Many children with ADHD have problems with self-esteem. Why? And how can you improve your child's self-esteem?

What is Self-esteem?

There are so many definitions bandied around. We like to think of it simply as being comfortable in your own skin. In children, we like to see it as a kind of protective covering that protects them from the sometimes harshness of life making more able to weather the storm, more able to cope with conflict in life, more realistic and more optimistic too. And as parents, we play a crucial role in determining how our kids see themselves.

Self-esteem is about self-value. It's not about being bigheaded or bragging. It is about how we see ourselves, our personal achievements and our sense of worth.

Self-esteem is important because it helps children feel proud of who they are and what they do.

It gives them the power to believe in their abilities and the courage to try new things. It helps them develop respect for themselves, which in turn leads to being respected by other people.

We can all get some comfort from knowing that there are no absolute right or wrongs in parenting, no expert can give advice about our own particular situation, as every parent and child is totally unique, it would be impossible to know accurately what each individual situation was like and therefore impossible for any expert to have THE answer.

The thing about nourishing self-esteem in our children is that it starts with us as the parent and our own self-esteem. As the quote goes:

'Worry not so much what you say to your child but what you do when you're around them'

Our children notice how we are all the time, which is why we promote the concept of being great role models to our kids and 'being the behaviour you want to see'

So as we move on we must all start off by recognising that we are all doing the best we can for our children and therefore we need to start by giving ourselves a pat on the back for what we are doing well. We need to celebrate our successes with our child and if there are things we read, we would like to have a go at or like to do more of, then make a mental note and start practicing in small steps. We must also celebrate our progress along the way and be kind to ourselves if we get it wrong or fall down along the way.

How is Self-esteem Affected by ADHD?

Your child's self-esteem is shaped by:

• how s/he thinks
• what s/he expects of his/herself
• how other people (family, friends, teachers) think and feel about him/her

Many children with ADHD have problems in school and with teachers and sometimes have difficulties at home. They find it difficult to make and keep friends.

People often don't understand their behaviour and judge them because of it. They disrupt situations, often gaining punishments, so they may find it easier not to bother trying to fit in or do work at school.

All this means children with ADHD often feel bad about themselves. They might think they're stupid, naughty, bad or a failure. Not surprisingly, their self-esteem takes a battering and they find it hard to think anything positive or good about themselves.

The Problem of Exclusion

Hyperactive, disruptive behaviour is a key factor of ADHD. Children with ADHD can't help behaving this way, but teachers trying to cope with a disruptive child may deal with it by excluding her from the classroom.

Birthday parties and social events are a natural part of growing up, but other parents may not want to invite a child who is known to have bad behaviour. Again, this can lead to a child with ADHD being excluded.

Exclusion only adds to your child's negative feelings and reinforces the idea that they are naughty.

How Can You Improve Your Child's Self-esteem?

If your child is lacking in self-esteem, there are things you can do to help.

Praise and reward: you need to make your child feel positive about them self, so try and give praise wherever possible. This can be for large or small actions - for example, if they have tried hard at school or helped clear up after a meal. As well as verbal praise, giving small rewards can highlight accomplishments. Get them to exercise their own judgment and praise themselves.

Love and trust: don't attach conditions to your love. Your child needs to know you love her no matter how she behaves. Tell your child she's special and let her know you trust and respect her.

Goals: set goals that are easily achieved and watch your child's confidence grow.

Sports and hobbies: joining a club or having a hobby can build self-esteem. Depending on your child's interests, the activity could be swimming, dancing, martial arts, crafts or cooking. No matter what the hobby, your child will gain new skills to be proud of - and for you to praise. Sometimes children with ADHD will go off their activity, so be prepared to come up with new ideas.

Focus on the positive: get your child to write a list of everything they like about them self, such as their good characteristics and things they can do. Stick it on their bedroom wall or in the kitchen, so they see it every day. Encourage your child to add to it regularly.

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How Can We Promote Self Esteem in Our Children

Allow your children some opportunities to be themselves, letting them choose an activity: remember the story about the parent who went to the zoo and let their child explore the zoo on their agenda. It was so frustrating for the parent who wanted the child to see as much as possible and so rewarding for the child who wanted to spend 2 hours with the penguins!

• Help them develop their own tools for problem-solving, resist the temptation to solve for them, and offer support instead.
• Involve your children in discussions, if they are old enough, about what to do if they misbehave, ask them what they could do to prevent it happening again, and what support, if any, do they need from you. Avoid labeling or name calling, even in your mind.
• Remain firm, fair and consistent with discipline.
• To be consistent takes resources, so spend time doing what you need to do to stay calm and patient.
• Listen to your child, pay full attention, with lips shut to show them that what they say really matters to you.
• Use the language of self-esteem, 'decide', 'choice', and stress the consequences of choices with your child.
• Make it safe to fail, for you and for them, remember it's OK to apologise if you get it wrong.
• Respect is a 2-way thing - we cannot expect a child to learn to respect others if we do not show them respect from which they can learn this from.
• Become a positive role model, if you are excessively harsh on yourself; pessimistic or unrealistic about your abilities your child may eventually mirror you. In contrast, if you nurture your own self-esteem your child will have a great role model.
• Show your love to your child.

Remember just like us, children do not acquire self-esteem at once, nor do they always feel good about themselves in every situation. If your child is feeling down you could try this small exercise. You could help them to write a letter to a make-believe child who is also having a bad day, let your child advise the make-believe child on how to feel good about themselves.

Getting and Giving Criticism

There are times when criticism is necessary, but children with low self-esteem aren't good at accepting criticism - or giving it nicely.

How you give criticism is important. Criticism is the other part of making your child feel loved: sarcastic, negative comments can undo all your hard work to be encouraging. So is there such a thing as good criticism?

If you want to teach your child how to accept criticism, you need to give it in a constructive way.

This means being calm, not angry, and focusing on the behaviour you want to change instead of criticising the person. It also helps if you can find positive things to say to balance the criticism. Using 'I' tends to be less aggressive than 'you'.

So if your child is struggling with a piece of school work, don't say 'you're stupid', but 'I loved the way you read the first page. It's only a couple of words you're stumbling on. That word is...'

All these things apply when your child gives criticism. For example, 'I like playing with you, but it's too cold to play outside today.'

Dealing with Criticism

The best way for your child to deal with criticism is to:

• listen to what's being said. Don't interrupt to contradict or make excuses.
• agree with it, where possible.
• ask questions if unsure about anything.
• admit mistakes and apologise.
• calmly disagree if it's unfair, e.g. by politely saying, 'I don't agree with you'.

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Learn about mental health conditions associated with self-injury and the types of self-harm.

Self-injurious behavior is common in the following conditions:

• Borderline Personality Disorder
• Mood Disorders
• Eating Disorders
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Dissociative Disorders
• Anxiety Disorders and/or Panic Disorder
• Impulse-control Disorder Not Otherwise Specified
• Self-injury as a diagnosis

Self-injury Itself as a Diagnosis

Favazza and Rosenthal, in a 1993 article in Hospital and Community Psychiatry, suggest defining self-injury as a disease and not merely a symptom. They created a diagnostic category called Repetitive Self-Harm Syndrome.

