As a professional relationship coach, over the years I have listened as partners pour out their hearts to me, justifying their position to the detriment of the relationship.

There are as many relationship issues as there are people, however if I were going to make a list of the most frequent issues I would say that money, in-laws, sex, control issues, unfulfilled expectations and a lack of effective communication top the list.

It is one thing to know there is a problem and it is quite another to not do anything about it. You must first acknowledge that a problem exists before it can be fixed. Part of the healing is to acknowledge that there are indeed problems that you may be responsible for. Knowing that is not enough. DOING something different is!

Relationship derailment is a troubling phenomenon. However, it's time for the death of finger pointing. Blame in a love relationship doesn't work!

There is a payoff for everything you do. The payoff for pointing a finger at your partner and blaming him or her for your relationship condition is: you don't have to take responsibility for your share of the problem.

Although blaming has no redeeming value, if you must place blame, you would be wise to accept responsibility and know that the blame goes to the person looking back at you in the mirror.

Relationship problems are shared problems. To manage the complexity of a stormy relationship you must accept responsibility for your share of the problem. When you can do that, the problem is half solved. Not only will this change you, it will change your relationship with your partner.

It is time to STOP blaming someone else for the misery you are creating for yourself. It's time to forgive yourself and your partner so the hurt will heal. The hurts won't heal until you allow yourself to forgive.

Perhaps your relationship deserves a powerful new focus. The responsibility of both partners is to acknowledge that there is a problem, talk about it in the most loving way you can and reach a conclusion with a workable solution that will benefit both of you.

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Ideally, having a partner who understands the concept of team and the responsibility that goes with it contributes greatly to creating a greater attitude of team, which sheds light on solutions instead of keeping the focus on the problem.

True love allows for disagreements. Problems are not there to break you. They help make you a better partner; they help you grow. Acknowledging when you are wrong is not a sign of weakness; it is a sign of strength.

If your relationship is off track, the cost of complacency is obviously substantial. Waiting for your partner to "come around," may prove futile. Go first. You must take the first step while you are still afraid. Doing so helps to inoculate your relationship against a relapse.

Your relationship priorities are clear now, right? Go first. Say it.

"I was wrong and I am sorry."

It probably doesn't need to be said, however I will say it anyway. Saying "I'm sorry" over and over for the same mistake doesn't work! Not making the same mistake again does. It demonstrates your sincerity and respect for your partner and makes a significant contribution to your relationship.

Do what's right!

Those seven words will help make your perceptions clearer, your judgments sounder, your relationship and your life work better and you will be closer to your heart's desire; a healthy love relationship and marriage.

Do you want to be happy or do you want to be right?

next: Are You Being Authentic in Your Relationship?

As society has become increasingly aware of the prevalence of child abuse and its serious consequences, there has been an explosion of information on posttraumatic and dissociative disorders resulting from abuse in childhood. Since most clinicians learned little about childhood trauma and its aftereffects in their training, many are struggling to build their knowledge base and clinical skills to effectively treat survivors and their families.

Understanding dissociation and its relationship to trauma is basic to understanding the posttraumatic and dissociative disorders. Dissociation is the disconnection from full awareness of self, time, and/or external circumstances. It is a complex neuropsychological process. Dissociation exists along a continuum from normal everyday experiences to disorders that interfere with everyday functioning. Common examples of normal dissociation are highway hypnosis (a trance-like feeling that develops as the miles go by), "getting lost" in a book or a movie so that one loses a sense of passing time and surroundings, and daydreaming.

Researchers and clinicians believe that dissociation is a common, naturally occurring defense against childhood trauma. Children tend to dissociate more readily than adults. Faced with overwhelming abuse, it is not surprising that children would psychologically flee (dissociate) from full awareness of their experience. Dissociation may become a defensive pattern that persists into adulthood and can result in a full-fledged dissociative disorder.

The essential feature of dissociative disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness. If the disturbance occurs primarily in memory, Dissociative Amnesia or Fugue (APA, 1994) results; important personal events cannot be recalled. Dissociative Amnesia with acute loss of memory may result from wartime trauma, a severe accident, or rape. Dissociative Fugue is indicated by not only loss of memory, but also travel to a new location and the assumption of a new identity. Posttraumatic Stress Disorder (PTSD), although not officially a dissociative disorder (it is classified as an anxiety disorder), can be thought of as part of the dissociative spectrum. In PTSD, recall/re-experiencing of the trauma (flashbacks) alternates with numbing (detachment or dissociation), and avoidance. Atypical dissociative disorders are classified as Dissociative Disorders Not Otherwise Specified (DDNOS). If the disturbance occurs primarily in identity with parts of the self assuming separate identities, the resulting disorder is Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder.

The Dissociative Spectrum

The dissociative spectrum (Braun, 1988) extends from normal dissociation to poly-fragmented DID. All of the disorders are trauma-based, and symptoms result from the habitual dissociation of traumatic memories. For example, a rape victim with Dissociative Amnesia may have no conscious memory of the attack, yet experience depression, numbness, and distress resulting from environmental stimuli such as colors, odors, sounds, and images that recall the traumatic experience. The dissociated memory is alive and active--not forgotten, merely submerged (Tasman Goldfinger, 1991). Major studies have confirmed the traumatic origin of DID (Putnam, 1989, and Ross, 1989), which arises before the age of 12 (and often before age 5) as a result of severe physical, sexual, and/or emotional abuse. Poly-fragmented DID (involving over 100 personality states) may be the result of sadistic abuse by multiple perpetrators over an extended period of time.

Although DID is a common disorder (perhaps as common as one in 100) (Ross, 1989), the combination of PTSD-DDNOS is the most frequent diagnosis in survivors of childhood abuse. These survivors experience the flashbacks and intrusion of trauma memories, sometimes not until years after the childhood abuse, with dissociative experiences of distancing, "trancing out", feeling unreal, the ability to ignore pain, and feeling as if they were looking at the world through a fog.

The symptom profile of adults who were abuse as children includes posttraumatic and dissociative disorders combined with depression, anxiety syndromes, and addictions. These symptoms include (1) recurrent depression; (2) anxiety, panic, and phobias; (3) anger and rage; (4) low self-esteem, and feeling damaged and/or worthless; (5) shame; (6) somatic pain syndromes (7) self-destructive thoughts and/or behavior; (8) substance abuse; (9) eating disorders: bulimia, anorexia, and compulsive overeating; (10) relationship and intimacy difficulties; (11) sexual dysfunction, including addictions and avoidance; (12) time loss, memory gaps, and a sense of unreality; (13) flashbacks, intrusive thoughts and images of trauma; (14) hypervigilance; (15) sleep disturbances: nightmares, insomnia, and sleepwalking; and (16) alternative states of consciousness or personalities.

