Michael J. Montegut, Ph.D., Guest Author

'A LETTER from my love to-day!
Oh, unexpected, dear appeal!'
She struck a happy tear away,
And broke the crimson seal.

John Davidson. 1857 - 1909

Communication is a word we hear often when people talk about improving relationships. We receive voluminous communication from every corner of our lives and from a myriad of sources: e-mail, radio, postal mail, telephone, pagers, FAX, television, cell phones and more every year. A lot of people I speak with think they cant escape contact with those around them. They feel that they do a pretty good job of interacting with others, especially when they have all the fancy, high-tech communication tools.

But in relationships it is the quality of the communication that makes the most difference, not necessarily the quantity or speed of delivery. If you say the same thing, in the same way, over and over every day, your loved ones can become inured to it.

This is especially true with the daily I Love You that is the staple of most loving, committed relationships. Just because you say it, does not mean that the message was received or perceived as sincere. Sincerity is always at risk with quick and easy forms of communication. It is easy to get into the habit of saying those three words with such ease that it is automatic.

One of the most powerful and sincerest forms of communication that we see very little of today is letter writing. I am not talking about e-mail or post-its. I mean a real letter that is written on real paper and dropped in the non-virtual mailbox down the street. Letters take time and thoughtfulness to create.

But what about the more efficient forms of communication in this technologically advanced age?

continue story below

E-mail is easily written and often curt. Since e-mail is meant to allow quick and easy communication we often send messages without careful consideration. Furthermore, when e-mail is received the reader does not pause for a deep look because of the dozen other e-mail they received at the same time.

And forget those cutsie e-cards. They serve a purpose. They let someone know you are thinking about them and many times they may make them laugh (which is a good thing.) But in general, e-cards are not an effective delivery system for deep communication. As with paper greeting cards, the message in the e-card is filled out for you most of the time.

And the phone? Why not that most ubiquitous of 21st century communication tools, the cell phone?

When you make a phone call you and the person you are talking to can both be doing a handful of other things at the same time, and as a result this form of verbal communication can be poorly thought out and impulsive. Ultimately the phone, especially the cell phone, is meant to be used as a device of convenience. And deep, intimate, carefully considered and sincere communication does not have convenience as the main objective.

Greeting cards do not count (unless the sender has enclosed a substantial personal note which is rare). The greeting card industry has capitalized quite successfully on our inability to write from our own hearts, either due to lack of time or a perceived lack of creativity.

There are thousands of cards for every imaginable occasion with a heartfelt message already written out for us. All we have to do is sign our name (Even this is falling out of vogue in some circles - I have been given cards by people who do not sign their names so that the receiver can recycle the card and use it on someone else Yikes!!) Why is it that we need to buy our heartfelt sentiments in sterile, prepackaged form?

A letter, even a short one, can be symbolic of dedication. It shows commitment because it takes a little more time and care to organize ones thoughts and put them on paper. In addition, the written word is permanent and physical, two things that are a big part of committed relationships. It is a lot harder to deny what we have written than it is to deny what weve said.

For instance, if you say you are sorry to someone verbally you can equivocate and feel the person out so that you can alter your message depending on how you think things are going. Most people see through duplicity and equivocation in written form immediately. A letter forces you to state your feelings with permanence and, if you are practiced and take your time, clarity.

When was the last time you received a letter that was either written or typed out by hand? I am willing to bet that this is an exceedingly uncommon occurrence for most of you.

Please write again soon. Though my own life is filled with activity, letters encourage momentary escape into others lives and I come back to my own with greater contentment.

Elizabeth Forsythe Hailey

The writing of a letter also provides the opportunity to surprise someone. Place it in a location where they will find it at an unusual moment. For example, as they are riding the train to work or about to eat their lunch. Any place where they will discover it and take pause is good.

This is also much more romantic than just handing someone note or sending them an e-mail. In fact, if you are in a long distance relationship and normally correspond by e-mail every day, it will be a big and welcome surprise for your partner to get some real mail.

People often tell me that they do not feel they have any facility with writing and so cannot produce a letter, even a short one. A lot of people simply do not know what to say to their loved ones in a letter. If you think about it, you just have to say how you feel and what you are thinking. No one is completely devoid of feelings and no one has a blank mind (ever).

Sometimes people are overwhelmed with many feelings and thoughts. If you find that this is your situation, make a list of the top 3 feelings and thoughts that are swirling around in your head. Then pick one and address it.

For instance, your top three thoughts or feelings related to your partner might be:

1. You forgot to kiss me goodbye this morning.
2. Do you really like that couch we ordered or are you just going along?
3. I really need some time alone with you. . . without the kids.

Even if you say what you feel in plain, simple, language (and this can be the best way most times) this is more than enough to make the point that you care. And the more you write the easier it will be and you will become more proficient at communicating your true feelings to others.

There is one caveat. Do not use writing as a way of avoiding confrontation or inflicting pain. The "Dear John" letter is a prime example. Remember that just as the written word has the power to spread love, it can also do damage to a relationship.

Choose your words wisely and never send a letter written in anger or use the written word as an alternative for something that should clearly be done face-to-face.

I write entirely to find out what I'm thinking, what I'm looking at, what I see and what it means. What I want and what I fear.

Joan Didion

Many therapists and coaches see writing as a powerful form of therapy. Getting everything down on paper clears your head of tumultuous thoughts and emotion. It helps to calm most people. There is even a sense of accomplishment when you have successfully described your feelings or concerns and can see them on paper. This is why journal writing is prescribed by so many therapists.

