Resources

Helpful Resources in Stow, OH

Topic Spotlight

Taking Care of Intense Emotions by Donna McDonald, Ph.D.

As humans, we all experience difficult emotions. Emotions, even difficult ones, are important for many reasons.  They let us know more about our needs and how we are experiencing the world.  


However, sometimes emotions can feel overwhelming.  In these moments, our minds and bodies can become activated as if they are responding to a threat.  We may get stuck in racing thoughts, notice our heart beating fast or that we’re breathing quickly.  We may feel agitated and have difficulty focusing.  Activating calming processes that let our mind and body know that you’re safe and cared for work as effective coping strategies.   

We’ve found a few short YouTube videos highlighting skills that can help you calm and soothe the body and mind.  They are all evidence-based practices and backed by research.  In the videos, you will even see some of those researchers speaking.  Dr. Marsha Linehan (paced breathing) and Dr. Kristin Neff (self-compassion) have both completed years of research on helpful coping skills and ways to be kind to ourselves. Dr. Linehan has developed a type of therapy called Dialectical Behavior Therapy and many of the skills discussed in the videos.  Although these skills are in-the-moment strategies to help calm or soothe your strong emotions, they can have long-term impacts.   


The TIPP Skill: Calming yourself through Temperature, Intense Exercise, Paced Breathing and Progressive Muscle Relaxation. (2.5 minutes)   

https://www.youtube.com/watch?v=8nVady7A3Qo 


  • Additional Information on Temperature: You can also feel calmer by cooling yourself down by drinking cold water, applying ice to your face or hands, taking a cool shower, or even opening a window or going outside on a cool day.  Warm temperatures are more comforting.  Try drinking a warm drink, wrapping yourself in a blanket or taking a warm bath or shower.   


  • Additional Information on Intense Exercise:  Although 20 minutes of exercise is ideal, even a couple minutes can help.  Try running in place, turning on music and dancing around, or even just shaking your arms and legs.  A brisk walk is also helpful.   





Grounding Using the Five Senses: Grounding helps you get out of your head by focusing on something external (2 minutes):

https://www.youtube.com/watch?v=8lM8pgMgjEs   

  

Self-Soothe: Usually we find things that appeal to our senses to be relaxing or soothing (3 minutes):

https://www.youtube.com/watch?v=CwnHez9TC6c 

    

Self-Compassion:  Being kind to yourself in moments of stress is essential (2-3 minutes each) (Features Dr. Kristin Neff): 

https://www.youtube.com/watch?v=Qes9HoxfkE0 

https://www.youtube.com/watch?v=85HK_eRu-g4  

   

Being Mindful of your Emotions: You can also learn to be with your emotions in a new way – letting them come and go without struggle (4 minutes): https://www.youtube.com/watch?v=NECs97k_8Z4  

  


Other Ideas and Resources:  


Remember to check on sleep and eating: Not getting enough sleep or nutritious food makes us more vulnerable to difficult emotions. If you haven’t slept well or eaten lately, you may want to make time to do so.

   

Naming:  Simply labeling or naming what we are experiencing or feeling can also help.  Once the mind knows what is happening, it becomes quieter.  Noticing and naming emotions without judging them also helps us take a step back and gain some distance.  So, try saying things like “this is anxiety” or “I’m noticing sadness” or even “this is a difficult moment.”

 

Connecting with others: Connection is an energy giving, calming process.  Getting a hug or hearing kind words from someone we care about can help us manage strong emotional responses. 


Distraction: Sometimes we just need to get our minds off a difficult situation and give our emotions time to settle.  Using distracting activities can be useful in those moments.  However, distractions should be used in moderation and as short-term solutions.  Distracting ourselves too much can lead to avoiding important things in our lives and putting off needed tasks. 

 

The website Now Matters Now has lots of additional ideas, videos, and support for managing strong emotions: https://nowmattersnow.org/   


NOTE: If your strong emotions include thoughts of self-harm, death, or suicide, please connect with a mental health professional.  The following is a list of crisis resources that are available 24/7.   