Diagnosis

The diagnosis of dissociative disorders starts with an awareness of the prevalence of childhood abuse and its relation to these clinical disorders with their complex symptomatology. A clinical interview, whether the client is male or female, should always include questions about significant childhood and adult trauma. The interview should include questions related to the above list of symptoms with a particular focus on dissociative experiences. Pertinent questions include those related to blackouts/time loss, disremembered behaviors, fugues, unexplained possessions, inexplicable changes in relationships, fluctuations in skills and knowledge, fragmentary recall of life history, spontaneous trances, enthrallment, spontaneous age regression, out-of-body experiences, and awareness of other parts of self (Loewenstein, 1991).

Structured diagnostic interviews such as the Dissociative Experiences Scale (DES) (Putnam, 1989), the Dissociative Disorders Interview Schedule (DDIS) (Ross, 1989), and the Structured Clinical Interview for Dissociative Disorders (SCID-D) (Steinberg, 1990) are now available for the assessment of dissociative disorders. This can result in more rapid and appropriate help for survivors. Dissociative disorders can also be diagnosed by the Diagnostic Drawing Series (DDS) (Mills Cohen, 1993).

The diagnostic criteria for the diagnosis of DID are (1) the existence within the person of two or more distinct personalities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self, (2) at least two of these personality states recurrently take full control of the person's behavior, (3) the inability to recall important personal information that is to extensive to be explained by ordinary forgetfulness, and (4) the disturbance is not due to the direct physiological effects of a substance (blackouts due to alcohol intoxication) or a general medical condition (APA, 1994). The clinician must, therefore, "meet" and observe the "switch process" between at least two personalities. The dissociative personality system usually includes a number of personality states (alter personalities) of varying ages (many are child alters) and of both sexes.

In the past, individuals with dissociative disorders were often in the mental health system for years before receiving an accurate diagnosis and appropriate treatment. As clinicians become more skilled in the identification and treatment dissociative disorders, there should no longer be such delay.

Treatment

The heart of the treatment of dissociative disorders is long-term psychodynamic/cognitive psychotherapy facilitated by hypnotherapy. It is not uncommon for survivors to need three to five years of intensive therapy work. Setting the frame for the trauma work is the most important part of therapy. One cannot do trauma work without some destabilization, so the therapy starts with assessment and stabilization before any abreactive work (revisiting the trauma).

A careful assessment should cover the basic issues of history (what happened to you?), sense of self (how do you think/feel about yourself?), symptoms (e.g., depression, anxiety, hypervigilance, rage, flashbacks, intrusive memories, inner voices, amnesias, numbing, nightmares, recurrent dreams), safety (of self, to and from others), relationship difficulties, substance abuse, eating disorders, family history (family of origin and current), social support system, and medical status.

After gathering important information, the therapist and client should jointly develop a plan for stabilization (Turkus, 1991). Treatment modalities should be carefully considered. These include individual psychotherapy, group therapy, expressive therapies (art, poetry, movement, psychodrama, music), family therapy (current family), psychoeducation, and pharmacotherapy. Hospital treatment may be necessary in some cases for a comprehensive assessment and stabilization. The Empowerment Model (Turkus, Cohen, Courtois, 1991) for the treatment of survivors of childhood abuse--which can be adapted to outpatient treatment--uses ego-enhancing, progressive treatment to encourage the highest level of function ("how to keep your life together while doing the work"). The use of sequenced treatment using the above modalities for safe expression and processing of painful material within the structure of a therapeutic community of connectedness with healthy boundaries is particularly effective. Group experiences are critical to all survivors if they are to overcome the secrecy, shame, and isolation of survivorship.

Stabilization may include contracts to ensure physical and emotional safety and discussion before any disclosure or confrontation related to the abuse, and to prevent any precipitous stop in therapy. Physician consultants should be selected for medical needs or psychopharmacologic treatment. Antidepressant and antianxiety medications can be helpful adjunctive treatment for survivors, but they should be viewed as adjunctive to the psychotherapy, not as an alternative to it.

Developing a cognitive framework is also an essential part of stabilization. This involves sorting out how an abused child thinks and feels, undoing damaging self-concepts, and learning about what is "normal". Stabilization is a time to learn how to ask for help and build support networks. The stabilization stage may take a year or longer--as much time as is necessary for the patient to move safely into the next phase of treatment.

If the dissociative disorder is DID, stabilization involves the survivor's acceptance of the diagnosis and commitment to treatment. Diagnosis is in itself a crisis, and much work must be done to reframe DID as a creative survival tool (which it is) rather than a disease or stigma. The treatment frame for DID includes developing acceptance and respect for each alter as a part of the internal system. Each alter must be treated equally, whether it presents as a delightful child or an angry persecutor. Mapping of the dissociative personality system is the next step, followed by the work of internal dialogue and cooperation between alters. This is the critical stage in DID therapy, one that must be in place before trauma work begins. Communication and cooperation among the alters facilitates the gathering of ego strength that stabilizes the internal system, hence the whole person.

Revisiting and reworking the trauma is the next stage. This may involve abreactions, which can release pain and allow dissociated trauma back into the normal memory track. An abreaction might be described as the vivid re-experiencing of a traumatic event accompanied by the release of related emotion and the recovery of repressed or dissociated aspects of that event (Steele Colrain, 1990). The retrieval of traumatic memories should be staged with planned abreactions. Hypnosis, when facilitated by a trained professional, is extremely useful in abreactive work to safely contain the abreaction and release the painful emotions more quickly. Some survivors may only be able to do abreactive work on an inpatient basis in a safe and supportive environment. In any setting, the work must be paced and contained to prevent retraumatization and to give the client a feeling of mastery. This means that the speed of the work must be carefully monitored, and the release painful material must be thoughtfully managed and controlled, so as not to be overwhelming. An abreaction of a person diagnosed with DID may involve a number of different alters, who must all participate in the work. The reworking of the trauma involves sharing the abuse story, undoing unnecessary shame and guilt, doing some anger work, and grieving. Grief work pertains to both the abuse and abandonment and the damage to one's life. Throughout this mid-level work, there is integration of memories and, in DID, alternate personalities; the substitution of adult methods of coping for dissociation; and the learning of new life skills.

This leads into the final phase of the therapy work. There is continued processing of traumatic memories and cognitive distortions, and further letting go of shame. At the end of the grieving process, creative energy is released. The survivor can reclaim self-worth and personal power and rebuild life after so much focus on healing. There are often important life choices to be made about vocation and relationships at this time, as well as solidifying gains from treatment.