You can even write letters to communicate deep feelings that you may not be able to speak of effectively in person at the appropriate time (either because you are unavailable or because you do not remember the exact feeling you had at the time.)

continue story below

Here is a great idea that I got from a book by Mark and Dianne Button called, "The Letter Box: A Story of Enduring Love." The authors suggest that you write letters to your loved ones at important times in their lives and keep the letters tucked away in a small box for your loved ones to open at a later date.

For instance, you can write a letter to your child on the day of his birth describing all the joy you are experiencing and what it is like to hold him for the first time. You give this to him when he are 30 years old or perhaps on the occasion of the birth or his first child. Now that's something you can't do with an e-mail!

Take the time to try this. Commit right now to write your partner or a loved one a personal note expressing your positive feelings toward them. Do it on paper. If a letter is too daunting, then write a couple sentences. If that is too scary, then try just a few words.

Just say what you feel, no matter how simple or silly (this is often best). Have faith that it will make their day. Put your letter to them where they will find it unexpectedly or mail it though the regular mail.

I can guarantee that you will receive a positive response from them. And your letter can keep giving. Because, unlike words that are spoken (and then only a memory), a letter can be reread and experienced over and over.

By taking the time to express your love in a permanent and clear form, you will are recommitting to your loved one and to the vitality of your relationship with them.

Copyright © - Michael J. Montegut, Ph.D.. All rights reserved. Reprinted with Permission.

next: Questions, Questions and More Questions

List of national self-help support groups for alcoholism, drug abuse and drug addiction.

The primary goal of addiction support groups, whether for a drug addiction or alcoholism, is to maintain the individual's sobriety and secondarily to help others maintain their sobriety. Below is a short list of alcoholism and drug abuse support groups. A comprehensive listing can be found at the American Self-Help Clearinghouse website.

Alcoholics Anonymous (A.A.)

Alcoholics Anonymous is a 12 step program of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

http://www.alcoholics-anonymous.org/

Narcotics Anonymous (N.A.)

Narcotics Anonymous is a 12 step program fellowship of men and women, who share their experience, strength and hope with each other, that they may solve their common problem and help others to recover from drug addiction. There are no dues or fees for membership, and they are not allied with any institution, organization or denomination. Their primary purpose is to help other addicts achieve recovery from drug addiction.

http://www.na.org/

Alanon

For over 50 years, Al-Anon (which includes Alateen for younger members) has been offering hope and help to families and friends of alcoholics. It is estimated that each alcoholic affects the lives of at least four other people - alcoholism is truly a family disease. No matter what relationship you have with an alcoholic, whether they are still drinking or not, all who have been affected by someone else's drinking can find solutions that lead to serenity in the Al-Anon / Alateen fellowship. There are no dues or fees.

http://www.al-anon-alateen.org/

Naranon

Nar-Anon is a twelve-step program designed to help relatives and friends of addicts recover from the effects of living with an addicted relative or friend. Nar-Anon's program of recovery is adapted from Narcotics Anonymous. The only requirement to be a member is that you have experienced a problem of drug addiction with a family member or friend. Nar-Anon is not affiliated with any other organization or outside entity and there are no dues or fees for membership.

http://nar-anon.org/

Cocaine Anonymous (C.A.)

Cocaine Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and others recover from cocaine and crack addiction. As with other 12 step programs, there are no dues or fees for membership and Cocaine Anonymous is not allied with any other sect, organization or institution. Their primary purpose is to help other Cocaine addicts to achieve recovery.

http://www.ca.org/

Codependents Anonymous (C.O.D.A.)

Codependents Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and recover from dysfunctional relationships. As with other 12 step programs, there are no dues or fees for CODA membership and they are not allied with any other sect, institution or organization. The only requirement of CODA membership is a desire to develop a healthy and loving relationship.

http://codependents.org/

Gamblers Anonymous (G.A.)

Gamblers Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others recover from their gambling addiction. As with other 12 step programs, there are no due or fees for G.A. membership and they are not allied with any other institution, sect or organization. Their primary purpose is to help other compulsive gamblers to recover.

http://www.gamblersanonymous.org/

Overeaters Anonymous (O.A.)

Overeaters Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from overeating and food addiction. As with other 12 step programs, there are no dues or fees for O.A. membership and they are not affiliated with any other organization, sect or institution. Their primary purpose is to help other overeaters to recover.

http://www.oa.org/

next: Treatment Approaches for Drug Addiction
~ addictions library articles
~ all addictions articles

Supportive-expressive psychotherapy proves effective in treating hard drug users by helping them maintain gains made in addiction treatment.

Supportive-expressive psychotherapy is a time-limited, focused psychotherapy that has been adapted for heroin addicts and cocaine addicts. The therapy has two main components:

• Supportive techniques to help patients feel comfortable in discussing their personal experiences.
• Expressive techniques to help patients identify and work through interpersonal relationship issues.

Special attention is paid to the role of drugs in relation to problem feelings and behaviors, and how problems may be solved without recourse to drugs.

The efficacy of individual supportive-expressive psychotherapy has been tested with patients in methadone maintenance treatment who had psychiatric problems. In a comparison with patients receiving only drug counseling, both groups fared similarly with regard to opiate use, but the supportive-expressive psychotherapy group had lower cocaine use and required less methadone. Also, the patients who received supportive-expressive psychotherapy maintained many of the gains they had made. In an earlier study, supportive-expressive psychotherapy, when added to drug counseling, improved outcomes for opiate addicts in methadone treatment with moderately severe psychiatric problems.

References:

Luborsky, L. Principles of Psychoanalytic Psychotherapy: A Manual for Supportive-Expressive (SE) Treatment. New York: Basic Books, 1984.

Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O'Brien, C.P. Psychotherapy in community methadone programs: a validation study. American Journal of Psychiatry 152(9): 1302-1308, 1995.