The diagnostic criteria for Repetitive Self-Harm Syndrome include: preoccupation with physically harming oneself repeated failure to resist impulses to destroy or alter one's body tissue increasing tension right before, and a sense of relief after, self-harm no association between suicidal intent and the act of self-harm not a response to mental retardation, delusion, hallucination

Miller (1994) suggests that many self-harmers suffer from what she calls Trauma Reenactment Syndrome.

As described in Women Who Hurt Themselves, TRS sufferers have four common characteristics:

1. a sense of being at war with their bodies ("my body, my enemy")
2. excessive secrecy as a guiding principle of life
3. inability to self-protect
4. fragmentation of self, and relationships dominated by a struggle for control.

Miller proposes that women who've been traumatized suffer a sort of internal split of consciousness; when they go into a self-harming episode, their conscious and subconscious minds take on three roles:

1. the abuser (the one who harms)
2. the victim
3. the non-protecting bystander

Favazza, Alderman, Herman (1992) and Miller suggest that, contrary to popular therapeutic opinion, there is hope for those who self-injure. Whether self-injury occurs in tandem with another disorder or alone, there are effective ways of treating those who harm themselves and helping them find more productive ways of coping.

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Types of Self-Harm

Self-injury is separated by Favazza (1986) into three types. Major self-mutilation (including such things as castration, amputation of limbs, enucleation of eyes, etc) is fairly rare and usually associated with psychotic states. Stereotypic self-injury comprises the sort of rhythmic head-banging, etc, seen in autistic, mentally retarded, and psychotic people. The most common forms of self-mutilation include:

• cutting
• burning
• scratching
• skin-picking
• hair-pulling
• bone-breaking
• hitting
• deliberate overuse injuries
• interference with wound healing
• and virtually any other method of inflicting damage on oneself

Compulsive Self-harm

Favazza (1996) further breaks down superficial/moderate self-injury into three types: compulsive, episodic, and repetitive. Compulsive self-injury differs in character from the other two types and is more closely associated with obsessive-compulsive disorder (OCD). Compulsive self-harm comprises hair-pulling (trichotillomania), skin picking, and excoriation when it is done to remove perceived faults or blemishes in the skin. These acts may be part of an OCD ritual involving obsessional thoughts; the person tries to relieve tension and prevent some bad thing from happening by engaging in these self-harm behaviors. Compulsive self-harm has a somewhat different nature and different roots from the impulsive (episodic and repetitive types).

Impulsive Self-harm

Both episodic and repetitive self-harm are impulsive acts, and the difference between them seems to be a matter of degree. Episodic self-harm is self-injurious behavior engaged in every so often by people who don't think about it otherwise and don't see themselves as "self-injurers." It generally is a symptom of some other psychological disorder.

What begins as episodic self-harm can escalate into repetitive self-harm, which many practitioners (Favazza and Rosenthal, 1993; Kahan and Pattison, 1984; Miller, 1994; among others) believe should be classified as a separate Axis I impulse-control disorder.

Repetitive self-harm is marked by a shift toward ruminating on self-injury even when not actually doing it and self-identification as a self-injurer (Favazza, 1996). Episodic self-harm becomes repetitive when what was formerly a symptom becomes a disease in itself. It is impulsive in nature and often becomes a reflex response to any sort of stress, positive or negative.

Should self-injurious acts be considered botched or manipulative suicide attempts?

Favazza (1998) states, quite definitively, that self-mutilation is distinct from suicide. Major reviews have upheld this distinction. A basic understanding is that a person who truly attempts suicide seeks to end all feelings whereas a person who self-mutilates seeks to feel better. Although these behaviors are sometimes referred to as parasuicide most researchers recognize that the self-injurer generally does not intend to die as a result of his/her acts. Many professionals continue to define acts of self-harm as merely and totally being symptomatic of borderline personality disorder instead of considering that they may well be disorders in their own right.

Many of those who injure themselves are strongly aware of the fine line they walk but are also resentful of doctors and mental health professionals who define their incidents of self-harm as suicide attempts instead of seeing them as the desperate attempts to release the pain that needs to be released in order to not end up suicidal.

Author Chris Zeigler Dendy shares struggles and challenges of raising teenagers with ADHD and provides tips for parenting ADHD teens.

Part I: The first in a two part series.

Parenting a teenager with ADHD may be compared to riding a roller coaster: there are many highs and lows, laughs and tears, and breathtaking and terrifying experiences. Although parents crave calm uneventful weeks, unsettling highs and lows are more likely the norm with these teenagers.

The Challenges

Without a doubt, raising sons with ADHD has been the most humbling and challenging experience of my life. Even with my background as a veteran teacher, school psychologist, mental health counsellor and administrator with over thirty years experience, I often felt inadequate and doubted my parenting decisions.

Parenting these children is not easy for anyone! A wise child psychiatrist once observed, "I'm so glad I had the opportunity to raise 'an easy child' in addition to my child with ADHD. Otherwise I would have always doubted my parenting skills." Obviously, there are no simple parenting or counselling answers. We all--the child, parents, and professionals--struggle with the best way to treat this condition.

During adolescence, the "job descriptions" for parents and teens are often in conflict. The parents' primary job is to gradually decrease their control, "letting go" of their teenager with grace and skill. In contrast, the teenager's main job is to begin the process of separating from his parents and becoming an independent, responsible adult. For better or worse, part of the teen's job is to experiment with making his own decisions, testing limits, and exercising his judgment. When the teen starts this process, parents may feel they are "losing control". Ironically, the natural tendency is to exert even more control. After all, giving freedom and responsibility to teenagers with ADHD is enough to unnerve even the most stout-hearted parent.

Unfortunately, for teens with ADHD, several factors complicate the process of growing up. First and foremost, the four to six year developmental delay exhibited by most teens with an attention deficit often causes problems. A 15 year-old may act as though he were 9 or 10 but thinks he should have the privileges of a 21 year-old. They are more impulsive than their classmates and seldom think of consequences before they act. Chronologically (by virtue of age), teenagers are ready to assume their independence; developmentally (by virtue of maturity) they are not.

Secondly, they are more difficult to discipline than their peers; they do not learn from rewards and punishment as easily as other teens. Early on, parents learn that punishment alone is ineffective. Furthermore, use of physical punishment is no longer a viable parenting strategy. Behavioural interventions effective in childhood such as, "time out" or "stars and charts", lose much of their effectiveness during the teen years. Unfortunately, their emotionality, low frustration tolerance, and tendency to "blow up" make it difficult to resolve problems calmly.

Third, coexisting problems such as, learning disabilities, sleep disturbances, depression, or executive function deficits are extremely common and make it more difficult to develop an effective treatment plan.
With all these challenges, we parents worry and worry some more about our children. What does the future hold? Will our teenager ever graduate from high school, much less go to college? Will he be able to hold down a steady job? Does he have the skills to cope with life?