This is challenging and satisfying work for both survivors and therapists. The journey is painful, but the rewards are great. Successfully working through the healing journey can significantly impact a survivor's life and philosophy. Coming through this intense, self-reflective process might lead one to discover a desire to contribute to society in a variety of vital ways.

next:Aspects of the Treatment of Multiple Personality Disorder

References

Braun, B. (1988). The BASK model of dissociation. DISSOCIATION, 1, 4-23. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. Loewenstein, R.J. (1991). An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatric Clinics of North America, 14(3), 567-604.

Mills, A. Cohen, B.M. (1993). Facilitating the identification of multiple personality disorder through art: The Diagnostic Drawing Series. In E. Kluft (Ed.), Expressive and functional therapies in the treatment of multiple personality disorder. Springfield: Charles C. Thomas.

Putnam, F.W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.

Ross, C.A. (1989). Multiple personality disorder: Diagnosis, clinical features, and treatment. New York: Wiley.

Steele, K., Colrain, J. (1990). Abreactive work with sexual abuse survivors: Concepts and techniques. In Hunter, M. (Ed.), The sexually abused male, 2, 1-55. Lexington, MA: Lexington Books.

Steinberg, M., et al. (1990). The structured clinical interview for DSM III-R dissociative disorders: Preliminary report on a new diagnostic instrument. American Journal of Psychiatry, 147, 1.

Tasman, A., Goldfinger, S. (1991). American psychiatric press review of psychiatry. Washington, DC: American Psychiatric Press.

Turkus, J.A. (1991). Psychotherapy and case management for multiple personality disorder: Synthesis for continuity of care. Psychiatric Clinics of North America, 14(3), 649-660.

Turkus, J.A., Cohen, B.M., Courtois, C.A. (1991). The empowerment model for the treatment of post-abuse and dissociative disorders. In B. Braun (Ed.), Proceedings of the 8th International Conference on Multiple Personality/Dissociative States (p. 58). Skokie, IL: International Society for the Study of Multiple Personality Disorder.

Joan A. Turkus, M.D., has extensive clinical experience in the diagnosis and treatment of post-abuse syndromes and DID. She is the medical director of The Center: Post-Traumatic Dissociative Disorders Program at The Psychiatric Institute of Washington. A general and forensic psychiatrist in private practice, Dr. Turkus frequently provides supervision, consultation, and teaching for therapists on a national basis. She is co-editor of the forthcoming book, Multiple Personality Disorder: Continuum of Care.

* This article has been adapted by Barry M. Cohen, M.A., A.T.R., for publication in this format. It was originally published in the May/June, 1992, issue of Moving Forward, a semi-annual newsletter for survivors of childhood sexual abuse and those who care about them. For subscription information, write P.O. Box 4426, Arlington, VA, 22204, or call 703/271-4024.

next:   Aspects of the Treatment of Multiple Personality Disorder

A child's growth is a continuous process, a gradual sequencing from one stage of physical and mental development to another-"Each child sits before he stands; he babbles before he talks" (Gesell). It's a marvelous process to watch and a marvelous opportunity for parents to foster and implement important periods of growth.

At School

In reality, the responsibility of the parent is twofold. Not only should proper emphasis be placed on movement and exercise in the home but whenever possible the school's approach to physical education should be monitored. A good P.E. program in elementary school ideally will offer three or four periods a week of 45-60 minutes' duration. The program need not necessarily be highly structured and should certainly not be highly competitive. Movement is the key, and that can include simple activities (running in place, jumping jacks) and games (Simon Says, Twister). The P.E. program should progress developmentally from grade to grade and should be designed to offer maximum benefit to every child, no matter how small or Late-maturing.

A word of caution: Parents must be careful of physical conditions that might limit a child's movements and participation. Most schools ask, for their records, that a medical report be on file at the school, but it is the parent's responsibility to see that the report is accurate and up to date and that everyone on the faculty who needs to be aware of the report knows about it.

In the Community

For youngsters who are interested in competitive sports, almost every community offers after-school and summer sports such as soccer, baseball, and football. But these highly organized activities can promote stress if emphasis is placed on winning rather than just enjoying the game. An observant parent can usually quickly tell if the child is paying a high emotional price rather than just having fun. And it should be noted that in some highly organized sports, the youngsters spend more time standing around and watching than actually participating.

The local YMCA and YWCA usually offer well-rounded pro- grams that include fitness exercises and swimming The fitness program may consist of carefully structured aerobics, and the swimming program is usually designed for individual mastery rather than competition.

At Home

Parents are enormously busy people-perhaps both parents work outside the family; perhaps there are several children in the family with differing needs and demands; perhaps it is a one-parent family. The activities that follow are offered with precisely those situations in mind. They are simple, inexpensive, enjoyable, arid can be adapted for groups (the whole family and/or friends) as well as for individual youngsters.

Simple Motor Activities

Keep a simple record of your child's physical development. Every year on his birthday, write down his weight and height. Find a convenient wall space, place a ruler on the child's head, draw a line, and date it. Children love to watch how much they have grown. While your child is standing in place, have him count the number of times he can go up and down on his toes.

Set aside time in the family schedule for a family walk, perhaps just 15 minutes, or a Saturday afternoon leisurely hike for an hour or more depending on the youngster's age and stamina. A family walk is a great way for parents and siblings to interact and chat-something that is often difficult to fit into the busy lifestyles of the nuclear family. Walks can also provide an in-depth look at changes in Mother Nature and the community during different seasons of the year.

And then there are the very simple motor activities: hopping, jumping, skipping, and climbing. All are important in a child's growth patterns. Each one calls upon various muscle groups to require extensive use.

Remember hopscotch? All that is needed is a piece of chalk and a couple of pebbles. If parents will recall their own childhood, they may tap into some games that were fun and that, without knowing it; build strong bones and muscles.

Try rolling-on a level plane or on a hill. Inside. Outside. How many different ways can the child roll? Arms outstretched; arms at sides; one arm stretched the other to the side, Slow rolls. Fast rolls.

Head and neck exercises. Turn head side to side, down and up, while standing, sitting, lying on the back and on the stomach.

Have the child walk across a fallen log or along a narrow curb. Have him repeat the walk, holding a bulky object in one hand, then the other hand, over his head. Repeat going backward and sideways.

Row a boat on dry land. The child must calculate which oat to use in order to turn a specific direction. (The parent will have to figure this out first!)

Water activities for pool, lake, or rub (be prepared to get splashed!). Hold a ball and ask the child to hit it with his hands (right and left), elbows, knees, feet. If swimming lessons are available, enroll your youngster. The earlier, the better.

Just tossing a ball from parent to child is excellent for eye-hand coordination as well as large muscles. Don't let the activity get boring. Vary it by asking the child to kick the ball (using alternate feet) or batting it (with alternate hands). Ball size is important. Large enough for a success experience. Small enough for a challenging experience.

