Category Archives: dr. Hokemeyer

Toxic Relationships: Recognizing Key Signs

Toxic Relationship

What is a toxic relationship?

A toxic relationship is any relationship we have with another person that makes us feel drained, anxious or less then. Instead of building us up and making us feel good about ourselves, these relationships break us down in subtle and not so subtle ways. We can have toxic relationships with just about anyone, from the receptionist at the dentist, to our boss or co-workers, to our parents and children, to our most intimate romantic partner. The more intimate the relationship, the harder it is to recognize that the relationship is toxic- and the harder and more painful it is to change it.

What are the signs of a toxic relationship?

1. How do you FEEL around the person?

-Do you get anxious thinking about your next interaction with them? (anticipatory anxiety)

-Do you have a physical reaction? (your stomach hurts, your head spins, you feel ungrounded or unsafe)

-Are you drained emotionally and physically after you leave the toxic person?

2. How do you ACT around the person?

-Are you making excuses for or needing to constantly defend yourself and your actions?

-Do you become a person who you are not normally either by becoming overly hostile or passive?

3. Do you need to RECOVER after you leave them?

-Are you so drained emotionally and physically that you need to go to bed, eat, drink or take drugs?

-Do you swear that you will never see or interact with them like that again?

-Do you scratch your head and wonder “What was that about?”

Why is it so hard to get out of toxic relationships?

-Because we get addicted. We think we need the approval, validation and love of a person who once gave it to us.

-We keep chasing the original high, hoping it will come back to us.

-We deny the truth of the situation, because it’s painful. Who wants to admit that they are addicted to a toxic relationship. There’s an incredible amount of shame associated with that.

What to do to get out?

-Be willing to admit there is an issue.

-Because our denial is so strong around toxic relationships we need to write our feelings down and create a record of them. Keep a journal of how you feel before, during and after your interactions with your trigger person.

-Find a trusted friend or professional with whom you can test your reality. The nature of toxic relationships is that they are crazy making. They make us doubt ourselves and our self worth.

-Set boundaries. Limit your time and exposure to certain people who trigger negative emotions in you.

-Believe in yourself and trust that the universe will provide a better more loving place for you.

 

 

 

 

 

The DSM-5: Update to Changes

The DSM-5 is the main tool clinicians- and insurance companies- use to code mental health conditions. It’s also a highly controversial scientific manual for in addition to codifying mental health issues, it often stigmatizes the people who are diagnosed.

On December 1, 2012, the American Psychiatric Association’s board of trustees approved the newest version. This was no simple task. It took 13 years to complete and involved the participation of 1,500 mental health experts.

The changes to the DSM-5 attempt to view mental health issues on a spectrum rather than in fixed boxes. The best example is the changes to the diagnosis of autistic disorders. Previously, autism was codified as stages of severity that began with Asperger’s. Under the DSM-5, these sharp distinctions are lost and in their place a single autism spectrum disorder has been established.

Other changes include additions and eliminations. New diagnosises include:

Hoarding

Bing Eating

Skin Picking

The DSM-5 did not include diagnosis codification for:

Children who experience difficulty after their parents divorce

Hypersexual behavior

While not a perfect manual, the DSM-5 is our profession’s best effort in diagnosing and treating the wide range of mental health disorders from which people suffer.

 

Asperger’s Syndrome

As the facts of the Sandy Hook tragedy come to the fore, we are learning more and more details of the Lanza family’s life. A New York Times article suggests that the son may have suffered from Asperger’s Syndrome which is a psychological condition that impacts a person’s ability to empathize with or find compassion for other human beings. WebMD provides the following succinct and clear definition of Asperger’s.

WebMD

Asperger’s syndrome (or disorder) is a developmental disorder in which people have severe difficulties understanding how to interact socially. People with Asperger’s syndrome may not recognize verbal and nonverbal cues or understand normal social rules, such as taking turns talking or recognizing personal space.