  • Summit County 24 Hour Crisis Hotline: 1-330-434-9144 
  • National Suicide Prevention Hotline: 988 
  • Text Crisis Line: text 4hope to 741-741 
  •  For Young People of Color

                     Text Steve to 741-741 to access a culturally trained counselor  https://www.stevefund.org/  

                      Call 1-866-488-7386 or text start to 678-678 

  • Go to Hospital Emergency Rooms: Akron City or Akron General Cleveland Clinic


Apps for iPhone and Android


Affirmations/Motivation

I AM

Motivate

Motivation


Concentration and Productivity

Focus


Games – to promote mindfulness/distraction

Connect

Word Cross

Word Search

Mandala

Colorfy

Color

Zen Sand

Heat Pad

Fluid

Fluid 2

 

Medication Management

Pill Reminder


Mood Charting

eMoods

Perspective




Mood Management/Anxiety Management/Meditation/Sleep

Calm

Headspace

ZEN

Petit BamBou

Bloom Ten Percent

The Tapping Solution

Clarity – mood tracking, journaling, education mindfulness, affirmations, chat

ShutEye

InsomniaCoach

Mooditude

Unmind


Music/Podcasts 

TED 

YouTube 

Spotify 

 

Self-care/growth 

Shine 

Fabulous 

Elevate – personalized brain training 

Me+ 

 

Suicide Prevention 

Safety Plan 

Safety Net 

Virtual Hope Box 

Jason Foundation 


Books of Interest

Anxiety Disorders

  • Beyond the Relaxation Response (1984) by Herbert Benson, New York: Times Books.
  • Bipolar: The Elements of Bipolar Disorder, A Practical Guide (2002) by Jay Carter, Psy.D., Wyomissing, PA, Unicorn Press
  • Mastery of Your Anxiety and Panic (2007) by David H. Barlow and Michelle G. Cranske, New York, NY: Oxford University Press
  • Mastery of Your Anxiety and Worry (2006) by Richard E. Zinbarg, Michelle G. Cranske and David H. Barlow, New York, NY: Oxford University Press.
  • The Anxiety and Phobia Workbook (4th ed., 2005) by Edmund J. Bourne Ph.D., Oakland, CA: New Harbinger Publications, Inc.
  • The Mindfulness and Acceptance Workbook for Anxiety (2007) by John P. Forsyth, Ph.D. and Georg H. Eifert, Ph.D., Oakland, CA: New Harbinger Publications Inc.
  • The OCD Workbook, Your Guide to Breaking Free from Obsessive-Compulsive Disorder (c. 2005) by Bruce M. Hyman, Ph.D. and Cherry Pedrick, R.N..Oakland, CA: New Harbinger Publications, Inc.
  • The PTSD Workbook (2002) by Mary Beth Williams, Ph.D., LCSW, CTS and Soili Poijula, Ph.D., Oakland, CA: New Harbinger Publications Inc.
  • S.T.O.P. Obsessing, How to Overcome Your Obsessions and Compulsions (1991) by Edna B. Foa and Reid Wilson, New York: Bantam.
  • When Perfect Isn't Good Enough (1998) by Martin M. Antony, Ph.D. and Richard P. Swinson, M.D., Oakland, CA: New Harbinger Publications, Inc.

Assertiveness

  • Driven to Distraction (1994) by Edward Hallowell, M.D. and John Ratey, M.D. New York: Pantheon Books.
  • The Assertive Woman (3rd ed., 1997) by Stanlee Phelps and Nancy Austin, San Lois Obispa, CA: Impact.
  • You Mean I'm Not Lazy, Stupid or Crazy? (1993) by Kate Kelly and Peggy Ramundo, forward by Larry B. Silver, M.D., Cincinnati, Ohio: Tyrell and Jerem Press.
  • Your Perfect Right: A Guide to Assertive Living (7th ed., 1995) by Robert Albertini and Michael Emmons, San Losi Obispa, CA: Impact.

Autism

  • 100 Day Kit for School Age Children - access here 
  • 100 Day Kit for Young Children - access here
  • Asperkids: An Insider’s Guide to Loving, Understanding, and Teaching Children with Aspergers Syndrome (2012) by Jennifer Cook O’Toole. (Please note that Asperger’s Disorder is now referred to as autism spectrum disorder)

Attention Deficit Disorder

  • Delivered from Distraction-Getting the Most out of Life with Attention Deficit Disorder (Trade Paperback Edition, 2006) by Edward M. Hallowell, M.D. and John J. Ratey, M.D. Ballantine Books, New York, N.Y.
  • Smart but Scattered-The Revolutionary Executive Skills Approach to Helping Kids Reach Their Potential-(4 to 13 year olds), (2009) by Peg Dawson, Ed.D. and Richard Guare, Ph.D., Guilford Press, New York, N.Y. 10012
  • Smart but Scattered Teens-The Executive Skills Program for Helping Teens reach Their Potential (2013) by Richard Guare, Ph.D., Peg Dawson, Ed.D. and Colin Guare, Guilford Press, New York, N.Y 10012
  • Taking Charge of ADHD-The Complete Authoritative Guide for Parents (3rd Edition, 2013) by Russell A. Barkley, Ph.D., Guilford Press, New York, N.Y. 10012.
  • Taking Charge of Adult ADHD: Proven Strategies to Succeed at Home, at Work, and in Relationships, by Dr. Russell Barkley (2022), also available as audio book
  • The ADHD Workbook for Teens (2010) by Lara Honos-Webb, Ph.D., Instant Help Books- An Imprint of New Harbinger Publications, Inc., Oakland, CA 94609

Career Development

  • What Color is Your Parachute (30th ed., 1999) by Richard Bolles, Berkeley, CA: Ten Speed.