Looking Back On the Teenage Years

During the teen years, our sons both struggled terribly. As expected, my husband and I faced the typical teen challenges associated with ADHD: poor school performance, forgetfulness with chores and homework, disorganization, losing things, messy rooms, disobedience, talking back, low frustration tolerance, lack of awareness of time, and having a sleep disturbance.

1. School was always the major source of conflict with our sons. Both our boys did okay in elementary school. However, they fell apart in middle school when they had more classes and teachers, had greater academic demands placed on them and were expected to be more responsible and independent. Developmentally they were not ready to complete their work independently. Both boys struggled academically in middle and high school and were in real danger of failing classes. Failure to complete homework or chores was a source of daily battles. The zeros for failure to turn in homework alternately baffled and infuriated us. It was not unusual to go into final exams with a passing grade hanging in the balance. Will they pass or fail? We didn't always know.

2. Emotionally charged conflicts were also common. Our children didn't always do as we asked. Obviously, their disobedience and our yelling battles were frustrating and a major source of embarrassment. As a result we often harboured grave doubts about our own parenting skills. Fear and frustration were our constant companions and at times overwhelmed us. Our reactions ranged from anger and depression to verbal attacks upon our children.

3. Sleep problems were the underlying cause of ongoing fights before school each morning. I can't believe it took us so long to recognize that our son's sleep disturbance--difficulty falling asleep and waking up--was a serious handicap. Unfortunately, most treatment professionals never addressed this issue. But the problem is so obvious: if a student is experiencing sleep deprivation, he cannot do well in school.

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Behaviours That Worry Parents the Most

When our sons were teenagers we were frightened by some of their actions. In those days we lacked basic information about the challenging behaviors teenagers with ADHD often exhibit. Subsequently, Dr. Russell Barkley's research has been especially helpful. Awareness of these potential trouble spots often helps parents anticipate problem areas, implement preventive strategies, avoid being unnecessarily frightened and subsequently overreacting to misbehaviour. Here are a few of the more serious behaviours about which we worried the most, along with brief tips from Teenagers with ADD and ADHD.

1. Driving and ADHD. Both our boys received more than their share of speeding tickets. Initially we were baffled by this behaviour. At the time, we were not aware of Dr. Barkley's research that our ADHD teens are four times more likely to get speeding tickets than other drivers.

Tips:

1. Send to driver training classes.
2. Gradually increase driving privileges as they drive safely and without tickets.
3. Talk with the doctor about taking medicine while driving during the early evening.
4. Link driving privileges to responsible behaviour, e.g. for child who is failing a class, try "When you bring home a weekly report with all work completed, you will earn the privilege of driving to school next week." This gives parents greater leverage to influence behaviour. Helpful tips are also available in ADHD and Driving by Dr. Marlene Synder.

2.Substance Use and ADHD. Experimenting with substances is also something many parents worry about a great deal. Children with ADHD may be more likely to experiment with substances plus tend to start at earlier ages. Substance experimentation may progress to abuse and eventually evolve into the more serious medical problem of addiction. The greatest risk for substance abuse is among children with more complex coexisting conditioning, e.g., ADHD and Conduct Disorder or ADHD and Bipolar.

Several factors are often linked to substance abuse:

• having friends who use substances
• being aggressive and hyperactive
• school failure
• low grades
• poor self-esteem

Keep in mind, even if the teenager wants to stop using substances, he may not be able to take that step. So nagging will not help. Don't be judgmental or preachy! If your child is experiencing serious substance abuse problems, convey a sense of deep concern and help him find professional help.

Tips:

1. Be aware of your child's friends and subtly influence his choice of companions as much as possible, e.g., "Would you like to invite John or Mark?"
2. "Fine-tune" the treatment plan until serious aggression and hyperactivity are brought under control, e.g. teach anger management or adjust medications for better results.
3. Educate yourself and your child about substances and signs of abuse.
4. Avoid scare tactics.
5. Provide supervision.
6. Ensure success at school.

3.Suicide Risk and ADHD. Underneath their tough "I don't care" veneer, these teenagers are often very sensitive and hide a lot of pain and hurtful life experiences. The risk of a suicide attempt is a very serious concern. One research study indicated that attempts occurred in between 5-10 percent of students with ADHD. On a couple of occasions we personally came face to face with the frightening knowledge that our sons were so depressed and their self-esteem so battered that they were at risk for a suicide attempt. One parent shared this personal story: "We could never quite see misbehaviour the same after hearing our son say, 'I wish I could go to sleep and never wake up.' I sat up all night reassuring him we would work out whatever problems he faced. We were humbled, realizing that we needed to re-evaluate our parenting styles."

Tips:

1. Become familiar with the warning signs of suicide risk.
2. Take any threat to commit suicide seriously and seek professional help.
3. In the interim, listen to him talk about his concerns.
4. Ask about suicidal thoughts. "Have you considered harming yourself?
5. Tell him how devastated you would be if anything happened to him.
6. Remove potential weapons or dangerous medications from home.
7. Keep him busy plus provide supervision (engage in sports, movies, or video games).

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4.Brushes with law enforcement are not uncommon. These ADHD children act impulsively, which may result in their being "invited" to juvenile court. If that happens in your family, don't overreact and assume that your child is going to be a delinquent. Obviously, brushes with the law often give parents a clear signal that the teenager is struggling and needs more guidance and supervision.

Tips:

1. Be aware of the factors contributing to delinquency. "Deviant" friends who are breaking the law and abusing substances are influential factors. Here's a piece of interesting trivia: the peak time for juvenile crime is right after school.
2. Keep your teenager busy after school or provide supervision. If necessary, hire a cook/housekeeper to keep an eye on things at home.
3. Some mothers may decide to work part-time so they can be home when their children are home.
4. Identify the problem behaviours, implement an intervention strategy, and believe that you and your child will cope with the crisis.

Generally speaking, my husband and I were watchful of our sons' activities, tried to keep them busy with wholesome activities, knew their friends, knew where they were and with whom, provided inconspicuous supervision, offered our home as a place for teenage friends to congregate, and sought "win-win" compromises when they proposed unacceptable activities.

In Closing:

In spite of the challenges these children with ADHD present, my view of the long-term outcome of adults with ADHD is probably more positive than most people. ADHD runs in my family and the people I know with this condition have been successful in their chosen careers. By sharing my family's experiences, both the good and bad, it is my goal to give you critical information about your teenager plus a sense of optimism that your family will cope successfully with ADHD. Like most parents of children with ADHD, my husband and I were victims of a code of silence regarding our children's behaviour. We thought we were the only family to experience these ADHD behaviours and were too embarrassed to tell anyone about our children's failures and misbehaviour. So we share this information with you now, so that you will know that you are not alone on this journey. Because we have survived the ride, we can offer a sense of hope for a brighter future based upon our own first-hand experience.