Asperger’s syndrome and autism belong to a class of disorders called pervasive developmental disorders. Asperger’s syndrome shares some similarities with autism. Like those with autism, children with Asperger’s syndrome have abnormal social interactions, facial expressions, and gestures, and unusually focused interests. Unlike those with autism, children with Asperger’s syndrome usually have normal intelligence and language development (although the rhythm, pitch, and emphasis are irregular), age-appropriate self-reliance, and interest in the world around them.

Children with Asperger’s syndrome have a better outlook than those with other developmental disorders. Many lead productive, independent lives in adulthood.

Asperger’s syndrome affects males more than females. Its cause is unknown, although it tends to run in families, suggesting a possible genetic link.

Talking to Your Kids About Tragedies: Age Appropriate Guidelines

Many parents mistakenly assume they can shield their children from the tragedies that occur in the world around them. Unless they live in a hermetically sealed bubble, they cannot. Children, no matter what their age, are incredibly intuitive. They feel what’s going on- especially when what’s going on makes them feel threatened and unsafe.

For this reason, it’s important for parents to discuss tragedies with their children in age appropriate ways. How tragedies are explained to a 4 year old is markedly different from how they will be explained to an adolescent. To help you in this regard, I’ve copied  guidelines from the government agency SAMHSA below. These guidelines explain what is appropriate and what is inappropriate to share with children of various ages.

PRESCHOOL CHILDREN, 0–5 YEARS OLD

Very young children may go back to thumb sucking or wetting the bed at night after a trauma. They may fear strangers, darkness,
or monsters. It is fairly common for preschool children to become clingy with a parent, caregiver, or teacher or to want to stay in a place where they feel safe. They may express the trauma repeatedly in their play or tell exaggerated stories about what happened. Some children’s eating and sleeping habits may change. They also may have aches and pains that cannot be explained. Other symptoms to watch for are aggressive or withdrawn behavior, hyperactivity, speech difficulties, and disobedience.

Infants and Toddlers, 0–2 years old, cannot understand that a trauma is happening, but they know when their caregiver is upset. They may start to show the same emotions as

their caregivers, or they may act differently, like crying for no reason or withdrawing from people and not playing with their toys.

Children, 3–5 years old, can understand the effects of trauma. They may have trouble adjusting to change and loss. They may depend on the adults around them to help them feel better.

EARLY CHILDHOOD TO ADOLESCENCE, 6–19 YEARS OLD

Children and youth in these age ranges may have some of the same reactions to trauma as younger children. Often younger children want much more attention from parents or caregivers. They may stop doing their school work or chores at home. Some youth may feel helpless and guilty because they cannot take on adult roles as their family or the community responds to a trauma or disaster.

Children, 6–10 years old, may fear going to school and stop spending time with friends. They may have trouble paying attention and do poorly in school overall. Some may become aggressive for no clear reason. Or they may act younger than their age by asking to be fed or dressed by their parent or caregiver.

Youth and Adolescents, 11–19 years old, go through a lot of physical and emotional changes because of their developmental stage. So, it may be even harder for them
to cope with trauma. Older teens may deny their reactions to themselves and their caregivers. They may respond with a routine “I’m ok” or even silence when they are upset. Or, they may complain about physical aches or pains because they cannot identify what is really bothering them emotionally. Some may start arguments at home and/or at school, resisting any structure or authority. They also may engage in risky behaviors such as using alcohol or drugs.

Is Your Child a Narcissist?

We live in a narcissistically driven society. Our kids, products of a Facebook culture that promotes celebration and aggrandizement of Self, and reality television that presents distorted and self obsessed role models, threatens their emotional development. In this great article, Dr. Karyl McBride highlights some of issues parents need to be on the look out for in raising emotionally healthy children.

Am I Raising a Narcissistic Child?