Woody, G.E.; McLellan, A.T.; Luborsky, L.; and O'Brien, C.P. Twelve month follow-up of psychotherapy for opiate dependence. American Journal of Psychiatry 144: 590-596, 1987.

Source: National Institute of Drug Abuse, "Principles of Drug Addiction Treatment: A Research Based Guide."

next: Individualized Drug Counseling
~ all articles on Principles of Drug Addiction Treatment
~ addictions library articles
~ all addictions articles

Thoughtful quotes about the past, living in the past, and trying to change the past.

Words of Wisdom

"I do not possess what I remember so much as it possesses me." (Richard Bode)

"The trouble with you is you think you have time." (Don Juan to Carlos Costaneda)

"One can never change the past, only the hold it has on you." (Merle Shain)

"Among the dead there are those that still have to be killed." (Fernad Desnoyers)

"What's past is prologue." (Shakespeare)

"The past should be a springboard, not a hammock." (unknown)

"Every journey into the past is complicated by delusions, false memories, false naming of real events." (Adrienne Rich)

"Life is thickly sewn with thorns, and I know no other remedy than to pass quickly through them. The longer we dwell on our misfortunes, the greater is there power to harm us." (author unknown)

"Life can only be understood backwards, but must be lived forwards." (Soren Kierkegaard)

"One must never lose time in vainly regretting the past or in complaining against the changes which cause us discomfort, for change is the essence of life." (Antole France)

"It's but little good you'll do watering last years crops." (Frederick Loomis)

next:Pleasure

Note to editor: all references which are now in parentheses, in the form of a name and a data, should be numbered as footnotes and placed at the end of the book with the other footnotes, chapter by chapter. The references might best be grouped as a bibliography-reading list, with the footnotes referring to them by name and date.

Are you sad? Do you have a low opinion of yourself? Does a sense of helplessness and hopelessness weigh you down? Do you feel this way for days or weeks at a time? Those are the elements of depression.

If this is how you are feeling, you surely want to regain a pleasant outlook on life. You also need to prevent depression returning later. Happily, there now are aids to attain those goals. (But fighting depression takes effort. And there are certain benefits of being depressed which you may be reluctant to give up.)

Nowadays, a depression sufferer usually can get relief with active cognitive psychotherapy, or with tested anti-depressant medications, or with both. The U. S. Public Health Service summarizes as follows: "Eighty percent of people with serious depression can be treated successfully. Medication or psychological therapies, or combinations of both usually relieve symptoms in weeks."1 Both kinds of treatment have been shown in controlled experimental research to benefit a large proportion of depression sufferers, within a few months or even weeks. Drugs, however, control the depression, whereas psychological therapy can cure it. (For information about the scientific results, see Appendix B and the books cited in the reference list.) All this is good news indeed for depression sufferers.

Only a quarter century ago, medical and psychological science had little to offer depressed people. Traditional Freudian-based therapy put you on a couch or in an easy chair, and started you talking at random. You and your therapist hoped that in the course of two to five expensive hour-long sessions a week, continuing for many months or years, you would come across sensitive incidents in your past. Those "insights" were expected to relieve you of the pain the incidents induced. But the success rate was not high, nor was psychoanalysis proven effective by scientific tests.

Traditional therapy was founded upon the crucial assumption that people are irresistibly disturbed by their past experiences, and cannot change their emotional life by changing their current patterns of thinking. Recent scientific research has shown, however, that this assumption is false. People can indeed overcome depression by changing their current thought patterns. That is, though you may have been disturbed by events in your past, you now (in Albert Ellis's phrase) disturb yourself by your current mental habits.

Modern cognitive therapy -- which fully coincides with the wisdom of the ages on this point -- begins with the assumption that we have considerable control over our own thinking. We can choose what we will think about, even though following through on the choice requires effort and is not always fully successful. We can select our goals, even though the goals are not infinitely flexible. We can decide how much we will agonize over particular events, though our minds are not as obedient as we would like them to be. We can learn better ways to understand the data of our objective situations, just as students learn to gather and analyze data scientifically, rather than being forced to accept the biased assessments we have tended to make until now.

This book teaches you a newly-sharpened version of cognitive psychotherapy that has a more comprehensive theoretical base and wider curative outlook than earlier versions. You may use it by yourself to overcome depression, or you may use it in conjunction with a therapist. Most sufferers can benefit from the assistance of a wise counselor, though finding such a helpful person is not easy.

There is still more good news: Psychiatrist Kenneth Colby, famous for his artificial-intelligence computer simulation of paranoia, has developed a computer-based system of psychotherapy for depression based on the key ideas of this book. You "speak" to the computer, and the computer speaks back on the screen, which helps you help yourself. A disk to run the program on an IBM-PC computer is included with this book. It can be a help and a comfort to many readers.

My Personal Story and Negative Self-Comparisons

This book emerges not only from the body of new scientific discoveries, others' and my own, but also from my personal experience of deep and prolonged melancholy. Here is my story.

I was depressed -- badly depressed -- for thirteen long years from early 1962 to early l975. When I say that I was depressed I mean that, except for some of the hours when I was working or playing sports or making love, I was almost continuously conscious of being miserable, and I almost continuously reflected on my worthlessness. I wished for death, and I refrained from killing myself only because I believed that my children needed me, just as all children need their father. Endless hours every day I reviewed my faults and failures, which made me writhe in pain. I refused to let myself do the pleasurable things that my wife wisely suggested I do, because I thought that I ought to suffer.

As I look back now, in comparison to re-living the better of the days when I felt as I did then, I'd rather have a tooth pulled and have the operation bungled, or have the worst possible case of flu. And in comparison to re-living the worse of those days in the first year or two, I'd rather have a major operation or be in a hellish prison.