References:

Barkley, Russell A. Attention Deficit Hyperactivity Disorder. New York: The Guilford Press, 1998.
Dendy, Chris A. Zeigler Teaching Teens with ADD and ADHD (Summary 28). Bethesda, MD: Woodbine House, 2000 Dendy, Chris A. Zeigler Teenagers with ADD. Bethesda, MD: Woodbine House, 1995.

About the author: Chris Dendy has over 35 years experience as a teacher, school psychologist, mental health counselor and administrator plus perhaps more importantly, she is the mother of two grown sons with ADHD. Ms. Dendy is the author of two popular books on ADHD and producer of two videotapes, Teen to Teen: the ADD Experience and Father to Father. She is also cofounder of Gwinnett County CHADD (GA) and a member and Treasurer of the national CHADD Board of Directors.

For more information contact CHADD at 8181 Professional Place, Suite 201, Landover, MD 20875; http://www.chadd.org/

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Believing a child's behavior problem is always the result of bad parenting is simply not true. But parents can get help to better deal with the behavior problem.

We've all seen it - a little girl throwing a fit in the bread aisle or a little boy kicking and screaming in front of the fragrance counter. Most parents have seen their own child behave the same way from time to time. Yet, it's common for people to react to this kind of behavior by blaming the parent.

Being a parent is hard, and all parents are bound to make some mistakes. Different parents use different parenting techniques. Some parents try to negotiate. Others use "time-out." Sadly, some parents become so frustrated and embarrassed by their child's behavior that they do resort to slapping, shaking or yelling at the child. Some seem to do nothing.

However, believing that a child's behavior problem is always the result of bad parenting is like believing poor grades are always the result of an ineffective teacher. Even the best teachers have students who get poor grades, and even the best parents can have a child with a behavior problem. The fact is that behavior problems can be a sign of mental and emotional problems.

Some parents simply do not have the knowledge, skills or support they need to help them manage a child's behavior problem. Parents often are dealing with their own issues, such as unemployment, poverty or illness.

In spite of these challenges, all parents have strengths. Most parents know from experience what a child needs most. Parents are committed to both their child and their community. Parents are dedicated to helping children grow healthy and strong. Most of all, parents have a "built-in" motivation to do what's best for their child (read some Parenting Quotes for inspiration.).

By building on these kinds of strengths, parents can develop better ways to take charge of their lives and to succeed. The key, however, is to find out what those strengths are.

"I don't see dysfunctional families," says Barbara Huff, Executive Director of the Federation of Families for Children's Mental Health. "I see families that are over-stressed and under-supported."

There are many resources available to parents who have a child with a mental, emotional or behavioral problem. The federal Center for Mental Health Services, a component of the Substance Abuse and Mental Health Services Administration, can tell you about services and support programs in your area. Many of these organizations have mentoring programs, support groups, parenting classes or respite care.

How do we know these kinds of programs work?

"When you build on child and family strengths," says Huff, "what you get is what kids do best and what families do best."

Sources:

• National Mental Health Information Center

Visualization is used to treat alcohol and drug addictions, depression, panic disorder, phobias, and stress. Learn more about visualization.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Visualization involves the controlled use of mental images for therapeutic purposes. It has been proposed that the use of imagery in visualization may correct unhealthy attitudes or views. People who practice this mind-body technique call on memory and imagination. In some regards, visualization is similar to hypnosis or hypnotherapy. The technique is usually practiced alone. Visualization audiotapes are available.

Theory

The theoretical basis of visualization is that the mind is able to cure the body when visualized images evoke sensory memory, strong emotions or fantasy. There has been limited scientific study of the effectiveness or safety of visualization. Visualization is sometimes considered a subtype of guided imagery.

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Evidence

There is no evidence for this technique.

Unproven Uses

Visualization has been suggested for many uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using visualization for any use.

Anxiety Bone marrow transplant (adjunct therapy) Cancer Depression Immune activity

Neurological rehabilitation Pain Psychological disorders Psychological disorders associated with nursing homes Stress-related disorders

Potential Dangers

Visualization is generally regarded as safe in most people, although safety has not been thoroughly studied. In theory, inward focusing may cause pre-existing psychological disorders to surface. Use of visualization should not delay the time it takes to see a health care provider for potentially severe medical conditions.

Summary

Visualization has been suggested for a number of health conditions, although there has been limited scientific study in this area. It is not recommended that you rely on visualization alone to treat potentially severe illnesses. Speak with your health care provider if you are considering visualization.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Visualization

Natural Standard reviewed more than 35 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Cohen MH. Regulation, religious experience, and epilepsy: a lens on complementary therapies. Epilepsy Behav 2003;4(6):602-606.
2. Crow S, Banks D. Guided imagery: a tool to guide the way for the nursing home patient. Adv Mind Body Med 2004;20(4):4-7.
3. Kimura H, Nagao F, Tanaka Y, Sakai S. Beneficial effects of the Nishino breathing method on immune activity and stress level. J Altern Complement Med 2005;11(2):285-291.
4. Lang EV, Benotsch EG, Fick LJ, et al. Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000;355(9214):1486-1490.
5. Miyake A, Friedman NP, Rettinger DA, et al. How are visuospatial working memory, executive functioning, and spatial abilities related? A latent-variable analysis. J Exp Psychol Gen 2001;130(4):621-640.
6. Morganti F, Gaggioli A, Castelnuovo G. The use of technology-supported mental imagery in neurological rehabilitation: a research protocol. Cyberpsychol Behav 2003;6(4):421-427.
7. Sahler OJ, Hunter BC, Liesveld JL. The effect of using music therapy with relaxation imagery in the management of patients undergoing bone marrow transplantation: a pilot feasibility study. Altern Ther Health Med 2003;9(6):70-74.

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Getting Off The Rollercoaster

Included with this book is an option to purchase an Audio Cassette of seven inspirational songs I have composed. You will find the words printed for your convenience in these closing pages.

The following is a list of seven inspirational songs I have composed

1. Don't Let Go of Your dreams
2. The Believing Way
3. Miracles Matter
4. Breakaway
5. Don't be Afraid
6. Talk to Me
7. It's gonna be Alright

Don't Let Go of Your dreams

by Adrian Newington. © 1991

This is the day,
the rest of your life will begin.
A new world of Love,
a new world of Peace to live in.
And the walls that you've built can come down.
And the Love in your heart can come out.

(Chorus)

Don't let go of your dreams.
Always believe, in the freedom they'll bring.
Don't let go of your dreams.
In your Love is your Life,
and your life has meaning and worth.

Quite and still,
this is the way you will learn.
There in your heart,
a Love to help you return.
From the many rods, you have crossed.
While searching for Love never lost.

(Chorus)

Don't let go of your dreams.
Always believe, in the freedom they'll bring.
Don't let go of your dreams.
In your Love is your Life,
and your life has meaning and worth.

So long you've been away,
trying to find your love.
So long you've been confused,
from daring to be,
what you thought you should be.