Don't forget beanbags-quite a different experience from throwing or catching a ball. Let the child toss and catch it himself-standing, sitting, lying down, alternate hands. Can he catch it on the top of his hand? a shoulder? a knee? a foot?

Differing chairs. The child sits down and gets up from chairs and stools of varying heights, descending and standing up slowly and without using his hands. The lower the chair, the more difficult the task.

Kangaroo hop. Have the child hold something (for example, a beanbag-or if you want to make it difficult, an apple or an orange) between his knees, then jump with feet together. Front wards, backwards, sideways.

Save your large bleach bottles. With the bottoms cut off, they make nice scoops for catching games, using tight objects such as a whiffle ball or beanbag.

Wheelbarrow. Hold the child's legs white he "walks', with his hands along a marked route.

Find a place where the child can see his shadow. Then see how creative you can be in directing his activities: "Make your shadow tall, short, wide, thin, make it jump, stand on one foot, touch its feet," etc.

Most of the activities that have been described can, for the most part, be done inside or out. It is important that they be done in a spirit of good fun and recreation. Once they become a chore, the child, either subtly or overtly, will decrease his effort and the sought after physical development will diminish. The secret probably ties in offering a variety of activities with an attitude of good cheer. And there may be a bonus - parents may discover that they, too, are in better shape!

next: Birth Order

In the course of speaking publicly about anorexia, I have heard the anguish in hundreds of voices as they've said, "She is such a beautiful girl, she doesn't need to diet --- if she would just eat." It seems so obvious, she's underweight and needs to gain weight --- if she would 'just eat' everything would be 'just fine.' Unfortunately, it is not that simple at all. Whenever you find yourself tempted to believe that the solution is for her to "just eat," it may be helpful for you to remember that people develop anorexia for many different reasons. Remind yourself often that anorexia recovery is a complicated process that requires more than simply facing fears related to food and weight and learning to cope with them. It is a process that demands a deep introspective look at one's life and at one's own self. It is a process which necessitates exploring one's wants, needs, and desires for the individual herself as well as for her life in general. Recovery compels the individual to examine the underlying issues that led to the development of her anorexia in the first place. Dealing with and reconciling all of the thoughts and feelings attached to each of these areas takes time and patience from everyone involved. You may already understand that recovery requires a good deal of motivation and effort from the individual herself, and your knowing this may cause you to wonder if there is anything you can you do that will positively impact her recovery process. And there are in fact many things that you can do throughout her recovery process that can make a world of difference --- for both of you.

Because there is no one way or right way to recover, and because what works for some people does not work for or even remotely help others, it is crucial to develop a line of communication that flows openly and honestly in both directions: from you to her and from her to you. You need to be able to give each other gentle feedback about the helpful and sometimes not so helpful things that you both do and say to each other. An open line of communication will eliminate your fear of inadvertently saying 'the wrong thing' and being in some way detrimental to her recovery. We are all human and although we mean well, we sometimes do say 'the wrong thing.' But that does not mean that you have single-handedly annihilated her recovery. If your lines of communication are solid, she will be able to tell you that what you said was not helpful, and she may be able to suggest other things that you could say or do that would be more helpful to her. You in turn will be able to hear her feedback and respond to it compassionately. For example, if you say "Wow, you look really great! Have you finally put on some weight?" She could respond with, " I know you mean well, but it's really hard for me to hear you say things like 'you look great,' because I still think that you really mean that I look fat. When you ask if I've put on weight it really confirms for me that my fear is a reality. I'm trying really hard to concentrate on what's inside of me instead of how I look." You might then offer, " I didn't realize it had that effect on you. I will try to watch out for that in the future, but please know that even though I mean well I may make a mistake and say something that isn't helpful. But if you will keep letting me know how what I say affects you, I know we can get through this together." With sound communication the process is reciprocal, meaning that it also works in the opposite direction. You will be able to let her know when she unintentionally hurts your feelings or needs more from you than you are able to give. And she in turn will be able to absorb that information and respond to you in a tender manner. If you are both communicating effectively, there will be no problem too great for you to work out and overcome together.

Practice your communication skills often by encouraging her to talk about how she feels and be an empathic listener. I cannot overemphasize the fundamental importance of empathy, it is so vital in the recovery process. What exactly is empathy anyway? Empathy essentially means that you are trying to understand something exactly the way she understands it, as opposed to the way you think she should understand it. Empathy is putting yourself in her shoes and being in her experience with her. Try to imagine how she feels by listening attentively and with compassion. Accept her point of view and how she feels without trying to change it with statements like, "Oh, don't let that bother you, it's not that important" or "Just let it go. You're a great person, look at all you have going for you." Show her that you care and that you are making a genuine effort to understand by offering her words such as, "It sounds like an aching that grows inside you with each passing day," or "That sounds so frustrating; I can only imagine how angry you must be. That would make me really angry, too." Offering her compassion opens the door for both of you to talk in more detail about how she experiences the world around her. Your acceptance and willingness to see things as she does will enable her to say freely, "It's really more like..." and further clarify her situation and feelings for both of you, thus taking the conversation to a much more intimate level. It is so helpful for every individual to be able to share her point of view, her thoughts, and her feelings without being judged. It will certainly help her feel less alone in the world, and she will undoubtedly take comfort in the fact that you understand and appreciate her on a much deeper level.

If she is in emotional pain, be there with her in it. Give her the space to both experience it and move through it. It can be difficult to see someone we care about in pain, and you may find yourself immediately wanting to 'fix' it and make her feel better. You may feel compelled to give her all sorts of advice or to cheer her up. But think about a time in your own life when you felt intense grief. Perhaps you lost someone you loved, or perhaps there were some tragic circumstances in your life. What did you really want to hear? That it wasn't that bad? That you are blessed with a fabulous life? That you should get over it? Or did you really want and need compassion, a warm embrace, and a soft voice offering you comfort as you shared your inner most pain? Sometimes just being there provides the most healing kind of comfort there is. To give someone the sense that you really understand where she is coming from, and to do that with gentleness and compassion is one of the most precious gifts we as human beings can give to one another.

I'm not at all suggesting that anyone wallow in their misery. It's just that sometimes we worry so much about saving someone from their pain, that we go to the opposite extreme and try to rush them out of it before they have even had the chance to heal from it. Many people worry that their loved one will be trapped in that pain forever. Others find that witnessing their loved one's pain causes them great discomfort, and they try to 'talk them out of their pain' for that reason. But keep in mind that all pain is legitimate and has a purpose. Trust that pain needs to be recognized and experienced in order to be moved through, and that it is in moving through our pain that we eventually come to heal from it. If your loved one is constantly being diverted from her pain by being told that she "shouldn't feel that way" or that "it's not that bad," then she will remain trapped in it and unable to grow from the experience. You will undoubtedly find if you walk with her through her pain that you will both learn and grow. While it may be true that time heals all wounds, it is love, comfort, and caring that makes the healing process more bearable and complete.

