating behaviors. We cannot know what it is like to have the particular limitations that someone else has –anymore than they can understand the particular limitations we tote around with us.

Sometimes someone will say to me in the context of therapy how badly they feel that they are struggling with some particular issue – anxiety, or depression, for example – when (from their perspective) other people all seem to be going around, carefree and without this sort of anguish. In a country in which 20% of women and 10% of men are prescribed antidepressant medications each year, and who knows how many various prescriptions for anxiety, it hardly seems fair, to oneself or others, to assume that everyone is skipping along as carefree as they often very deliberately attempt to appear. Then there are physical pains and illnesses; the sufferings of loved ones; the anxiety for a loved one in a danger zone; grief; loneliness. These are so often invisible except for the side effects of passing crankiness or thoughtlessness or scatterbrained-ness that annoy other people who are, to quote Kierkegaard, being “objective” about others.

For the person who is suffering and, unable to see evidence of suffering in others, believes s/he is alone, it is disheartening. To be so alone in suffering…! But no one is alone in their suffering.

Not all the objective/subjective dichotomy concerns suffering. Sometimes it is about unseen limitations or differences. No doubt you have something you are not naturally good at doing. Perhaps it’s spelling, or “being handy,” or math. If you are a grownup who is doing well in life, you may have turned this into a kind of joke, or perhaps you use this as exhibit A, the evidence that you know you’re not perfect: “Oh, I know I’m far from perfect…you should see the disaster my checkbook is,” but in fact you have a certain secret pride that you do not have to bother with this, or that your flaw is so small and even borders on not being a real defect at all…and, after all, at least you are not “stupid/lazy/arrogant/whatever you perceive in someone else.” Yet unless you are in that experience, you cannot understand the frustration of someone with a brain injury who on the one hand knows that a certain skill set used to come naturally but is now a fuzzy memory and source of perpetual struggle. You cannot know what it is really like for someone with an IQ thirty points below yours to struggle through a complex and fast-paced world, when their processing speeds are so much slower, and you likewise cannot know what it might be like for someone with an IQ thirty points higher than yours to bear patiently with you.

Part of good psychotherapy, like good spiritual growth, is becoming aware of one’s flaws – not for the purpose of self-recrimination and useless shame, but as opportunities for growth of oneself as well as a growth in compassion for other people. The process, once begun, is the work of a lifetime.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

If you won the lottery…!

We all know the stats: that six months after a major windfall, such as the lottery jackpot, people are no happier than they were before they won. Most of us assure ourselves, WE would do better. WE would know how to manage that blessing in such a way as to increase the happiness of many people – including ourselves – on an ongoing basis. WE would be happier, not succumb to dopey decisions and would never blow up our lives with self-destructive, self-indulgent bad behavior.
Here’s a question: what would you do if you won the lottery, and why aren’t you doing some version of that already?
If you imagine you’d travel, see new places and try new cuisines, are you saving money for a trip and seeking free/cheap adventures in your own area, experimenting in the kitchen and otherwise exploring here at home?
If your job is a poor fit, are you meeting your intellectual and creative needs via outside pursuits, or investigating how to transition to something that’s a better fit, or are you just feeling “stuck”?
Most changes people imagine making after winning a lottery are really superficial and thus, much to their surprise, they show up in that new, changed life with the same “them,” with all their flaws, quirks, and preferences. That means that we all would tend to level out at whatever our prior level of contentment was, pre-jackpot. If you’re a happy person, you’ll keep on being happy…and if you’re cranky, well, you’ll just be a rich, miserable person to be around instead of a not-rich miserable person. Worried people will keep on worrying until they decide to learn how to change that – which doesn’t require a lottery jackpot.
You can be happier today. You can find a new adventure in your town this weekend. You can learn something exciting and be on the way to mastering a new skill this week. Alternately, you could sit around and wait to win the lottery. You get to pick.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC
© 2016
Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Too busy!

People brag about the strangest things.

Not getting enough sleep is one; are Americans in some sort of dysfunctional competition to see who can get by on the least possible sleep – regardless of the effect on their mental and physical health?

Another is being busy – so very, very busy – that one could not possibly do anything healthy, or creative, or refreshing in any way.