Over the years I consulted psychiatrists and psychologists from several traditional schools of thought. A couple of them left me with the impression that they didn't have a clue about what I was saying and had simply somehow passed the necessary exams to get into a well-paying business. A couple of them were human, understanding, and interesting to talk to, but could not help me. And toward the end of that time, the psychiatrists and psychologists did not even offer me hope, and certainly no hope of a quick cure. My own training in psychology was no help, either.

Then I read about what was, at that time, a new and different approach to psychological problems -- Aaron Beck's Cognitive Therapy, which in Albert Ellis's somewhat different form is called Rational-Emotive Therapy. (I shall consider them together under the label "cognitive-behavioral therapy" or just "cognitive therapy", along with Frankl's Logotherapy, recent variants such as Interpersonal Therapy, and also behavioral therapy.)

The core of cognitive-behavioral therapy is a thoughtful problem-solving procedure that quickly can get to the root of the depression, and directly yank out that root. Within that vision of the individual as able to change his or her depressed thinking, I then developed an analysis of the cause of depression centering on the depressed person's negative self-comparisons. And I worked out the logic of what I call "Values Treatment," which can provide a powerful force for people to use the resources of cognitive therapy and thereby cure themselves of depression; that is what Values Treatment did for me.

Within two miraculous weeks I banished my depression, and I have since then been able to keep depression at bay. (Such a quick cure is not usual, but it is not wildly exceptional, either.) Starting April, l975, I have almost always been glad to be alive, and I have taken pleasure in my days. I have occasionally even been ecstatic, skipping and leaping from joy. And I am joyful more often than most people, I would judge. Though I must still fight against depression from time to time, I have not lost more than a minor skirmish since then, and I believe that--if my family and community stay safe from catastrophe--I have beaten depression for life. The Epilogue at the end of the book gives the details of my passage from sadness to joy.

After I had cured myself, I wondered: Could I use my new advances in cognitive therapy --- Self-Comparisons Analysis and Values Treatment -- to help others, too? I proceeded to counsel with other persons who were depressed, and I found that these ideas could indeed help many of them get over their depressions and find new joy in life. Then I wrote a short version of this book, and leading psychiatrists and psychologists who read it agreed with me that the book -- including Self-Comparison Analysis, and the therapeutic approach derived from it -- makes a new contribution not only to sufferers from depression but also to the theory of the subject. And people to whom I have given early copies, some of whose cases I'll mention later, have reported dramatic salvation from their own depressions - not in every case, but often.

*** I hope that there will soon be a smile on your face, too, and laughter bubbling inside you. I don't promise you instant cure. And you will have to work at overcoming the depression. You must exercise your intellect and will in outwitting the traps that your mind lays for you. But I can promise you that cure and joy are possible...A tip for the road: Try treating your fight to overcome depression as an adventure, and think of yourself as a valiant warrior. More power to you, and luck.

Afterword For Those Interested in the Scientific Evidence

The experimental evidence for the success of cognitive therapy in helping depression and other miseries has been mounting up. For thirty years now, a variety of studies have shown cognitive therapy to be helpful. And in 1986 the National Institute of Mental Health of the U. S. Department of Health and Human Services completed a tightly-controlled three-university study lasting six years (and costing ten million dollars!) comparing a) encouragement only, b) drug therapy, c) Beck's Cognitive Therapy, and d) Interpersonal Psychotherapy; both these latter psychotherapies emphasize the key element of altering one's own thinking and behavior. The results at the conclusion of treatment showed that the active psychotherapies were as successful as the standard drug imipramine in reducing the symptoms of depression and improving the patient's ability to function. Drug treatment produced improvement more rapidly, but the active psychotherapies caught up later. Severely depressed and less-severely depressed patients both benefited from the active psychotherapies.(7)

These findings are extraordinarily impressive because drug therapy has been the favorite of the medical establishment in recent years. And cognitive-behavioral therapy has none of the side-effect dangers, physical and psychological, that accompany drugs. Furthermore, as noted earlier, the drugs control rather than cure depression. Hence, even if drugs are to be used, psychotherapy is appropriate in combination with the drugs in order to root out the underlying causes and move toward real cure.

Afterword About Drug Therapy for Depression

Neither I nor anyone else can give you authoritative advice about whether drugs are right for you. It surely makes sense to hear what one or more physicians has to say to you about drugs. Finding a wise physician, however, is particularly difficult when the ailment is depression. The problem is, as two noted psychiatrists put it, that depression "may arise from a biological malfunction, from actual losses, deprivations, or rejections, or from personal limitation. The difficulty in sorting out such causal fact is a source of enormous confusion in the diagnosis and treatment of disorders of mood."(2) And as two other reliable psychiatrists put it, "depression is almost certainly caused by [many] different factors", and hence "there is no single best treatment for depression."(3) Your best bet is listen to medical advice, and also advice from one or more psychologists, and then make your own decision about whether you want to try drugs first, or psychological therapy first, or both together.

Perhaps the most important piece of knowledge is that, contrary to what some physicians will tell you, drugs are not an all-purpose cure for depression. Perhaps the only major exception is the case of a person who has suffered real tragedy from death or other great loss, and is slow in putting the tragedy behind her/her. A sprained brain is very different than a sprained ankle. An out-of-order brain is very different than an out-of-order kidney or pituitary gland. Even if drugs relieve the depression while you are taking the medication, you almost surely need to straighten out your thinking so that the depression will not recur after you stop the drugs, and so that you will know how to fight off depression if it does recur.