Our blind spots can inhabit the next generation.
Published on February 14, 2011 by Karyl McBride, Ph.D. in The Legacy of Distorted Love

It is a deep desire in adult children raised by narcissistic parents to parent their own children in a different way. Next to the primary fear of “Am I Narcissistic Too?” is the burning quest to not repeat the patterns with our offspring. This is heart warming and hopeful. It is true that children deserve to have at least one person who is irrationally crazy about them!
Elan Golomb expresses a worrisome thought in her book,Trapped in the Mirror… “If the parent has a narcissistic bent, the pressure to copy is strong.” We do tend to parent as we have been parented, unless we gain further awareness and bring vision to our blind spots. What could be more important? Even if you do not have children, this awareness can be helpful because you might be a teacher, aunt, uncle, or friend to a child.

There are no perfect parents, and to expect that is somewhat delusional. It’s a big commitment to be a parent and one that carries an incredible responsibility. But, we can look at a different approach and be “quite good enough.” Parenting is a monumental task, the most rewarding and the most difficult you undertake. The beginning is your own recovery because without that, the blind lead the blind.

As I treat adult children raised by narcissistic parents and move forward with additional research, the eight principles of parenting identified in Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers, remain my guidepost for parental awareness.

In a nutshell, the eight principles are as follows:

• Be aware you can unconsciously pass along the legacy
• Parent with empathy
• Teach accountability
• Be aware of entitlement
• Teach values
• Value the personhood, not only the accomplishments
• Allow authenticity
• Create a parental hierarchy

Although this is a brief version, let’s take a look at each of the eight principles.

Don’t Pass On the Legacy:

Adult children raised by narcissistic parents have internalized that “not good enough” feeling. Without recovery, we model that message and are at risk to pass it on to our children if we do not embrace recovery. We don’t have to tell them…they see it in how we handle ourselves.

Parent with Empathy:

Empathy, the ability to identify with and understand other’s feelings, is the cornerstone for reversing narcissism. Learning to parent with empathy and compassion is crucial. It is a learned skill and is not automatic to most parents. It involves tuning into the emotional world and caring what that looks like regardless of the behaviors we see.

Teach Accountability:

If a narcissist raised you, you know that narcissists are rarely accountable for their behavior. It is always someone else’s fault, and projection of feelings is the name of the game. We must teach our children to “own” their behavior then reward that honesty.

Be Aware of Entitlement:

We should believe that our kids are the greatest! But, it does not mean that others have to agree or that they should get special treatment. It does not mean they are better than others or deserve something special from the outside world. They do deserve “special” from us! This is where we teach the value of family and familial love.

Teach Values:

Ahhh, refreshing! It is so important for each parent to review what their values are and what they want to teach their children. This takes some time and introspection and is worth doing! Then you can parent and teach along the guidelines of your value system and not just act and react to the behaviors. Each misbehavior or kind deed becomes a teaching moment.

Value the Personhood, not only the Accomplishments:

This is key. Tuning into who your child is, rather than what he or she does, is of utmost importance. It is important to reward accomplishments. But, be sure to look at who they are and their unique personality traits and acts of kindness. Following a value system and noticing those traits when exhibited, is essential in developing a moral child. Notice how they handle things and interact with other people. Note their cute way of responding and being. Emphasize their uniqueness. And, don’t expect them to fit into a conscripted mold because it makes you look good. Put THEM before what they DO or DON’T DO.

Allow Authenticity:

This means: LET THEM FEEL! Whatever feelings children have, make them ok. We don’t have to agree with them. Feelings don’t have brains. Feelings are feelings are feelings. The most important thing here is to teach them to express their feelings in appropriate ways.

Create a Parental Hierarchy:

This means that you are not a peer to your child. You are the parent, the teacher and the guidance guru. They do not have to like you or what you are saying all the time. You must be in control of the situation to make them feel safe. It also means that adult issues are kept adult issues and not discussed with children. When your child becomes a teenager, for instance, do not discuss your sexuality or relationships with them. They don’t want to hear it. You do get to be the boss. But, don’t over use that power and be sure to balance it with empathy about what they feel.