(Chorus)

Don't let go of your dreams.
Always believe, in the freedom they'll bring.
Don't let go of your dreams.
In your Love is your Life,
and your life has meaning and worth.

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Getting Off The Rollercoaster

The Believing Way

by Adrian Newington. © 1990

Composed by my Awakening to the value of Persistence of Faith in ones own abilities, and the Actions of Life which respond to those who maintain such attitudes.

Let me tell you 'bout a way to change your life.
That can make your dreams unfold before you eyes.
But you've got to break the link.
and change the way you think.
For there's a chain that binds,
and it'll drag you down each time.

First of all you've got to open up your heart.
And let go of feelings locked within your past.
Then a wonderful peace,
will come when you release,
and you start to see,
how your life can turn around.

(Chorus)

It's the believing way.
And it'll bring you happy days.
And it's a Giving way,
it's a Loving way
It's the believing way.
And you will come to understand.
That your destiny can change,
by your own hand.

Anything that you believe in can come true.
But your Patience and your Faith must see you through.
Keep your head up high.
Don't let the world deny,
all the things,
that you believe can come your way.

(Repeat Chorus)

Miracles Matter

by Adrian Newington. © 1989

Many times in our lives we are graced with simple gifts that tend to go un-noticed as we live our complex lives. But in the stillness of True Self, we will find much beauty abounding. That beauty is all around us and within us.

The scarlet light,
of evening skies,
the moon that softens up the night.
The mountain snows,
the wind that blows,
the changes to our lives.
In a Yellow Rose,
is what nature knows,
and nature is God's wisdom out on show.

(Chorus)

Miracles matter, they help you believe.
Miracles Matter, they're what we need.
Miracles matter, open your eyes.
Miracles matter, understand why.

An answered prayer,
people who care,
someone who's got some Love to share.
The will to strive,
when things aren't right,
a helping hand at the right time.
A baby's cry,
and happy times,
the Love between you and I.

(Repeat Chorus)

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Getting Off The Rollercoaster

Breakaway

by Adrian Newington. © 1987.

This song was a gift to myself and a dear friend of mine, to help us get by the early stages of Separation and Divorce that we were both experiencing at the same time.

Well I've been thinkin' about you,
and been wondering what's going through your mind.
I guess you're thinkin' about me,
Well I'm alright and I am doin' fine.
We were forced to the wall,
but still we found the strength to go on.

(Chorus)

It's time to breakaway from the old ways.
It's time, to make way for the new days,
it's time, it's time to breakaway.
It's time to breakaway... Breakaway!

Well I've been thinkin' about you,
and I can see you've got yourself back in line.
I guess you're thinkin' about me,
I'll play it cool and make the most of time.
We were hopelessly lost,
but still we found our way to the top.

(Repeat Chorus)

Well I've been thinkin' about you,
You'll be right just give yourself some time.
I guess you're thinkin' about me,
I'll play it cool and make the most of time.
We've got to follow our dreams,
this time 'round it's gonna work out.

(Repeat Chorus)

Don't be Afraid

by Adrian Newington. © 1987

This song was composed from the feelings of compassion I experienced after a friend revealed to me, that her Father had behaved in the most inappropriate way possible that any Father could with a young Daughter. Though the song was meant for one, I sing it for many in the hope that my Love through my music, may touch your heart with friendship and understanding.

Don't be afraid of the nightime.
Don't let your fears take you over.
If you want to,
I can show you,
a brand new day.
So you don't have to be afraid,
of the nightime, anymore.

You said to me,
you've been living, in a shadow.
I thought that I could bring you,
into sunlight.
If you hear, what I'm sayin'
I'll offer you a way.
So you don't have to be afraid,
of the nightime, anymore.

My wish for you is to lead a life,
in the sunshine.
And if you need, a helping hand,
you can have mine.
At the dawn, there's no sorrow,
all things are passing by.
So you don't have to be afraid,
of the nightime, anymore.

---

Getting Off The Rollercoaster

Talk to Me

by Adrian Newington © 1990

I composed this song for a dear friend of mine and her family. My friends niece developed a serious medical condition which sent the young girl into a coma, and this my way of saying that I was always thinking of them in my heart and in my prayers.

The song is Jesus singing to my friend and her family.

I am what your troubled heart yearns for.
I have seen your tears,
and I know your fears.
I have life and Love to give to you.
If you would talk to me,
if you'd believe in me.

(Chorus)

Anytime you call,
trust that I can hear,
when your heart aches,
for one you Love.
I have only Love,
I long to give to you,
but all I ask of you,
is Love me too.

Simple words I long to hear from you.
No matter where you are,
No matter what you do.
Freedom in your heart I'll give to you.
To know my Love with ease.
To walk in three fold peace.

(Repeat Chorus)

I am what your troubled heart yearns for.
If you would talk to me.

It's gonna be Alright

by Adrian Newington. © 1990

This song will always remind me of a profound Peace that descended upon me in a period of sorrow. In an touch, I was transported from sorrow to joy, and could not help but immediately respond to this new peace and joy by the expression through song. Within five or so minutes, I had the essence of the song, and the rest just followed very soon after.

A peaceful feeling came to me today.
What I needed most, to take my tears away.
In a touch the shadows deep inside,
made way for Love as tears subside,
by a voice that whispered gently to my heart.
And it said...

(Chorus)

It's gonna be alright.
Everything is gonna work out fine.
It's gonna be alright.
Everything is work out fine.
It's gonna be alright,
it's gonna be alright.

I never knew this peace could ever be.
To think it's always been inside of me.
There when I was most in need,
gentle thoughts would come to me.
To teach me how to listen to my heart.

(Repeat Chorus)

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next: Getting Off the Roller Coaster Bibliography

Three studies reveal ways to help kids get to healthier weights.

Childhood obesity is growing at an alarming rate, but experts say parents are more powerful than they imagine at helping kids fight the problem.

About 17 percent of US children and teens, ages two to 19, are overweight, according to the US National Center for Health Statistics.

But three studies presented at the Pediatric Academic Societies annual meeting offer ways to help kids get to healthier weights.

Helping your child have good self-esteem can motivate him or her to lose weight, found Kiti Freier, Ph.D., a pediatric psychologist at Loma Linda University in Loma Linda, Calif.

When she interviewed 118 overweight children participating in a 12-week program, she found that good self-image was even more important than how much excess weight they carried in predicting whether they were ready to lose excess weight.

"Their readiness to change relates to whether they felt supported, not how big they were," she says.

The message for parents of overweight children is clear: Do not point out how overweight they are. Instead, try something like this: "We love you so much. We want you to be healthy and have a long life," says Dr. Freier. Then offer them a plan and support.

Understanding What Overweight Means

The second study revealed that parents may have the mistaken belief that a child is not overweight when he or she actually is overweight.

Dr. Elena Fuentes-Afflick, at the University of California San Francisco, tracked the attitudes of Latina mothers with preschool-age children on their children's weight.