Is it real busy-ness? It’s hard to say, but I have my suspicions that it often comprises some combination of underestimating how much time is frittered away on time-wasters, taking on a lot of extra and unnecessary tasks, and, sometimes, more than a hint of pride. You know, the people who find out you actually read books in the evening or squeeze in a date night with your spouse and give that little smile and a hint of a sniff when they say, “Well, it must be nice…” Well, yes, actually, it is. Very nice.

Pride, or arrogance, aren’t necessarily obvious. Healthy humans have a normal, natural need to feel needed and wanted. This is a good, but the fear that somehow your absence will cause all of creation – or at least your workplace or the kitchen at home – to immediately crumble into dust is not good. Even Jesus and Moses sometimes sneaked off for some very necessary R&R, either to be alone with God or also with some of their most loved, trusted friends.

Some people are going through a stage of life that is very busy. People with school-aged kids who each  participate in one extra activity will indeed be temporarily overly busy, driving to practice or lessons. They check homework, look under the sofa for shin guards, and use their vacation time for pediatric appointments for yet another ear infection. This stage is transient. Even too-busy parents, though, often hide time-wasters into their day.

When someone asserts always being “too busy” to do things they claim they really want to do, then I suspect that perhaps they don’t actually want to do those things. It would be better to say, “Oh, no – last thing I want to do is be stuck in a gym five mornings a week,” then to dodge exercise by pretending they are just too, too busy. Once they are honest about the issue (apparently they would rather do something else than spend hours on the human version of a hamster wheel) they are free to figure out how to meet the essential need (enough exercise to stay healthy) and stop dodging reality with brag-worthy busy-ness.

It’s hard to give up the busy excuse to oneself. It might be a polite dodge to other people (but remember that “let your yes mean yes and your no mean no” admonition?) but it’s just pointless to lie to oneself.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

A little out of sync…

Intellectually gifted children are a challenge for grownups.

Their ability to learn and apply information may be far ahead of their peers but their emotional and motor skills may be completely normal (read: average and right on schedule). So your highly gifted six-year-old, who can visualize Johnny Depp’s pirate ship but whose little fingers can only manage 5-year-old’s motor skills, will be angry and frustrated to the point of tears over a boat that looks perfectly fine to you. Your gifted twelve year old will, with the emotional fragility of a middle-school-aged heart, grapple with the existential questions peers more often face in college.

This kind of asynchronous development is hard for the child, too…and will continue to be so, until adulthood. It’s easier for adults to find a few intellectual peers with whom to deeply connect. The more gifted the child, the harder this will be, simply because of the mathematical odds. Intellectual giftedness comprises only 2% of the population. Highly gifted persons are less than 1/1000 of the population; for them, the odds of finding someone on par, or, an even happier event, encountering someone sharper in intellectual terms, is slim. It’s important for grownups to be aware of the interior struggles gifted children face and provide opportunities for support, encouragement and sometimes some careful education on why they feel so different from other kids.

Add to this gifted kids’ tendency to need a little less sleep, be a little more bouncy, be in a hurry to learn and do, ask a lot of questions…or, conversely, be very quiet, observant and introverted, and the challenge for parents and teachers becomes clear.

Interested in learning more? There are a lot of resources out there: American Mensa and SENG are two excellent sources of information and support for the gifted child (or grownup) in your life.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

What can it be, besides ADHD?

Your child is bouncy. He doesn’t seem to pay attention; she forgets to follow through on tasks. The book bag is a disaster area; necessary books never seem to make it home; and you regularly have to turn around and go home to pick up shin guards or ballet shoes.

Well, what can it be, besides ADHD – the psychiatric diagnosis of Attention Deficit/Hyperactivity Disorder, diagnosed off a checklist and sometimes suspected of being over-diagnosed?