In summary, the true antithesis to narcissism is empathy. If you do not know how to do that, find resources to help you. Nothing could be more important in raising strong, moral, and self-assured children. Remember it starts with our own recovery. As the late Alice Miller so eloquently stated, “Traumata stored in the brain but denied by our conscious minds will always be visited on the next generation.”

Divorce Step Family Style: Dr. Hokemeyer quoted in New York Times

In today’s Style section of the New York Times, Elissa Gootman penned a great article on how to negotiate relationships with step children in a divorce. I’m honored that she closed the article on a positive, up beat note that contained my discussion of how in the midst of the turmoil, make sure you are guided by love- Love of self and others! Here’s the section I’m referring to:

WHAT’S YOUR MOTIVE?

The decision to nurture former step-relationships can mean accepting certain awkward situations, like waiting in the same hospital as your former husband while your former stepdaughter-in-law gives birth to a baby who would have been your stepgrandchild.

When a client of Dr. Hokemeyer’s expressed a desire to be present at the hospital while the daughter of her longtime but now former husband gave birth, the therapist worked with her to answer what he considered the key question: what was her motive?

“When there’s a divorce, there’s a profound sense of loss, and people try to mitigate that loss by holding on to relationships that they would be better off letting go,” Dr. Hokemeyer said. “Make sure that you are acting out of genuine love and concern for the other person, and not out of anger and attempts to manipulate.” In the birth case, Dr. Hokemeyer and his client determined that her motives were pure. She genuinely cared for her ex-stepdaughter-in-law and wanted to preserve their relationship, which was meaningful and deep, though convoluted to describe

‘Smiles’ linked to teen deaths

Latest designer drug called ‘Smiles’ linked to teen deaths

By Stephanie Pappas

Published September 24, 2012 in Fox News.com

LiveScience

Law enforcement officials and parents are concerned about the next in a long line of illegal synthetic drugs: 2C-I, also known as “Smiles.”

The drug, a hallucinogen, has been linked to two deaths in East Grand Forks, North Dakota, though little is known about this drug’s dangers. Other synthetic drugs, including K2 or “fake weed,” have caused problems by proliferating before being made illegal.

“There is hardly any research at all in the scientific literature on these things, even in animals, much less any sort of formal safety evaluation in humans,” said Matthew Johnson, a professor of behavioral pharmacology at Johns Hopkins University.

A new high

2C-I is part of the 2C family of drugs, a group of closely related molecules that have psychedelic effects. Along with the other 2Cs, 2C-I was discovered by chemist and synthetic-drug guru Alexander Shulgin, who published the formulas of psychoactive drugs in his book “PiHKAL: A Chemical Love Story.” As of July 2012, the Drug Enforcement Administration classifies 2C-I as a Schedule I controlled substance, making it illegal to manufacture, buy, sell or possess the drug. [Trippy Tales: The History of 8 Hallucinogens]

Read more: http://www.foxnews.com/health/2012/09/24/latest-designer-drug-called-miles-linked-to-teen-deaths/#ixzz27mDjZXAO

Managing Transition and Change

Transitions can be surprisingly hard – here are suggestions for coping.
Published on May 15, 2010 by F. Diane Barth, L.C.S.W. in Off the Couch

“Deirdre* spent her spring semester in another country. As she prepared to come home, she emailed me to set up an appointment “soon after I get back. It’ll give me something to hang onto while I’m going through this ending process. I’m really sad to be leaving my new friends. And it’ll help me ground myself while I’m trying to settle in again at home.” A wise young woman, Deirdre knew that much as she was looking forward to getting back, re-entry would not be simple. “I know I’ll feel different; and I’ll want everyone else to be different, too,” she said, and added, “It’s been a mixed experience. There have been good and bad things about it, but I’m glad I did it.”

And then she asked,”But why does time seem to be speeding by and slowing down at the same time?”