It is also important to remember that she is an individual separate from her eating disorder. Get to know who she is by paying attention to the things that make her smile. Notice what puts the twinkle in her eyes. Wonder with her about whatever it is that she wonders about. Show her that you appreciate who she is by letting her know when and how she touches your heart. Tell her how happy she makes you; let her know about the light she brings into your life. Believe in her ability to heal, to grow, and to flourish. Most of all tell her that you believe in her. Express your concern with a warm embrace or hold her hand; a caring touch is often so healing. It can be so hard for an anorexic to like herself and be gentle with herself. But your treating her with gentleness, compassion, and respect will help her to be able to do that for herself somewhere down the road. She may feel so innately bad that it may be difficult for her to accept or even hear your compassion for her --- but don't give up! Continue to be gentle and compassionate, for this one day will help her to hear the loving voice of her own heart. Her critical inner voices may be muffling and overriding that loving voice now, but one day it will be that loving voice that will finally prevail.

Encourage her to seek treatment; getting help in the early stages of the eating disorder often makes treatment go a little smoother. Encourage her from a kind, caring place, as opposed to a harsh or rigid one. Convey your caring and concern through your eyes, your touch, your tone of voice, and your mannerisms. The concerned, compassionate look in your eye and your gentle hand on her shoulder will be a far more compelling and effective way to convince her to seek treatment than yelling, shaming, or threatening her will ever be. Think of parents who set gentle but firm boundaries for their small children. They tend to receive the results they desire much faster and with far less stress than the red-faced parents we sometimes see repeatedly screaming at their children in grocery stores. It feels so much better to be on the receiving end of tender firmness than it does to be on the receiving end of out of control anger. In the course of encouraging her to seek treatment, you may offer to help her locate doctors, therapists, nutritionists, programs, and books. Keep in mind, however, that while you can offer to help her find these resources, you cannot force her to use them.

It is also important for you to be aware of and recognize your own limits. We all have them. Pretending that you do not have limits and forcing yourself to do more than you are able to do will only make you feel resentful and angry. She is bound to sense that resentment and anger which in turn may cause her to feel both guilty and ashamed. You can see how ignoring your own limits will only hurt both of you in the end. If you are able to be there for her and listen only for a certain period of time each day or each week, be clear both with her and within yourself about when and how long that time is. It is better to commit yourself for a shorter period of time and then really be there for her during that time, than it is to make yourself overly available to the extent that you are constantly distracted while you are together. Ask yourself what it is that you are willing and able to do. Are you willing to keep certain problem foods out of the house for her? Are you willing to cook specific meals for her? Are you able to buy the specific foods that she may request? Once you have thought about these things, sit down and have an open discussion with her about these topics as well as any others that may arise for each of you. This may be a good time to also set certain limits around what you are able to tolerate. For example, if she is purging then she is the one who needs to clean up the bathroom afterwards, not you. This is one area where your open line of communication will be extraordinarily beneficial to you both.

Get support for yourself. It isn't easy to watch someone you care about wrestle with anorexia, and there is only so much that you can do. Remember that you have no control over her choices; you can only encourage her to make healthy ones. Ultimately she is the one who must decide whether and how she will live. Accepting that you have no power over her choices often evokes feelings of helplessness. It is a painful, frightening, frustrating, maddening, and sad experience indeed to feel helpless when someone we care so much about is in trouble. These feelings need a place where they can be expressed, and you need to express them for your own health and well-being. Everyone deserves to be true to his or her own self, and doing just that will also enable you to remain a reliable and trusted source of support for the person you care about. By constantly holding in your anger and frustration you are setting up a situation which will inevitably lead to your blowing up, and most likely at her. This will only further isolate her, and most likely make you feel guilty in turn. A neutral party can offer you a safe place to vent your anger and air your concerns, which will also help to ensure that you do not burn out. They can help you find constructive ways of talking with your loved one about how you feel and how you are affected, because that is important too. An impartial party can provide you with the opportunity to explore your own feelings. Many times people feel so guilty, worrying that perhaps they are the cause of their loved one's eating disorder. A good support person can help you explore these feelings while simultaneously reassuring you that no one causes an eating disorder alone.

Getting support may be particularly important if you are a parent. Most parents are faced with a host of unpleasant feelings stemming from their child's eating disorder. You most likely experience feelings of guilt, shame, frustration, anger, sadness, doubt, and denial in regard to your child's problem. It can be tremendously difficult to come to terms with the fact that this is one time that your child is really hurting and you can not fix it for her. You deserve to have support around these painful feelings. It may also be important somewhere in the course of your child's recovery for you to investigate certain aspects of yourself. For example, you may need to examine the ways you communicate and the roles you have played in the past as well as in the present. You may need to explore your own views of food, weight, dieting, and body image and how these views may be influential to her. These issues are certain to arise if you are involved in family therapy. Family therapy can be extraordinarily beneficial for everyone involved. It is a good place to explore and resolve communication problems, improve strained relations, and work out hurt feelings. Family therapy tends to be most helpful when all family members agree to look honestly and openly at any and all problem areas existing within the family's dynamics.

There are also a few more general tips which will be helpful for you as you support you loved one through her journey:

• Make sure you take care of yourself. Be good to you!
• Avoid commenting on her looks. If you say she is too thin that will only please her, because that is her goal. If you tell her she looks 'good' she will invariably interpret that to mean that she looks fat, therefore, this statement is likely to only further fuel her attempts to lose weight.
• Remember that she is not her anorexia. It is possible to love her and dislike her eating disorder at the same time. Love her unconditionally.
• Remember to avoid simplistic solutions such as "just eat." This will only add to her feeling misunderstood and isolated --- it overlooks the complexity and severity of the problem.
• Avoid discussing what, how, or when she should eat. You will inevitably wind up in a power struggle.
• Accept that there is nothing that you can do force her to eat, stop bingeing, or stop purging.
• Avoid trying to control her food intake and avoid making judgments about her choices and her behavior.
• When communicating use "I" statements, "You" statements tend to be judgmental. "I" statements show that you are taking responsibility for how you feel and think . For example, you can say "I am worried about you. Why don't we make an appointment with a doctor to just to make sure that you are medically safe." This sounds far less attacking and judgmental than: "You're too thin! What are you trying to do to yourself!?"
• Avoid labeling foods as good or bad.
• Do not advocate the diet mentality that is so prevalent in our culture.
• Focus on things which do not relate to food, weight, and exercise. Be there just for company. Remember that she needs people in her life who can respond to her on more than one level and about more than just her food intake and body weight.
• Despite the fact that I am suggesting to avoid certain topics of conversation, try not worry about saying the 'wrong' thing. You will not have an irreversible negative impact on her recovery. But worrying about that can and probably will silence you which will in turn prevent you from being supportive. It is better to say something with the intention of being supportive than to say nothing at all and have her interpret your silence as a lack of caring on your part.
• Encourage her to be human --- not perfect.

by Monika Ostroff, co-author, Anorexia Nervosa: A Guide to Recovery

next: Eating Disorders and Family Relationships
~ eating disorders library
~ all articles on eating disorders

Welcome! You are why I wrote Triumphant Journey: A Cyberguide To Stop Overeating and Recover from Eating Disorders. I'm glad you are here.