Depression is not likely to be caused simply by a biologically-induced chemical imbalance that a drug can neatly restore to balance. As Seligman4 puts it, "Does the physiology cause the cognition, or does the cognition cause the physiological change? ..the arrow of causation goes both ways.." And as another psychiatrist has recently written, "Drugs do not cure the illnesses, they control them."(5)

Only psychotherapy offers true cure in most cases of depression. And as the official statement of the American Psychiatric Association judiciously puts it, "All depressed patients need and can benefit from psychotherapy,"(6) rather than relying upon medication alone. Patients treated with cognitive-behavioral psychotherapy as well as drugs have fewer recurrences than patients treated with drugs alone, in one study.(5.1) Miller, Norman, and Keitner, 1989

I do not intend to suggest, however, that drug therapy may not be appropriate for you. Modern anti-depression drugs offer hope to some people who are otherwise doomed to misery for long periods of time. I myself probably would and should have tried such drugs during my long depression if they had been as well- established as they now are. Drugs are particularly indicated when the depression continues for a very long time, because "One thing seems sadly certain: the person who remains chronically depressed over time has a reduced chance of recovering."(8) What I am suggesting is that you should not only consider drugs, and that it might be wise to try cognitive therapy first. You can read more about anti-depressant drug therapy in Chapter 00.)

bntro 9-148 depressi February 19, 1990

next: Good Mood: The New Psychology of Overcoming Depression Chapter 1
~ back to Good Mood homepage
~ depression library articles
~ all articles on depression

Dear Mr. Peele,

I wondered what your thoughts were on the connection between individuals who have suffered sexual trauma (incest, molestation, rape, etc.) who then developed a chemical addiction. It seems to me there is a strong correlation here. I have read so many studies where sexual abuse appears to be a predictor of drug and alcohol addiction. Do your experiences reflect this thinking?

Diane

Dear Diane:

I read claims like yours often. Even people who generally agree with me make such claims. I don't believe it. In general, my feeling is that no type of specific trauma results in any type of specific dysfunction in adulthood. It is not merely my distaste for deterministic models of psychology and psychiatry that makes me say this. Whenever research on childhood and family trauma or experience is conducted (e.g., about childhood violence, FAS/"crack babies", children of alcoholics) is conducted, it finds that the majority of people from such backgrounds do not develop the malady in question. More importantly, even the heightened susceptibility to the problem is clearly not due to transference of a trait directly from parent to child. Rather, it is the culture of violence, drinking, etc. of which the household is part that supports and conveys this heightened likelihood to engage in a behavior or, more generally, it is the entire deprived, degraded, or disorganized home that leads to a host of disorders. This applies as well to fetuses born to drug or alcohol-abusing mothers, whose problems are the result of an entire environment of pre- and post-fetal abuse.

Stanton

References

Family violence:

R.J. Gelles and M.A. Straus, Intimate Violence, New York: Simon and Schuster, 1988.

J. Kaufman and E. Zigler, Do abused children become abusive parents?, American Journal of Orthopsychiatry, 57:186-192, 1987.

Children of alcoholics

E. Harburg et al., Familial transmission of alcohol use: II. Imitation and aversion to parent drinking (1960) by adult offspring (1977), Journal of Studies on Alcohol, 51:245-256, 1990.

FAS/Cocaine babies

E.L. Abel, An update on incidence of FAS: FAS is not an equal opportunity birth defect, Neurotoxicology and Teratology, 17:437-443, 1995.

R. Mathias, Developmental effects of prenatal drug exposure may be overcome by postnatal environment, NIDA Notes, January/February, 1992, pp. 14-15.

Two summaries of recent evidence that what have been identified as crack babies are victims primarily of poverty are provided in the Media Awareness Project library: J. Jacobs, The crack of doom is simply poverty; S. Wright, Crack cocaine babies aren't doomed to failure, studies show.

next: Does the Disease Concept of Alcoholism Benefit Native Americans?
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

Article on saying goodbye to a dying loved one and the opportunities that come from talking with a dying person.

Have you said goodbye to a dying loved one yet? Chances are good that you will. With medical advancements in the diagnosis and treatment of cancer and other degenerative diseases, we can anticipate 'dying time' much more accurately than ever before. A terminal diagnosis is a gift of time and a wake-up call that time is running out. How will you use the time? Will you see the end of life as an opportunity to talk, love, and grow from the experience of talking with the dying person, or will you bring out the crying towel and simply wait for your loved one to die?

The last stage of a loved one's life is a final opportunity to say "I love you" and to say goodbye. It is a chance to carry on a relationship until the very end or beyond; a time for growth; a time to let go of any hurt that may have been caused by a difficult relationship. Our book, Final Conversations: Helping the Living and the Dying Talk to Each Other, is for all who have lost a loved one to a terminal illness; it is for everyone who will lose someone in the future. It is for the surviving partners and for anyone who wants to understand the practical power and importance of communication at the end of life, and to learn how to have a better and more fulfilling final conversation.

Final conversations, simplified in our book to "FC-talk," include all the moments of talking, touching, and spending time with the Dying. (We decided to capitalize the Living and the Dying when we mean the person or people rather than the process.) These communicative moments potentially begin when you find out that someone you love is dying, and continue until the moment the person dies. FC-talk is not necessarily the "last" conversation that the Dying had with someone, although in some instances it is.

Seventeen years ago, Ellen was losing the love of her life. Her husband, Michael, was dying of a brain tumor. He was in his early forties and he was leaving a young wife and two young children. Ellen revealed that her FC-talk focused on keeping their relationship genuine until the moment of his death and beyond if possible. She wanted to be sure that Michael knew he was loved and that she had completed her relationship with him up until the moment of his death. She repeatedly told him that I loved him, that I would always love him. I really didn't want to live my life without him, but I didn't get to make a choice about it. I would do my very best job to raise our children right. I was just glad that we got to spend the time that we did together. I thought it was a privilege to be able to have shared my life with him. I was grateful for the time that we had and to have had his children.