The symptoms associated with ADHD can be due to a wide variety of issues; here are a few:

  1. Stress at home or in the environment. If you are having marital or other family difficulties, your child is stressed – whether you know it or not. Research indicates that a, adults are pretty lousy of telling when children are anxious or worried and b, the children of adults with marital problems, when tested in research studies, have high levels of stress chemistry metabolites in their urine.
  2. Maybe it’s not at home; maybe it’s the environment. Live in a noisy and/or high crime neighborhood? Is your child bullied or afraid of being bullied at school? Sources of ongoing stress will interfere with the parts of the brain that are important to focus, attention and memory.
  3. Insufficient sleep. Is your school-age child getting 9 or 10 hours of quality rest per night? Falling sleep by television, computer, or with a cell phone close at hand? These will all interfere with quality and quantity of sleep.
  4. What are overtired kids like? You know what you do when you’re driving late at night and you are too tired to be driving – so you bounce in the seat, sing too loudly and pretend having the windows open will magically keep you alert? Yeah, well…meet the 3rd grade kid who is up too late because of football or soccer practice a few times a week and fidgets around looking dazed in class.
  5. Insufficient exercise. The recommendation for children is two hours of physical activity a day – real activity, not standing-around-hoping-coach-lets-me-play-this time activity.
  6. Boredom. Brains + boredom = either shutting down and not trying at all OR driving grownups and other kids bonkers. Look out for the introverted or shy child who may shut down and go into dreamland; a lot of gifted children are very introverted and self-contained, and unlikely to be overtly disruptive. They simply tune out.
  7. Frustration. A child who is having difficulty – perhaps an undiagnosed or insufficiently supported learning disability – will often give up and stop trying. Remember that children personalize things; if they are struggling and the grownups act like they “should” be able to “get it,” the child assumes the adults know best and that the child must be flawed/”stupid” etc.
  8. Your (or some other involved grownup’s) inconsistency. If you flipflop on rules, fail to follow through, and run an unpredictable life for yourself and your child, it’s not fair to look at the child who seems scattered or (more likely) is gambling on this being one of those times when you are too stressed or preoccupied and let things slide, and blame the child.

You’ll notice that none of these issues can be blamed on the child. These are all grownups-need-to-pay-attention flags, not “naughty kid” flags. So, before you assume your child has a brain disorder, rule out the many factors that we grownups often unwittingly inflict on children and see if, with a few months of more consistent attention to these risk factors, your child’s behavior and morale improve.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

 

Why are personality disorders so difficult to treat?

Why are personality disorders so difficult to treat?

Well, there’s a complicated question! This post attempts to present an overview response.

A personality disorder, like just about all mental disorder diagnoses, is made based on a checklist of complaints, symptoms, and observations. However, personality disorders are very different from what we normally think of as emotional problems.

Consider, for example, depression. “Depression” is diagnosed when 2 weeks have passed and certain criteria have been met (and there’s no “pass” given for grief or other traumatic events in the new diagnostic manual, although we’re supposed to note it in the records). Most people know when they’re sad, irritable, unhappy, and hopeless. It feels awful and they want to get that bad feeling off of them. Some people might not think of it as “depression.” They might identify it as a “low time,” or it might be grief, or a normal adjustment to a new phase of life such as marriage, an empty nest, or graduating from college. It might be a normal but very painful response to some new curveball life has thrown at them: an illness, a layoff, retirement, etc.

A personality disorder is different because it is pervasive; like the personality of any person, it is part of everything. Your personality impacts how you interpret everything that happens, the way you react to people and events, the emotions you experience. This goes for healthy people as well as those whose patterns are far enough from the big, wide range of normal to merit a “disorder” status. So, when someone seems to have a personality disorder (say, narcissism), they are not experiencing their diagnosis as a messy, icky experience to be stopped. They are rolling along (over other people) and having their life. Everything comes through a lens that assures them that they are special, entitled to preferential treatment and to have their way, and, well, let’s face it, just better than us. Problems are experienced as due to the outside world and their own role in those problems is not apparent.

From a therapist’s perspective, when someone comes in with depression, even if that’s not what they, or we, might call it, they know they are unhappy and they want very much to feel like themselves again. They are hopeful that a counselor can help them push through this difficult time.