For over twenty years, I've been working in the field of eating disorders. Throughout this time, and probably forever, I keep learning from my clients, their friends and families and other important associates. I see who recovers from eating disorders and who is not yet ready or able to do the work that leads to eating disorders recovery.

In my opinion, the biggest blocks to recovery from anorexia, bulimia, and compulsive overeating are misinformation about eating disorders and an overconcern about what others think as opposed to a focus on how the eating disorder person thinks, feels and experiences the world. Before healing can begin, we have to focus on what's relevant to healing. Often this involves defying old habits and entrenched unrealistic ideas about self-sacrifice. People with eating disorders usually discover that they do best if they give their own recovery the number one priority in their lives.

This is why I wrote Triumphant Journey. I thought about the many hundreds, perhaps thousands, of courageous eating disorder recovery stories I've heard over the years. I took what I thought were the key issues and essential methods of recovery and put them into these pages. I hope you find here something helpful for you.

If you notice that something important is missing from these pages please let me know. My work and learning in this field is ongoing. I invite you to write with questions, comments and stories from your own experiences that can help me enrich this site. By many of us sharing viewpoints and experiences we can help to help each other. I look forward to hearing from you.

Joanna Poppink, M.F.T.

Disclaimer: By requesting information, resources or referrals you understand and agree that Joanna Poppink, M.F.T. and HealthyPlace.com are not responsible for the services, or lack thereof, of any of the providers or services listed in this post and that this communication and the contents of any of her written material are not psychotherapy nor a substitute for psychotherapy. You also understand that Joanna Poppink will not reveal your name or contact information to others without your permission, but given the nature of the state of technology today, e-mail communications are not confidential. If you need professional help, you are urged you to contact a licensed psychotherapist and/or physician in your community.

Introduction

Topics Include:

• kinds of overeaters
• benefits of moderate eating
• dilemmas for the overeater
• personal tools needed
• how secrets relate to overeating
• affirmations

Special Exercises to:

• stop overeating
• increase inner strength
• discover secrets
• develop self-respect

Introduction 1 - Idea for Triumphant Journey Begins

In 1991, I was cohosting a radio talk show concerning health issues with Tamiko in Beverly Hills, California. She asked me to write a brief "Ten Tips to Stop Overeating" that we could offer our listeners. Her idea was a card that people could tack on a refrigerator door.

I liked the idea of writing something simply and clearly that would help people understand how to stop overeating. But the subject is too complex for me to boil down to a card on a refrigerator door. I wish I could.

A refrigerator and snack cupboard card that might help would simply say, "Look in the exercise section of Triumphant Journey before you reach for non-essential food. You might find a better way to resolve your feelings and clear up your thinking than eating right now."

I thought of my own eating disorder history, of bingeing and throwing up for may years in secret, long before bulimia had a name. I remembered all the useless, self-deceiving and sometimes dangerous devices I used in my attempts to stop. I remembered my guilt, my growing sense of failure and despair, my loneliness and my stalwart attempts to look good. And finally, I remember accepting that my behavior would kill me. I lived believing that I would die in six months. I had no visions of any future for me and so never made long range plans that involved years of commitment.

Today, I know that bulimia was my greatest teacher. Moving through the despair of my eating disorder into a life of health, freedom and continual opportunity was and continues to be my Triumphant Journey.

I wanted to share the essence of the healing journey with my patients and especially to the people still trapped in lonely despairing eating disorders that can erode a soul.

The seeds of this book first sprouted in an article called, "Ten Tips to Stop Overeating," published by Resource Publications in Winter, 1991. Spring of 1992 Resources published my follow-up article, "Triumphant Journey: Understanding the Secrets of Overeating and Binge Behavior."

The many letters of appreciation I received from people struggling alone with their overeating moved and inspired me. I tried again to describe what I find to be the most helpful guidelines in addressing tenacious overeating. This book is growing out of those articles.

Contents:

Triumphant Journey: A Cyberguide To Stop Overeating and Recover from Eating Disorders

• Triumphant Journey - Introduction
• Part Two: Preparation: Are You An Overeater? A Check List
• Part Three: Exercises to Stop Overeating: 1 - 10
• Part Four: Time of Decision
• Part Five: The Creation of an Overeater -- Mary's Story
• Part Six: Twenty Inner Secret Discovery Questions
• Part Seven: Secret Discovering Exercises
• Part Eight: Using Affirmations to Stop Overeating
• Part Nine: Forms Of Help Beyond Triumphant Journey Cyberguide

Eating Disorders Articles by Joanna Poppink, M.F.C.C.

• Eating Disorder Early Recovery: 'How Do I Begin?' The 84,000 Ways
• Eating Disorder Recovery: Getting Better and Losing Friends
• The Basics of Eating Disorder Psychotherapy: How it Works
• For Teens: When You Discover a Friend is Bulimic or Anorexic
• Number One Reason for Developing an Eating Disorder
• Anorexia: True Story in a Sister's Words
• Anorexia When You Are Past Your Teens
• Eating Disorder Education: Benefits for Parents and Teens
• Eating Disorder Recovery
• Getting Through a Meal With Strength and Serenity
• Guided Imagery and Eating Disorder Treatment
• About Joanna Poppink

next: Triumphant Journey - Introduction
~ eating disorders library
~ all articles on eating disorders

Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

For many reasons, Step Five came easily for me.

First of all, I was ready to admit that I had been wrong. The groundwork had been laid by the terrible life situation where I found myself. The exact nature of my wrongs was clearly evident. My whole life was a mess and I was willing to pursue any alternative that gave relief.

Secondly, the first four steps had prepared me mentally and emotionally to accept that insane thinking and acting had brought me to this low point. The fog was lifting and I needed the catharsis of letting out all the pain bottled up inside me. I needed to talk with someone, to connect with another human being, to voice my realizations and bounce them off of another living person.