She analyzed data from interviews with 194 women and children taking part in the Latino Health Project.

The women were recruited during pregnancy and then interviewed annually for three years.

By the time they were three years old, more than 43 percent of the children were statistically overweight.

But, "in the group of kids overweight by our measure, three-quarters of those mothers thought their child's weight was just fine," says Dr. Fuentes-Afflick.

"We are living in a society where two-thirds of adults in the US are overweight or obese," says Dr. Fuentes-Afflick. "What concerns me is the risk that we are normalizing overweight body images."

Low Income Linked to High-Calorie Foods

In a third study, mothers in families where food is sometimes scarce due to money problems have a tendency to give their children high-calorie foods to boost overall calories or foods to stimulate the appetite.

These two practices should be avoided if they want their child to remain at a healthy weight, says Emily Feinberg, an expert at Boston University School of Public Health.

In her study, Feinberg interviewed 248 mothers of normal and overweight African-American and Haitian children, ages two to 12.

She found that 28 percent of them had shortages of food from time to time.

When that happened, 43 percent used nutritional drinks such as high-calorie instant breakfast drinks, and 12 percent used substances to stimulate appetite, such as traditional Haitian teas.

Feinberg says this was a well-meaning effort to be sure the children got adequate nutrition.

Instead, Feinberg says, these low-income mothers should "try in general not to focus as much on calories but on the quality of the diet. Instead of a nutritional drink supplement, we would recommend increasing the intake of fruits and vegetables."

Awareness Key for All

The studies provide valuable information for researchers and parents, according to Connie Diekman, a registered dietitian and director of university nutrition at Washington University in St. Louis.

The study relating a child's self-esteem to their readiness to lose weight also makes sense, comments Diekman.

"Self-esteem is a major factor in the establishment of healthy behaviors and [a lack of it] can contribute to overeating and eating disorders," she says.

The second study confirms the key role mothers play in determining what a child eats and weighs, says Diekman.

Finally, the last study on scarce food, "provides some support to why the prevalence [of overweight] is higher" in poorer populations, she says.

Always consult your physician for more information.

Sources:

• MUSC Children's Hospital (St. Petersburg, Fl.) press release

Unlike other forms of self-injury, suicidal self-injury has special meaning, particularly in the context of borderline personality disorder. How is suicidal self-injury differentiated from non-suicidal self-injury in these patients, and how can their behavior be properly assessed and treated?

Borderline personality disorder (BPD) is characterized by unstable relationships, self-image and affect, as well as impulsivity, that begin by early adulthood. Patients with BPD make efforts to avoid abandonment. They often exhibit recurrent suicidal and/or self-injuring behavior, feelings of emptiness, intense anger, and/or disassociation or paranoia. Suicidal and non-suicidal self-injury are extremely common in BPD. Zanarini et al. (1990) found that over 70% of patients with BPD had self-injured or made suicide attempts, as compared to only 17.5% of patients with other personality disorders. Nevertheless, clinicians consistently misunderstand and mistreat this aspect of BPD.

There has been considerable controversy surrounding the diagnosis of BPD, ranging from a sense that the term itself is misleading and frightening, to the fact that the diagnosis is often made in an inconsistent manner (Davis et al., 1993), to a lack of clarity about whether the diagnosis should be Axis I or Axis II (Coid, 1993; Kjellander et al., 1998). Furthermore, these patients are often excluded from clinical trials due to perceived risk.

More important, however, is the fact that suicidal self-injurious behavior is usually understood within the context of major depressive disorder, while the phenomenology of this behavior within BPD is quite different. In addition, self-injurious non-suicidal behavior is often understood by clinicians to be synonymous with suicidal behavior, but again, it may be distinguished separately, particularly within the context of BPD. It is possible that, although self-injury and suicidal behavior are distinct, they may serve similar functions. This phenomenon has important implications for treatment recommendations.

Suicidality in BPD Versus Major Depression

In traditional conceptualizations developed from suicidality seen as an aspect of major depression, suicidal behavior is usually understood to be a response to a deep sense of despair and desire for death, which, if unsuccessful, typically results in a persistence of depression. Vegetative signs are prominent, and the suicidal feelings subside when the major depression is successfully treated with antidepressants, psychotherapy or their combination. In contrast, suicidality in the context of BPD seems to be more episodic and transient in nature, and patients often report feeling better afterward.

Risk factors for suicidal behavior in Borderline Personality Disorder show some differences, as well as similarities, with individuals who are suicidal in the context of major depression. Brodsky et al. (1995) noted that dissociation, particularly in patients with BPD, is correlated with self-mutilation. Studies of comorbidity have produced unclear results. Pope et al. (1983) found that a large number of patients with BPD also display a major affective disorder, and Kelly et al. (2000) found that patients with BPD alone and/or patients with BPD plus major depression are more likely to have attempted suicide than patients with major depression alone. In contrast, Hampton (1997) stated that the completion of suicide in patients with BPD is often unrelated to a comorbid mood disorder (Mehlum et al., 1994) and to degree of suicidal ideation (Sabo et al., 1995).

Conceptualizing Self-Harm

Suicidal behavior is usually defined as a self-destructive behavior with the intent to die. Thus, there must be both an act and intent to die for a behavior to be considered suicidal. Non-suicidal self-harm generally implies self-destructive behavior with no intent to die and is often seen as being precipitated by distress, often interpersonal in nature, or as an expression of frustration and anger with oneself. It usually involves feelings of distraction and absorption in the act, anger, numbing, tension reduction, and relief, followed by both a sense of affect regulation and self-deprecation. Confusion in the field regarding the definition of the term parasuicide can lead to a misunderstanding of the differences in function and danger of suicidal and non-suicidal self-injury. Parasuicide, or false suicide, groups together all forms of self-harm that do not result in death--both suicide attempts and non-suicidal self-injury. Many people who engage in non-suicidal self-harm are at risk for suicidal behavior.

We propose that non-suicidal self-injury in BPD uniquely resides on a spectrum phenomenologically with suicidality. Perhaps the most distinguishing factor, as pointed out by Linehan (1993), is that self-injury may help patients to regulate their emotions--an area with which they have tremendous difficulty. The act itself tends to restore a sense of emotional equilibrium and reduces an internal state of turmoil and tension. One striking aspect is the fact that physical pain is sometimes absent or, conversely, may be experienced and welcomed, as validation of psychological pain and/or a means to reverse a sense of deadness. Patients often report feeling less upset following an episode. In other words, while the self-injury is borne out of a sense of distress, it has served its function and the patient's emotional state is improved. Biological findings pointing to relationships among impulsivity and suicidality support the notion that suicidality and self-mutilation, particularly within the context of BPD, may occur on a continuum (Oquendo and Mann, 2000; Stanley and Brodsky, in press).