Ellen emphasized that the message of love had to be clear, leaving no doubts. I think if you're smart enough of a human being, you actually convey to the person that you love them while it has meaning and while it has emotion. This was a conversation [that really mattered]; I mean, we were going to be separated. We knew we were going to be separated. And I just needed to be able to complete with him and to let him know that I've always loved him and that I always would love him. It was a privilege for me to grow up and spend my life with him. I think conversations that you have with people who you know are on borrowed time . . . even though we're all on borrowed time, we don't live like we're on borrowed time . . . I mean, I guess what I'm trying to say is that we should all live as if we all know we're terminal. Because we all are terminal!

I completed my relationship with him. I didn't walk away thinking, Aauugh, I should have said, I didn't say, I could have said, I wanted to say. There wasn't anything that we didn't really say. And in the final analysis, the most important, the absolutely most important things were all said. Because the person who is left doesn't get stuck holding a bunch of untied knots. It's complete. You're not dragging anything along with it. We both completed the relationship.

We both were able to let each other know that we didn't want it to go that way. But since it was going to go that way anyway, we made the most of that final time. After speaking together, we gave Michael the chance to complete his relationship with his family and his friends. We also gave him the opportunity to tell us anybody that he didn't want to come there. And there were some people, just a few, that he said, "I don't want to deal with them. I don't want to see them." So, it was a new level that a lot of people experienced in relationship to him and his death. Some were shocked that they were able to complete their relationship with Michael [through their FC-talk].

Because Ellen was in love with Michael to the end, she remained open to love and was lucky to find love for a second time. Ellen has now been happily married to Wally for many years.

Ellen isn't the only one who married again following the death of a beloved spouse. Cathy, Sondra, and Victoria all talked about the importance of FC-talk as a critical tool to assist the Living in moving on past the death. All of these young wives talked about the importance of the Dying giving the Living permission, and sometimes motivation, to continue living life. In these cases, the Dying gave the living permission—even encouragement—to marry again someday. Cathy's husband, Don, was thirty-two years older than she, so he knew that she would outlive him. Don began the conversation with Cathy about marrying again long before their FC-talks, and again when he was dying. Because he knew he was that much older than I, he said that I needed to make sure that I move on. Cathy often dismissed his suggestion while he was alive, but would remember it later. She appreciated his ultimate concern for her and their daughter Christina's future happiness.

Part of the completion of the relationship for these four dying husbands was their unselfishness and release of any personal jealousy of the Living. They knew that life is meant to be lived fully, with love, just as each of these marriages had been lived. For these wives, there was not going to be any guilt or looking back with regret. Completing the relationship honored love itself by acknowledging the love that had been, and by embracing the potential for the love that would be. All four of these women married again.

Sondra's husband, Steve, died of acute leukemia. He had just had four heart attacks in a two-week period. Clearly, he didn't have much longer to live. Steve told Sondra: "I don't want you to fear death. I don't want you to mourn if I pass away." The last thing that he wanted was any fear of that. And he said, "Death is part of life." I'll never forget that. "Everybody is going to die." He told me many times that "the worst thing you could ever do is to mourn my death. Don't mourn me; rejoice because I'm in a better place." Then he said, " I want you to remarry." He made me realize that this is not something that you're going to ever become bitter over. I had always thought previously that if somebody marries somebody, that you show your real love to them [after they die] by never marrying again, and you show that devotion to that person for a long time, even past their death. And, he said, "No, you will love." And he told me that "your real love for someone is to want the best for them."

A similar message was given to Victoria byher young husband, Kerry,whowas dying of cancer. Kerry was Victoria's first love. They had married young, and she was devastated at the thought of his death. Victoria recalled: We had great passion. I had never been with anybody else beyond casual dating. And I remember sitting in the hospital and saying, "I'll never marry again, there's no way." And he said, "I sure hope you will. I hope being married to me was good enough that it'll make you want to marry again."

Victoria elaborated on the importance of this FC-talk as a love message. When he told me I'd be okay without him, that I could live without him, that I should marry again, he was providing for my family. He was attempting to make sure that we had the best we could, that I would take good care of the girls, that I would have a good life. He was just continuing to be the loving husband and father that he had been all along. He was continuing to take care of us. I have known a lot of women that weren't given that kind of permission, that gift, who really felt uncomfortable with that idea [of moving on to love again]. Her words imply that women who do not receive that gift of letting go can remain stuck in uncompleted relationships and the memory of love—sometimes for the rest of their lives.

So, what did the Living teach us about love? Many things, as we describe in our book, but three points are worth mentioning here:

• Tell the people you love that you love them. Tell them often. Tell them now. Tell them before time runs out.
• Death is a great triage nurse for love. The dying process fails to nurture pettiness and triviality, and then only love remains. Love, the highest of human emotions, is nurtured to the end. Count on it.
• When you love someone so much that you think you can't live through their death yourself, that's when you really have to make yourself participate in FC-talk. To be able to say what needs to be said does help the Living cope. FC-talk helps the Living make the transition to a life without the Dying.

About the authors: Keeley and Yingling are communication experts who personally have had final conversations with loved ones, and who interviewed over 80 volunteers who wanted to share their experiences with others. Portions of this article were excerpted from the authors' book Final Conversations: Helping the Living and the Dying Talk to Each Other (VanderWyk & Burnham, 2007).

next: Articles: The Journey Through Cancer and The Seven Levels of Healing®

Walk by any college computer lab or dorm late at night and you will see hundreds of students frantically typing away on their computer terminals - but instead of school research and paper-writing, they're most likely spending several hours every night slaying monsters at gaming sites or chatting aimlessly with Internet pals hundreds of miles or even continents away. College counselors are starting to see those students who can't stop surfing the Internet at the risk of jeopardizing their grades. And administrators fear the rise of attrition rates due to Internet misuse on campus.