This is a season of change. Children move from school to camp. Adolescents graduate from high school and college. Even if school is no longer a part of your life, much of our culture cycles around the academic year. And leaving anything is almost always a mixed bag.

Deirdre’s words capture one of the hardest parts of transition for many of us – as we leave one situation and move into a new one, we often feel a mixture of emotions: sadness about saying goodbye to people and experiences that have been important to us, relief about ending unpleasant circumstances, and both excitement and anxiety about whatever awaits us. While we wait for that eagerly anticipated new thing to arrive – a baby, a new job, a new semester, a trip, a wedding or other event – time seems to drag by. And while we prepare to leave something or someone we love, time moves far too quickly.

The thing is, both of these experiences often happen simultaneously. Separation (which, if you’ve read some of my other blogs, you know is not one of my favorite experiences) almost always brings with it both loss and opportunity. So even when it’s a positive move, even when it’s something we very much want, it is often accompanied by feelings that don’t seem so happy.

Here are some suggestions for coping:

1- Recognize that mixed feelings are normal. You are not crazy if you are excited about moving into your new apartment and sad about leaving your old one at the same time. You’re just experiencing the feelings of loss and anticipation that are part of almost every life transition.

2- Similarly, recognize that feeling sad about leaving one situation or anxious about moving into another does not have to mean that you have made the wrong decision. Most of us have these feelings about even the best possible moves in our lives. In fact, the time that I worry about a possible problem is usually when a client tells me about an upcoming change without talking about some of the conflicts about it!

3- Try to put all of your confusing feelings into words. Tell a friend or a relative; but set the stage first, so that they don’t get worried that you have either gone off your rocker or, more likely, have made the wrong decision. Tell them that you are trying to sort out your feelings, which are contradictory, and you just would like them to listen – unless of course you say something that genuinely makes them think you’re forgetting to pay attention to something important.

4-Whether you are leaving a semester abroad, a house or neighborhood, a school or university, a job or a relationship, try to give yourself a little time to reflect on both the good and bad aspects of the experience. Do not try to pack in everything you have not done, or everything you meant to do in the short time you have left. And try not to turn it into an all-bad experience in your mind, something you are eager to get away from because it has been nothing but bad. This may make it easier to leave in the short term, but will have problematic consequences down the line.

5- Similarly, try to give yourself time to adjust to any new situation. It will not be perfect in the beginning. You will want to compare it with what you have left behind, which may suddenly take on all sorts of positive attributes you didn’t give it while you were in it. This too is normal. But try not to take these shifts too literally. We almost always look behind us with memories that are less complex than the actual experiences. Don’t be taken in by either a rosy or a very dark memory. And remind yourself that your present situation will change over time. Give it a chance. And give yourself a chance to adjust to the differences.

Interestingly, these factors often appear as clients start to get better in therapy. As much as we might want to change, we are also often afraid to leave behind relationships and parts of ourselves that feel familiar, even if they don’t seem to be the healthiest or most productive way to live. Early psychoanalysts called this “resistance.” I call it common sense. Only if we can pay attention to these opposites – both the pain and pleasure that comes with endings and the anticipation and dread of new beginnings, can we manage the transitions that are an ongoing part of every life.”

 

* Not her real name. Names and personal information have been changed to protect individuals and families.

The Shades of Depression (Dysthymia)

This post was published by the Harvard Medical School Newsletter and discusses dysthymia- a type of low grade, simmering depression that reduces the quality of our lives. It also has a negative impact on our relationships with our romantic partners, parents and children. The full article is reprinted below:

“Mood, like color, has a range of hues, from the bright shades of happiness to the dark ones of depression. A mood problem that’s down in the dark range, but doesn’t quite reach the level of depression, is dysthymia (dis-THIGH-me-ah). It refers to a long-term drone of low-grade depression that lasts for at least two years in adults or one year in children and teens. While not necessarily as crippling as major depression, its persistent hold can keep you from feeling good and interfere with your work, school, family, and social life. Think of dysthymia as a dim gray compared to depression’s blackness.