It is crucial to recognize, however, that even if patients with BPD self-mutilate and attempt suicide for similar reasons, death may be the accidental and unfortunate result. Because patients with BPD try to kill themselves so often, clinicians often underestimate their intent to die. In fact, individuals with BPD who self-injure are twice as likely to commit suicide than others (Cowdry et al., 1985), and 9% of the 10% of outpatients who are diagnosed with BPD eventually commit suicide (Paris et al., 1987). Stanley et al. (2001) found that suicide attempters with cluster B personality disorders who self-mutilate die just as frequently but are often unaware of the lethality of their attempts, compared to patients with cluster B personality disorders who do not self-mutilate.

Treatment of Suicidal Behavior and Self-Injury

While non-suicidal self-harm can result in death, it is more likely not to and, in fact, only occasionally leads to serious injury such as nerve damage. Yet, patients are often hospitalized on a psychiatric unit in the same way that they would be for a frank suicide attempt. In addition, while the intent is most often to alter the internal condition, as opposed to an external condition, clinicians and those in relationships with self-injurers experience this behavior as manipulative and controlling. It has been noted that self-injury can elicit quite strong countertransference reactions from therapists.

Although there is clearly a biological component to this disorder, the results of pharmacologic interventions have been inconclusive. Different classes and types of medications are often used for different aspects of the behavior (e.g., sadness and affective instability, psychosis and impulsivity) (Hollander et al., 2001).

One class of psychological intervention has been cognitive-behavioral therapy (CBT), of which there are a few models, e.g., Beck and Freeman (1990), cognitive-analytic therapy (CAT) developed by Wildgoose et al. (2001), and an increasingly well-known form of CBT called dialectical behavior therapy (DBT), developed by Linehan (1993) specifically for BPD. Dialectical behavior therapy is characterized by a dialectic between acceptance and change, a focus on skill acquisition and skill generalization, and a consultation-team meeting. In the psychoanalytic arena, there is controversy as to whether a confrontative, interpretative approach (e.g., Kernberg, 1975) or a supportive, empathic approach (e.g., Adler, 1985) is more effective.

Concluding Thoughts

This paper addresses contemporary conceptual and treatment issues that come into play in understanding suicidal and self-injuring behavior in the context of BPD. Diagnostic issues and the phenomenology of self-injurious behavior are important to consider. Treatment approaches include pharmacologic interventions, psychotherapy and their combination.

About the Authors:

Dr. Gerson is a research scientist in the department of neuroscience at the New York State Psychiatric Institute, an assistant project director at Safe Horizon and in private practice in Brooklyn, N.Y.

Dr. Stanley is a research scientist in the department of neuroscience at the New York State Psychiatric Institute, professor in the department of psychiatry at Columbia University and professor in the department of psychology at the City University of New York.

Source: Psychiatric Times, December 2003 Vol. XX Issue 13

References

Adler G (1985), Borderline Psychopathology and Its Treatment. New York: Aronson.

Beck AT, Freeman A (1990), Cognitive Therapy of Personality Disorders. New York: The Guilford Press.

Brodsky BS, Cloitre M, Dulit RA (1995), Relationship of dissociation to self-mutilation and childhood abuse in borderline personality disorder. Am J Psychiatry 152(12):1788-1792 [see comment].

Coid JW (1993), An affective syndrome in psychopaths with borderline personality disorder? Br J Psychiatry 162:641-650.

Cowdry RW, Pickar D, Davies R (1985), Symptoms and EEG findings in the borderline syndrome. Int J Psychiatry Med 15(3):201-211.

Davis RT, Blashfield RK, McElroy RA Jr (1993), Weighting criteria in the diagnosis of a personality disorder: a demonstration. J Abnorm Psychol 102(2):319-322.

Hampton MC (1997), Dialectical behavior therapy in the treatment of persons with borderline personality disorder. Arch Psychiatr Nurs 11(2):96-101.

Hollander E, Allen A, Lopez RP et al. (2001), A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder. J Clin Psychiatry 62(3):199-203.

Kelly TM, Soloff PH, Lynch KG et al. (2000), Recent life events, social adjustment, and suicide attempts in patients with major depression and borderline personality disorder. J Personal Disord 14(4):316-326.

Kernberg OF (1975), Borderline Conditions and Pathological Narcissism. New York: Aronson.

Kjellander C, Bongar B, King A (1998), Suicidality in borderline personality disorder. Crisis 19(3):125-135.

Linehan MM (1993), Cognitive-Behavioral Treatment for Borderline Personality Disorder: The Dialectics of Effective Treatment. New York: The Guilford Press.

Mehlum L, Friis S, Vaglum P, Karterud S (1994), A longitudinal pattern of suicidal behavior in borderline disorder: a prospective follow-up study. Acta Psychiatr Scand 90(2):124-130.

Oquendo MA, Mann JJ (2000), The biology of impulsivity and suicidality. Psychiatr Clin North Am 23(1):11-25.

Paris J, Brown R, Nowlis D (1987), Long-term follow-up of borderline patients in a general hospital. Compr Psychiatry 28(6):530-535.

Pope HG Jr, Jonas JM, Hudson JI et al. (1983), The validity of DSM-III borderline personality disorder. A phenomologic, family history, treatment response, and long-term follow-up study. Arch Gen Psychiatry 40(1):23-30.

Sabo AN, Gunderson JG, Najavits LM et al. (1995), Changes in self-destructiveness of borderline patients in psychotherapy. A prospective follow-up. J Nerv Ment Dis 183(6):370-376.

Stanley B, Brodsky B (in press), Suicidal and self-injurious behavior in borderline personality disorder: the self-regulation model. In: Borderline Personality Disorder Perspectives: From Professional to Family Member, Hoffman P, ed. Washington, D.C.: American Psychiatric Press Inc.

Stanley B, Gameroff MJ, Michalsen V, Mann JJ (2001), Are suicide attempters who self-mutilate a unique population? Am J Psychiatry 158(3):427-432.

Wildgoose A, Clarke S, Waller G (2001), Treating personality fragmentation and dissociation in borderline personality disorder: a pilot study of the impact of cognitive analytic therapy. Br J Med Psychol 74(pt 1):47-55.

Zanarini MC, Gunderson JG, Frankenburg FR, Chauncey DL (1990), Discriminating borderline personality from other axis II disorders. Am J Psychiatry 147(2):161-167.

After you have had a few dates with someone and you think it might be going somewhere, you begin to ask more serious questions about their childhood, family, job etc.

Eventually the relationship might progress to where the really tough questions must be asked. Like "have you ever slept with someone without using a condom" or "how much debt do you have"? There is no easy way to bring up these questions.

Recently, I received a copy of Michael Webb's newest book, 1000 Questions for Couples: What You Absolutely Must Know About the Person You Are With. This book is going to make those difficult questions much easier to ask.

The questions start off easy like "Has anyone dear to you died? How did you handle it" and "About what things are you most selfish." They slowly progress (just like your relationship should) until you get to those questions that you simply can't avoid if you are going to commit your life to living with someone.