Third, up to this point, I'd had very little to talk to God about. I was too busy playing god. Now, after being broken and hitting bottom, I had all kinds of questions, confessions, and admissions to address to my Higher Power. Now, I had all kinds of time to contemplate the exact nature of my wrongs. Now my ego was out of the way. Now I was no longer emotionally defended, but emotionally vulnerable. Now I was ready to pray, ready to listen, ready to connect with a Power greater than myself. The only way I knew to connect with God was through prayer.

Fourth, I was finally ready to admit my flaws and imperfections, which I had tried desperately to keep hidden by playing god. I'd played god too long. Being god and being perfect was hard work. I was tired, worn out, and near mental and physical exhaustion. I'd fooled no one but myself. I was ready to let God be God, and I wanted everyone to know I had permanently resigned from the job.

In initially working Step Five, I made the serious mistake of sharing with another person who did not know how to listen compassionately to a person in recovery. This person was familiar with the Twelve Steps, but had no clue regarding how to process the information I was sharing. Subsequently, much that should have been kept confidential was conveyed to the wrong ears. Many breaches of trust and much irreparable damage was done, making Step Nine impossible with some of the people I'd harmed. I worked Step Five too eagerly, and subsequently, have returned to this step and worked it correctly many times since.

Even so, Step Five initially provided the relief I needed to open up and start honestly admitting my mistakes, sharing my story, and relating my recovery experience.

Step Five unlocked the mystery of recovery for me because it helped me, without fear or shame, to honestly admit I needed to change. Through Step Five, I discovered I was indeed capable of changing. I knew what to change from Step Four. I gave God permission to start changing me.

next: The Twelve Steps of Co-Dependents Anonymous Step Six

Information on antidepressant medication to treat Alzheimer's patients with depression.

Researchers have discovered that treating depression in patients with Alzheimer's disease can have a significant impact on the well-being of these patients. They also found that treatment of depression can reduce caregiver stress.

In Alzheimer's and dementia patients, symptoms of depression are very common. In the beginning stages they are usually a reaction to the person's awareness of their diagnosis. In the later stages of Alzheimer's Disease, depression may also be the result of reduced chemical transmitter function in the brain. Simple non-drug interventions, such as an activity or exercise program, can be very helpful. In addition, both types of depression can be effectively treated with antidepressants, but care must be taken to ensure that this is done with the minimum of side-effects.

Antidepressants may be helpful not only in improving persistently low mood but also in controlling the irritability and rapid mood swings that often occur in dementia and following a stroke.

Once started, the doctor will usually recommend prescribing antidepressant drugs for a period of at least six months. In order for them to be effective, it is important that they are taken regularly without missing any doses.

Improvement in mood typically takes two to three weeks or more to occur, whereas side-effects may appear within a few days of starting treatment.

Antidepressant side-effects

• Tricyclic antidepressants, such as amitriptyline, imipramine or doxepin, which are commonly used to treat depression in younger people, are likely to increase confusion in someone with Alzheimer's. They might also cause a dry mouth, blurred vision, constipation, difficulty in urination (especially in men) and dizziness on standing, which may lead to falls and injuries.
• Newer antidepressants are preferable as first line treatments for depression in Alzheimer's.
• Drugs such as fluoxetine, paroxetine, fluvoxamine, and citalopram (known as the selective serotonin re-uptake inhibitors) do not have the side-effects of tricyclics and are well-tolerated by older people. They can produce headaches and nausea, especially in the first week or two of treatment. There is very limited information about the use of other newer antidepressants in people with Alzheimer's, although one large treatment study (M Roth, CQ Mountjoy and R Amrein, 1996) suggests that moclobemide (an MAOI not sold in the U.S.) is an effective treatment. Venlafaxine (Effexor) has many of the side-effects of tricyclic antidepressants, but can be very helpful in people who have not responded to other treatments.

Sources:

• Lyketsos CG, et al. Treating depression in Alzheimer disease. Efficacy and safety of sertraline therapy, and the benefits of depression reduction: the DIADS. Arch Gen Psychiatry July 2003;60:737-46.
• Schneider LS: Pharmacologic considerations in the treatment of late-life depression. Am J Geriatr Psychiatry 4:S1, S51-S65, 1996.
• Roth, M, Mountjoy, CQ and Amrein, R (1996) 'Moclobemide in elderly patients with cognitive decline and depression'. British journal of psychiatry 168: 149-157.
• Alzheimer's Association: Depression and Alzheimer's

next: Alzheimer's: Medications for Treating Anxiet

Are you an entrepreneur with ADHD? Here are solutions to common business problems ADHD entrepeneurs face.

I'm a AD/HD Entrepreneurial Coach and here are some quick tips to help your business.

1. Eat your dessert first
   How do you structure your day? Do you start with every morning off by doing the things you have to do but don't necessarily enjoy and put the more enjoyable parts of your day off until later? Most of us spend very little time doing the things that we do best. Since we tend to enjoy the things we do best, then it follows that most of us spend most of our time doing things that we don't really enjoy. Instead, we spend the majority of our days struggling to do things that we don't like to do. Then we wonder why we don't want to get out of bed in the morning to go to work. Working this way drains your energy and decreases your ability to succeed at what you are trying to accomplish.

   The things you do best should be the things you do first. Rearrange your schedule so the things you enjoy the most - which are usually the things we do best - are the first things you do when you start your day. Rather than feeling drained before 10:00, you'll be more productive and you'll have more energy to face the rest of your day.

2. Focus your energy on your strengths, not your weaknesses
   Research on workers shows that people spend less than 20% of their time in activities that make the best use of their talents and abilities. Four-fifths of their day - 80% of their time - is spent doing things that do not lie within their area of strength. Instead of investing their time on developing their business, these people are spending more and more of their time trying to do things that they aren't equipped to do.

   Is this happening to you? To find out, start keeping a work log. Writing down how you spend your time, whether it was spent doing something you do well that contributes to your business or whether it was spent doing things that may be necessary but aren't necessarily things you do well. Chances are good that you'll be surprised to learn how little of your day using your strengths. A coach can help you find ways to change or even reverse that ratio, changing your day so you're spending the majority of your time doing the things you do best.

3. Remember: What you pay attention to grows
   This relates to number 2 above. The office philodendron died because no one paid attention to it. The same is true of your business and even your personal life. What you pay attention to grows. The things we neglect tend to die. If you're paying attention to your weaknesses, then your weaknesses are going to grow. That's why it's so important to pay attention to what you do well. You "grow" your strengths and talents by focusing on the things you do well.

   Try this: Take a flashlight, hold it about three feet above the floor and point it to straight down in front of your feet. That small pool of light represents the things you do well. This is the area where you should spend most of your time, in part because that is what you do well and in part because that's where the light is. If you work in the light, you're less likely to bump into things. Now raise the flashlight to about four feet. Notice how the area covered by the light just grew? The same thing happens as you focus on your strengths instead of your weaknesses. As you raise the level of your performance by paying attention to what you do well, the circle of things you do well will increase.