You might have dysthymia if you feel depressed during most of the day. You carry out your daily responsibilities, but without much zest for life. The depressed mood lingers for more than two months at a time, and is accompanied by at least two of these symptoms:

overeating or loss of appetite
insomnia or sleeping too much
tiredness or lack of energy
low self-esteem
trouble concentrating or making decisions
feelings of hopelessness

 

This low-grade depression lasts an average of five years. That’s another way it differs from major depression, in which relatively short episodes can be separated by considerable spans of time. It’s possible for an episode of major depression to occur on top of dysthymia; this is known as double depression.

Dysthymia often begins early in life, during childhood, the teen years, or early adulthood. Being drawn into this low-level depression tends to make major depression more likely. In fact, up to 75% of people who are diagnosed with dysthymia will have an episode of major depression within five years.

This low-grade depression doesn’t usually fade away all by itself. Treatment, though, helps ease dysthymia and other depressive disorders in about four out of five people.

 


The Depression-Anxiety Link

Most people with major depression also suffer an anxiety disorder.
By Hara Estroff Marano, published on July 09, 2007 – last reviewed on August 27, 2012

What’s the best way to deal with depressiona and anxiety? Quickly and definitively. Whatever kicks them off, depression and anxiety both are maintained by styles of thinking that magnify the initial insult and alter the workings of the brain in such a way that the longer an episode exists, the less it takes to set off future episodes.

Anxiety and depression are probably two faces of the same coin. Surveys have long shown that 60 to 70 percent of people with major depression also have an anxiety disorder, while half of those suffering anxiety also have symptoms of clinical depression.

The stress response system is overactive in both disorders. Excess activity of the stress response system sends emotional centers of the brain into overdrive so that negative events make a disproportionate impact and hijack rational response systems. You literally can’t think straight. You ruminate over and over about the difficulties and disappointments you encounter until that’s all you can focus on.

Researchers believe that some people react with anxiety to stressful life events, seeing danger lurking ahead everywhere—in applying for a job, asking for a favor, asking for a date. And some go beyond anxiety to become depressed, a kind of shutdown in response to anticipated danger.

People who have either condition typically overestimate the risk in a situation and underestimate their own resources for coping. Sufferers avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable. Often enough, a lack of social skills is at the root. Some types of anxiety—obsessive-compulsive disorder, panic disorder, and social phobia—are particularly associated with depression.

The fact that anxiety usually precedes the development of depression presents a huge opportunity for the prevention of depression. Young people especially are not likely to outgrow anxiety on their own; they need to be taught specific mental skills.

Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression have also been proved effective against an array of anxiety disorders.

Although medication and CBT are equally effective in reducing anxiety/depression, CBT is better at preventing return of the disorder. Patients like it better, too, because it allows them to feel responsible for their own success. What’s more, the active coping that CBT encourages creates new brain circuits that circumvent the dysfunctional response pathways.

Cognitive-behavioral therapy teaches people to monitor the environment for the troubling emotional landmines that seem to set them off. That actually changes metabolic activity in the cortex, the thinking brain, to modulate mood states. It works from the top down. Drugs, by contrast, work from the bottom up, modulating neurotransmitters in the brainstem, which drive basic emotional behaviors.

Treatment with CBT averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. Drug therapy is typically recommended for months, if not years.

Exercise is an important adjunct to any therapy. Exercise directly alters levels of neurohormones involved in circuits of emotion. It calms the hyperactivity of the nervous system and improves function of the brain’s emotion-sensing network. It also improves the ability of the body to tolerate stress. What’s more, it changes people’s perception of themselves, providing a sense of personal mastery and positive self-regard. It also reduces negative thinking.

However, just telling a distressed person to exercise is futile, as depression destroys initiative. The best thing a loved one can do is to simply announce: “Let’s go for a walk.” Then accompany the person out the door.