When someone who meets criteria for a personality disorder comes to treatment, it’s usually because of some other issue, such as work or relationship problems. Remember that each of us is walking around, seeing the world through our own eyes and interpreting everything we experience, including our own thoughts and feelings, through our unique mental structure. You build that mental structure from the earliest moments of life. Is the world safe? Are my needs met? Are the grownups who tend to me patient, gentle and kind? Babies are already sorting out information and creating a set of basic assumptions about the world that will become essential aspects of their personality. It’s so deep, it’s hard to not take for granted that our way of making sense of things isn’t necessarily the only, or best, way. So when patterns of problems arise with colleagues, bosses or family, it’s hard to believe that the problem is fundamental to our mental structure; it defies logic and could be very insulting. The person may be suffering terribly, every day. This is definitely the case with some of the personality disorders, such as Borderline Personality Disorder, Avoidant Personality Disorder and Dependent Personality Disorder. Whether these or any of the personality disorder diagnoses, the person did not choose this burden and it isn’t their fault. However, presenting it as an internal problem – to them – can feel like blaming and attacking – which is definitely not the therapist’s intention.

Imagine if something terrible happened to you: a tsunami. Your workplace is destroyed. You lose your house. You lose your stuff. You catch a mosquito-borne illness and suffer long-term ramifications. It’s a series of terrible events and you find yourself traumatized and perpetually anxious. Is that anxiety your fault? Certainly not. Just so, the early life experiences that set people up for the challenges we call personality disorders are not their fault. However, it’s a problem that they can learn to heal, but that can sound like blaming the victim. Thus, if someone meets criteria for a personality disorder, trying to sell them on dealing with the personality disorder is pretty much like saying, “Look, an awful lot about the way you think and respond to things is kind of messed up. But, never fear! Together we can bulldoze your personality and how you think, feel and behave, pour a new slab, and then we’ll rebuilding you from the ground up. You’ll learn new ways of thinking, feeling and behaving.”

Even when it’s dressed up in tactful, compassionate psychological language, that, my friend, is a very hard sell indeed.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Oh, the drama!

It’s about 2/3 of the way through the spring term, so it’s time again for my intro psychology students to learn about the various personality disorders, as defined by the American Psychiatric Association. One interesting one – and not necessarily in a good way – is Histrionic Personality Disorder (HPD).

Traditionally, HPD was estimated to occur in perhaps 2-3% of the population. You know these folks; you’ve known them all your life. They’re exciting, intense, and fun; the life of the party, the center of attention…and they can’t turn it “off” when appropriate. It’s the “friend” who wears a very well-fitted white dress to your wedding; the family member who always has to make it “about them,” when it’s very, very much about someone else; the middle-aged parent who is trying to compete with a teenaged child to the point of embarrassment (for the child, that is). They lack empathy for anyone but themselves, but can emote with the best of them. Recent studies indicate that incidence of HPD is exploding – with some estimates as high as 27% of the young adult (under 35) population now meeting criteria for the psychiatric diagnosis. It’s thought that the two-generation long emphasis on having high self-esteem absent any achievement of good character or performance might be involved, as well as the current culture that elevates attention (any attention) as better than just chugging along, living your life happily with the people you love.

Which of our grandparents would ever, in million years, have imagined everyday people talking about how many “followers” they have, as if they were Jesus?

Like almost all psychiatric diagnoses, HPD is defined by a checklist; meet enough criteria according to the clinician holding the checklist, and you’ve earned the label. Of course, someone with HPD isn’t coming for therapy for help with HPD. Others may come for help with them, or it may become apparent within the context of counseling for some other issue: relationships, work conflicts, etc.   It’s sad, really, that it can be so difficult to realize one needs help, because at the root of this is a small child, still jumping up and down crying out, “Mommy! Watch this! Mommy – look at me!” and that small child in the unconscious just doesn’t realize that all the jumping up and down cannot make them feel “seen,” and they need to find other ways – more adult, meaningful ways – to feel connected and recognized. After all, everyone wants to be seen by eyes that love them; didn’t the film Avatar touch on that well, where the most intimate thing people could say to another living being was, “I see you”?

Like some of the other personality disorders, particularly Antisocial Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder, the person with Histrionic Personality Disorder will seem fine…in fact, better than fine. All four can be very charming, interesting, and fun. They can seem special and their attention can make the next victim caught in their vortex feel special until all heck breaks loose.

Be compassionate but beware. No matter how wonderful, loving and patient you are, healing the wounded heart under HPD is not a one-man or one-woman task.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.