   The principle of "what you pay attention to grows" applies to all areas of your life. If you pay attention to your marriage, it will grow. If you neglect you relationships, those relationships will die. If you pay attention to a particular skill, that skill will grow. Left unused, that same skill will eventually disappear.

4. Sip, don't gulp your decisions
   Entrepreneurs tend to move quickly. It's easy to get caught up in the excitement of a new project and move ahead before you or your business is ready. These impulsive decisions can create more problems than they solve. Learn to sip your decisions slowly and not gulp down choices that you might later regret. Savor the decision making process, "sipping" each choice you face like a fine wine, rather than gulping it down too quickly. Once you make a decision, see how it tastes before making another. Others may try to pressure you to speed up your decision-making process, but the reality is that there are very few decisions that can't wait for another twenty-four hours.

David Giwerc MCC,(Master Certified Coach, ICF) is the Founder/President of the ADD Coach Academy (ADDCA), http://www.addca.com,/ a comprehensive training program designed to teach the essential skills necessary to powerfully coach individuals with Attention Deficit Hyperactivity Disorder. He has been featured in the New York Times, London Times, Fortune and other well-known publications. He has a busy coaching practice dedicated to ADHD entrepreneurs and the mentoring of ADD coaches. He helped develop ADDA's Guiding Principals For Coaching Individuals with Attention Deficit Hyperactivity Disorder. He has been a featured speaker at ADDA, CHADD, International Coach Federation and other conferences. David is the current President of ADDA.

next: How Your AD/HD Affects Your Business
~ adhd library articles
~ all add/adhd articles

Over the past couple of months, my new marriage has required me to make some significant adjustments. I've had to adjust to new living arrangements, adjust to new household members, adjust how I spend my time at home, and of course, adjust the finances.

And these are just the adjustments I've thought of quickly, off the top of my head. I'm sure there are many other adjustments going on that I'm not even aware of yet.

In short, there's been a lot of upheaval in my life lately. There's been a lot of instability and uncertainty in the situation as well. Whose kids are going to stay? Whose kids are going to move? Whose kids are going to this school? Or that school?

Lately, the only constant has been change.

I can honestly say that I've handled some of the adjustments well. But others are proving extremely difficult for me, especially the lack of a quiet, creative work space closed off from the flow of human traffic through the house. On this topic, my patience and tolerance have been stretched seven ways to one too many times. I've been known to be mad, sad, and glad—sometimes several times—in the course of a single day.

Deep down inside, I'm forced to admit that I'm not handling the associated stress of all these adjustments very well. I do my best to respond to situations as they arise, but sometimes, my old behaviors, old attitudes, old expectations, and old doubts (fears) come creeping up on me and jump out.

The situation is testing my serenity and my sense of balance to the maximum. I am going through one of those times when I have deep serenity for a day and then wild chaos for a day.

I'm struggling.

I'm trying to look at the situation creatively. I'm trying to grow through these difficulties and become a better person through the struggle. I'm trying to make sure my expectations don't cloud my perceptions. I'm praying daily for a clear vision, a pure heart, and an open mind.

I guess this new marriage is one of the hardest things I've ever been through. Definitely much harder than the divorce.

So again, I find myself in a period of transition, when the answers aren't coming quickly or readily. At least not quickly and readily enough for me. I'm feeling agitated, impatient, and uncomfortable—like I'm wearing new clothes or breaking in a new pair of shoes. I need to work on pacing, timing, and keeping a balance between:

home / work
wife / kids
household chores / relaxation
time together / time apart

I'm sure there have been times when I've tried too hard to make it all fit together—and times when I haven't tried hard enough. Blending a family is tough business. I feel like I'm being asked to work a jigsaw puzzle with a thousand pieces, but with the added requirement that each piece must be kept face down.

Right now, I'm just very thankful that I don't have to go through any of this alone. Family and friends have expressed their understanding and offered their help.

Dear God, thank You for this opportunity to struggle and grow. Thank You for my new wife and the wonderful love You are showing me through her. Amen.

next: Healthy Giving

The topic of giving is important for all recovering co-dependents. I think co-dependent individuals tend to be very giving by nature. In regards to our significant relationships, we want to feel that by our giving, we are contributing to another person's growth or well being. This is the "helping" and "caretaking" role we often fall into.

Giving is also dangerous for co-dependents. Whether we are giving our affection, our money, or our time, we want to be appreciated for our giving. Our egos want the gift to be recognized. At the same time, we also don't want our significant others to take advantage of our generous nature or take our generosity for granted. We can become resentful if our gift is not acknowledged or received with the proper gratitude.

We may also give with an expectation of getting something in return. We give in the sense of striking a silent deal—since I'm doing something for you, I expect you to do something for me. This is a form of co-dependent manipulation and we tend to let such deal-making substitute for honest communication.

But what is healthy giving? How do we, as recovering co-dependents find balance in this area?

First we must realize that healthy giving is our choice. We must give our gifts freely because we want to. If we are giving from a sense of obligation or guilt, we are not truly giving. Healthy giving comes from the heart, based on our conscious decision to give a particular gift.

Second, healthy giving is for our benefit—not the recipient's. In fact, the recipient need not even be aware that we are giving something of value to them. We give for the joy that we derive from our ability to give. By giving freely, we are developing our capacity to give more. Like exercising a muscle. Healthy giving does not need to be proclaimed for all to see and hear, nor does it need to be acknowledged by anyone but the giver.

Third, we give what we can give at the moment. Perhaps we say a prayer for an addicted friend. Perhaps we give a smile to someone who is grouchy. Perhaps we forgive the cross remark a spouse or child cast our way. There are hundreds of gifts and opportunities for us to give without giving up our power or our sense of calm and balance. We never have to feel compelled to give beyond our means—emotionally, financially, spiritually, etc.

Fourth, we give without expectation of return. We give an unconditional gift, with no strings attached. There is a blessing for us in this type of giving. Giving is not about the other person. Giving is about us. We do not give in order to receive—we give for the joy of giving. Our motivation is love, kindness, compassion, and treating another person the way we would like to be treated. If we are giving in order for someone to like us, approve of us, love us, or do things for us in return, then we have fallen back into unhealthy giving.

What are some healthy gifts that we can give?

Acceptance
Encouragement
Hugs
Smiles
Good deeds
Forgiveness
Affirmations
Compliments
Cards and letters
Time
Prayers
Telephone calls
Listening
Favors
Volunteer services
Hospitality

Healthy giving is a way for us to get outside of ourselves and our problems (and all co-dependents need to do that!). Giving allows us to focus on helping others without enabling them and without getting caught in a web of crazy, co-dependent expectations.

next: Recovery Is...