Caught in the Net reveals how the combination of unstructured, free, and unlimited Internet use breed college communities of severe addicts, who are just beginning to awaken to the seriousness of plummeting grades and ruined social lives. Case studies, observations, and suggestions for a new outlook on the Internet in our universities serve as a wake-up call to students, faculty, parents, and counselors.

Dr. Young tours nationally on college campuses. Please contact us to arrange a College Lecture that will enlighten students, faculty, administrators, and college counselors. Click here to order Caught in the Net

next: Impact of Television Violence on Children
~ all center for online addiction articles
~ all articles on addictions

Book and Music

From the experience of loss, I was forced to begin a search.
Whatever it was I was looking for,
I ended up finding myself.

This book evolved from a fierce desire to know and understand myself, and the way in which individuals learn, grow and develop, (socially and spiritually), and as an expansion of my previous book, "Pools of Peace". Even though I had more than enough pages completed, I continually found myself thinking of ways to expand its contents as my own personal development and understanding expanded. I decided that "Pools" had the right amount of information within it, and further expansion on my philosopy was best put into a more detailed form.

As my thirst for knowledge of human development increased, the need for this information to be documented became paramount. Not only was there a need to share this knowledge with you, the readers, and with those who are close and dear to me, but a strange feeling of wanting to share it with myself. I believe that this came from the need to purge myself of the feelings and thoughts within. It was almost like giving myself a test on this subject that is so close to my heart; a way of laying out my inner self on paper and saying, "Yes!, this is exactly what I am feeling". Upon completion of such an exercise, the information seems to slip back into my pysche to become silently, but permanently resident within the core of my being. It is now first nature to me, and I am in a position to act without fear or reserve when any situation comes my way where Love and Compassion are the only answers.

Download a FREE book about developing Awarenessto bring about radical positive change.

continue story below

next: Getting Off the Roller Coaster Introduction

Ideas on how to improve social skills in children with ADHD as many ADHD children often lack the social skills necessary to get along with their peers and communicate with others.

How to Improve Social Skills in Children with ADHD

The direct teaching of social rules or conventions which guide interactions and which most children learn without direct input. These might include how to greet somebody, how to initiate a conversation, taking turns in a conversation, and maintaining appropriate eye contact.

Modelling of social skills such as the above for the target child to observe ; or shared viewing and discussing of a video-tape of two people talking or playing, including reference to any non-verbal messages which can be discerned.

Providing specific and structured activities which are to be shared with one or two selected classmate(s). These might range from some jobs to be completed in the school during break or lunch time, games involving turn-taking (board games based on logic or spatial intelligence such as Chess rather than games based on inference-making like Cluedo, simple card games ), tasks or mini-projects to be completed on the computer ( e.g. preparing large print labels for work to be displayed around the classroom or having the major responsibility for printing a class newsletter ).

Identifying particular skills in the target child and inviting him/her to offer some help to another child who is less advanced (e.g. if your child is really good with the computer then maybe they can help another child who may find computers more difficult).

Encouraging his or her participation in school clubs or organised/structured activities during the lunchtime.

Direct advice about when, and for how long, the child may go on about a favourite topic, perhaps with the use of a signal by which to indicate when to stop ( or not to start ! ). Giving notice of something fifteen minutes before the need to go out or change then a reminder every 5 minutes then every minute 2 minutes before the deadline - you must make sure to make it clear each time e.g. in 15 minutes we need to get ready to go to the shop, in 10 minutes we need to get ready to go to the shop, in 5 minutes we need to get ready to go to the shop, 2 minutes to get ready to go to the shop, 1 minute to get ready to go to the shop. Keep things very clear and specific.

Recognising the Viewpoints and Feelings of Other People

In the classroom setting, instructions should be very precise with no opportunity to misunderstand what is expected. It may be necessary to follow up group instructions with individual instructions rather than assuming that the target child has understood what is needed or can learn "incidentally" from watching what other children do.

Direct teaching about social situations such as how to recognise when someone is joking or how to recognise how someone else is feeling. This latter might begin with a series of cartoon faces with clearly drawn expressions indicating anger, amusement, etc., with the target child helped to identify the various feelings and guess what caused them.

Games or role play to focus upon the viewpoint of another person. This might include simply looking at pictures of children or adults interacting or working together or sharing some activity, and asking what is happening or what a given individual is doing, and what he might be thinking.

Direct teaching of what to do ( or what not to do ) in certain situations, such as when the teacher is cross either with the individual child or with the whole group.