There are questions on drug addictions, abuse, child rearing, finances and lots of questions about sex. And because these questions are coming from a book, you don't feel like "you" are asking them.

A special bonus that I really liked was the option to get 3-5 of the book's questions e-mailed to me each day. That way I could forward the questions on to my beloved and we could each read over them and forward the answers to each other that night. I can see where this would be very valuable for those in long distance relationships too.

Although I am married, I found questions in this book that I had not yet asked my wife. What a terrific opportunity to get to know her even better.

It is estimated that 83% of failed relationships could be prevented if couples asked each other the right questions. Are you among the 17%?

While there are a lot of questions in this book that are crucial for couples in the dating stage, the majority of the questions are useful for people who are already married. If you value your relationship, I encourage you to ask these "1000 Questions for Couples."

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Relationship Questions

Here are three relationship questions (out of 1,000) from award-winning writer Michael Webb. You should definitely know how your partner would answer these questions, or, if you don't, you should at least find out by asking him/her. Click here to read about all 1000 questions couples should ask each other.

Relationship Question #1

If you could live one year of your life all over again without changing a thing, what year would you choose? Why?

This is a variant on everyone's favorite fantasy where they get to go back and relive part of their lives and change things. But that fantasy focuses on our future-oriented thirst for the power to make our lives better. This question appeals more to our aesthetic sense about the past. Which year of your life did you appreciate the most, enjoy the most, find most exciting, find most interesting? This can tell you a lot about a person.

Relationship Question #2

Do you prefer receiving expensive gifts or a gift from the heart?

This question doesn't need much explanation. It's the difference between Zora and Sarah on Joe Millionaire. If you didn't watch that show, then it's the difference between a gold digger and a true romantic. Between diamonds and flowers.

Relationship Question #3

What first attracted you to me? How has that one attraction changed since then?

The first part of this question is fun to ask. The second part is difficult to answer. But you'll have to admit that, if you can get an honest answer, the question should reveal a lot about the foundations of your relationship.

Again, these were three relationship questions (out of 1,000) from award-winning writer Michael Webb.

next: The Dating Daze!

To help you begin your journey, there are a few concepts I have discovered that may be helpful to you. Please take this information only as it is intended: a perspective.

My recovery journey began by developing realistic expectations about the Twelve Steps.

First, this meant admitting the Twelve Steps, by themselves, weren't a magical, miraculous, quick-fix cure for my problems. My problems centered around my inability to form and maintain healthy relationships, and the Twelve Steps alone were not going to undo overnight 33 years of harming myself and others.

For me, the Twelve Steps are not an end unto themselves. They are one means to an end: serenity. They are not the only means to serenity, but they are a proven component if a person will commit to working an honest recovery program. This I can say with all confidence.

Secondly, I realized the Twelve Steps are not a do-it-yourself program, despite what popular self-help books say. The Twelve Steps are an integral part of a complete recovery program. They are the foundation. They are the cornerstone of the recovery house that I am building one day at a time, one brick at a time. They are one tool out of many with which I am building my new life.

In reality, no system of recovery is perfect. Results don't happen by osmosis. I don't get the true benefits of recovery just by reading books, going to meetings, and talking about the Twelve Steps. I began real recovery when I made key decisions to change my attitude toward life. Changing my attitude began by making a commitment to recovery.

Commitment is the primary reason a lot of people come to recovery meetings one time and never come back. They have problems with commitment. They are looking for a miracle cure. They are coming with the intent of changing someone else, not themselves. Some like living in pain, and are only looking for someone or some group where they commiserate over a cup of coffee or bash the person, place, or thing they blame for their problems.

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To recover from co-dependency, I had to make a commitment to an honest program of self-growth and self-discovery. The commitment principle applies to any worthwhile endeavor in life. I really did want to feel better. I really did want to find serenity. I really did want to set recovery goals and reach them. I really did want to develop and maintain fulfilling relationships.

Here then, are some secrets I've found to honest recovery and spiritual growth. These principles and decisions will also work for you if you are willing to make a commitment to work harder at recovery than anything else you've ever done . . .because the results are worth the effort.

• Make the decision, once and for all, to change what you can change (maybe the only thing you can change): your attitude. Give up, once and for all, trying to change what you cannot change: other people. Make these two decisions and never look back.
• Make the decision to accept yourself and your life situation, as they are, in this moment. Recovery isn't about becoming perfect. Recovery is about loving yourself enough to accept your imperfections, right now, and accepting that the agent of change will, gratefully, be a power greater than your own.
• Commit to attending real recovery meetings on a regular basis. Find a meeting where people are working at recovery, rather than having psycho-babble coffee groups. You'll have to try lots of different meetings before you can tell the difference. A real recovery meeting is a supportive and nurturing environment, where people can safely talk about their feelings and no one will respond critically or presume to give advice. In a real recovery meeting, people talk humbly about themselves, not their significant other, not their boss, not their co-workers, not their abusing spouse, etc. In a real recovery meeting, people are being honest with themselves and searching for answers, rather than using recovery as the ultimate form of denial.
• Surround yourself with positive recovering friends. Real friends who will support you without enabling you. Find at least one recovering person to whom you will be accountable. Someone who will confront you and challenge your thinking. Someone with whom you can safely share and with whom you can be honest, open, and sincere. If you can't find such a person, then ask your therapist to be that person. If you don't have a therapist, consider getting one. The Twelve Steps are not a substitute for professional help.
• Decide to be totally honest with yourself. Have the courage to look at and accept your strengths and your weaknesses; your assets and your liabilities; your successes and your failures.
• Decide, once and for all, to accept your past, learn from it, and start living a life filled with peace and serenity.
• Decide to get serious therapy to help you uncover the hidden parts of yourself that may be causing you grief and pain.
• Decide to discover God and God's will for your life. Build a relationship with God and create trust, faith, and confidence in a Higher Power outside of yourself. If you've been hurt by organized religion in the past, discover the vast differences between spirituality and religion. You are not required to be religious to recover. It's OK if you are uncomfortable with spirituality or the God concept; just decide to remain open to these ideas for now and be patient with yourself.
• Decide that you will courageously face your fears, your feelings, your past, your dark side—all parts of yourself. Embrace all the possibilities and potential for good within you. Believe that you are a beautiful person worthy of life's richest blessings. Love yourself unconditionally.
• Develop the willingness to courageously share your experiences, strength, and hope with those you meet along life's path who are hurting and searching for serenity. Search for those who are searching.
• Decide to work the Twelve Steps with the help of a local mentor or sponsor or therapist whom you can safely trust. Someone who knows how to listen and how to respond to a person in recovery. Some one who understands that unconditional acceptance and compassion and confidentiality are among the highest forms of love. Finding this person is essential.
• Dedicate your well being and your serenity to the ongoing study, discovery, and applied understanding of all the recovery resources and people available to you.
• Decide to love yourself, all of you, with all your heart. Develop a loving, esteeming, affirming relationship with yourself, because this is the basis for all your other relationships, including your relationship with God.

next: Boundaries