Avoiding Social or Communications Breakdown

• Helping the child to recognise his/her own symptoms of stress or distress, with a "script" by which to try relaxation strategies ; or having in place a system where it is acceptable for the child briefly to remove him/herself from the class as necessary.
• The establishment of a "buddy" system or a system where the child in question is encouraged to observe how other children behave in particular situations.
• Having selected peers specifically model social skills. The buddy might also be encouraged to be the partner of the ADHD child in games, showing how to play, and offering or seeking help if the child is teased.
• The use of the "Circles of Friends" approach designed to identify (social) difficulties, and to set targets and strategies by which other children in the class can be helpful and supportive, with the long term aim of increasing social integration and reducing anxiety.
• The availability of a regular time slot for support from an adult in terms of feedback concerning (social) behaviour, discussing what is going well and less well, and why ; and enabling the child to express concerns or versions of events.
• A clarity and explicitness of rules in the classroom to minimise uncertainty, and to provide the basis for tangible rewards.
• Reminders about conversation rules ; and using videos of TV programmes as a basis for observing appropriate interaction.
• In a group setting, adopting the circle time strategy of limiting verbal contributions to whomsoever is in possession of some object (while ensuring that the object circulates fairly among the whole group).
• Using a video of a situation to illustrate behaviour that is inappropriate in, for example, causing irritation to other children, then and discussing why ; making a video of the target child him/herself and discussing where there are incidents of good social behaviours.
• In respect of repetitive questioning or obsessive topics of conversation ......... :
• Provide a visual timetable plus bulletins of any innovations so there is no uncertainty about the day's routine.
• Make it clear that you will only respond to a question when a given task has been completed.
• Agree a later time for responding to the question and allow the child the opportunity to write it down so they don't forget.
• Specify one particular place, such as the playground, where the question will be answered.
• Explain quietly and politely that the child has asked this before and maybe suggest that it might be a good idea to write down the answer so that the next time they want to ask the same question rather than you becoming a bit exasperated with them that they can pick up the card where the answer is written.
• If obsessive talking appears to mask some anxiety, seek to identify its source, or teach general relaxation techniques.
• Specify times when the obsessive topic can be introduced, or allow an opportunity as a reward for finishing a piece of work.
• Provide time and attention, and positive feedback, when the child is not talking about the given topic.
• Agree with the child and his classmates a signal to be used by those classmates when they are tired of the topic.
• Allow some practice of talking at a reasonable volume, with an agreed signal to be given if it is too loud ; or tape-recording speech so that the child can evaluate the volume him/herself.

Peer Awareness

A common theme in much of the on going research and studies about social skills in the child with ADHD is that the work intended to help the child needs to involve other children to at least some extent. If the focus is upon peer interaction, there is little logic in seeking to improve performance by using only one to one sessions.

It would therefore be desirable for perhaps two or three non-ADHD peers to participate in the activities or video watching so that there could be a shared discussion and an actual possibility to practice some of the skills by the children in various make believe situations and not simply by target child and adult. This latter arrangement risks being somewhat abstract when evidence suggests the value of working on social skills within a social context.

Also, if peers are involved in the training strategies and share the same rules, this may reduce stress upon the ADHD child and increase the rate at which (s)he internalises the targeted behaviours in real situations they can identify with.

The idea that simply placing a child with ADHD in a mainstream class will not actually be the solution for that child to develop socially appropriate behaviours. There needs to be direct teaching or modelling of the behaviours, and it is likely that the number of such behaviours needs to be limited to one or two at a time if true learning and consolidation is to take place.

Learning from peers can take three forms:

Where the target child is placed within a group of peers whose positive social skills will be modelled constantly by others and where it has been made clear to the ADHD child what to observe and imitate. So the need to explain carefully what you want your child to watch the other children doing needs to be fairly specific - e.g. watch how this group take turns to throw the dice in the game.

The training approach involves peers being shown how to prompt some particular response from the child with ADHD and then to offer praise when the child acts appropriately. So the group you are working with need to know exactly what you are wanting your child to learn - e.g. turn taking so they can go round with the dice with the person with the dice passing this to the next child saying it is now your turn to throw the dice all round the group until it comes to your child's turn. Then the child before can hand your child the dice and say clear that it is now their turn to throw the dice and thank them for waiting nicely for everyone else to have their turn. Then once the child has thrown the dice for them to then pass the dice to the next child saying it is now your turn to throw the dice when that child can then say thank you for giving me my turn. Things like this although may sound very strange help our children to learn the idea of turn taking by constant reinforcement as they learn much better by various forms being taken - watching - speaking the instruction and then interaction of praise for getting it right.

The peer-initiated approach involves showing peers how to talk with the ADHD child and how to invite him or her to respond. It enables the other children to learn that this particular child has a problem and that you are trusting them to help the child to learn how to take part correctly, this therefore also helps the other children to work on the skills they need to continue to involve the child in other activities by asking them in the right manor and how to explain the rules in a way your child will understand in the future.

There is evidence that involving all children in the development of social skills has more benefits than working with the targeted child(ren) only ; there is also the point that this approach avoids singling out the child with the ADHD characteristics which might otherwise introduce a further disadvantage before one even begins ! There is a similar risk in a constant pairing of the ADHD child with a support assistant in that a dependency may be established, and any need or motivation to interact with other children is reduced.

A further implication behind all this is that there will be benefits in providing some sensitive awareness-raising among classmates of the nature of ADHD characteristics and behaviours. There is evidence ( e.g. Roeyers 1996) that giving peers this kind of information can improve the frequency and quality of social interaction between the ADHD child and classmates ; and that it can increase empathy towards the ADHD individual whose idiosyncrasies become more understandable and are not seen as provocative or awkward.

The whole point of this being a Social problem leads everyone to realise that the best way to help your child is to involve them in controlled social situations as this helps not only your child but it also allows others to learn how to involve your child in other situations without this causing as many problems as it may have done in the past.

REFERENCES

• Roeyers H. 1996 The influence of non-handicapped peers on the social interaction of children with a pervasive developmental disorder. Journal of Autism and Developmental Disorders 26 307-320
• Novotini M 2000 What Does Everyone Else Know That I Don't
• Connor M 2002 Promoting Social Skills among Children with Asperger Syndrome (ASD)
• Gray C My Social Stories Book
• Searkle Y, Streng I The Social Skills Game (Lifegames)
• Behaviour UK Conduct Files
• Team Asperger Gaining Face, CD Rom Game
• Powell S. and Jordan R. 1997 Autism and Learning. London : Fulton.
  (With particular reference to the chapter by Murray D. on autism and information technology )

next: Natural Alternatives: Super Blue Green Algae for ADHD
~ back to adders.org homepage
~ adhd library articles
~ all add/adhd articles