Child Development/Parenting

  • Adventures in Parenting. A free booklet from the National Institute of Child Health and Human Development (NICHD) can be obtained by calling

       1-800-370-2943 or online at wwwichd.nih.gov. It can be downloaded here.

  • Friends Forever: How Parents Can Help Their Kids Make and Keep Good Friends (2010) by Fred Frankel, Ph.D.
  • Good Friends are Hard to Find (1996) by Fred Frankel, Ph.D., Glendale, CA: Perspective Publishing, Inc.
  • How it Feels When Parents Divorce (1984) by Jill Krementz, New York: Knopf
  • Parenting with Love and Logic (1990) by Foster Cline, M.D. and Jim Fay, Colorado Springs, CO: Pinon Press.
  • Teens in Turmoil (2002) by Carol Maxym, Ph.D. and Leslie York, M.A., New York: Penquin Putnam.
  • The Adolescent Self (1991) by David B. Wexler, Ph.D., New York & London: W.W. Norton and Company.
  • The Boys and Girls Book about Divorce (1985) by Richard Gardner, New York: Bantam.
  • The Optimistic Child (1996) by Martin E. Seligman, Ph.D., Harper Perennial.

Chronic Illness

  • Heart Illness and Intimacy: How Caring Relationships Aid Recovery (1992) by Wayne Soctile, Baltimore: Johns Hopkins University Press.
  • Heartmates: A Guide for the Spouse and Family of the Heart Patient (3rd ed., 2002) by Rachel Freed, Minneapolis MN: Fairview Press.

Communication/Negotiation

  • Beyond Reason: Using Emotions as You Negotiate (2005) by Roger Fisher and Daniel Shapiro, USA: Penguin Books.
  • Getting to Yes, Negotiating Agreement Without Giving In (1991) by Roger Fisher and William Ury, USA: Penguin Books.
  • Verbal Judo: The Gentle Art of Persuasion (2004) by George Thompson, Ph.D. and Jerry Jenkins, New York, New York: HarperCollins Publishers, Inc.
  • You Just Don't Understand, Men and Women in Conversation (1990) by Deborah Tannen, New York: Ballantine Books.

Death/Grieving

  • A Broken Heart Still Beats (1998) by Anne McCracken and Mary Semel, Center City, Minnesota, Hazelden.
  • The Bereaved Parent (1978) by Harriet Sarnoff Schiff, New York, NY, Penquin Books, Inc.
  • When Bad Things Happen to Good People (1981) by Harold Kushner, New York: Schocken. (Spiritual help by a Rabbi).

General

  • Authoritative Guide to Self Help Resources in Mental Health (2000) by John Norcross, Ph.D., John Santrock, Ph.D., Linda Campbell, Ph.D., Thomas Smith, Psy.D., Robert Sommer, Ph.D., and Edward Zuckerman, Ph.D., New York, New York: The Guilford Press.
  • Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward (1994) by James O. Prochaska, Ph.D., John C. Norcross, Ph.D., and Carlo C. DiClemente, Ph.D., New York, New York, Harper Collins Publisher.
  • Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy (c. 2005) by Steven C. Hayes, Ph.D. with Spencer Smith, Oakland, CA: New Harbinger Publications, Inc.
  • The 10 Dumbest Mistakes Smart People Make and How to Avoid Them (1993) by Dr. Arthur Freeman & Rose DeWolf, Preface by Aaron T. Beck, M.D., New York: HarperCollins Publishers, Inc.
  • The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance, by Dr. Matthew McKay, Dr. Jeffrey Wood, and Dr. Jeffrey Brantley (2019)
  • The White Knight Syndrome: Rescuing yourself from your need to rescue others. (2009) by Mary C. Lamia, Ph.D. and Marilyn J. Krieger, Ph.D., Oakland, CA, New Harbinger Publication, Inc.
  •  When Someone You Love has a Mental Illness (Nov. 2003) A Handbook for Family, Friends, and Caregivers by Rebecca Wodis, MFT, Forward by Agnes Hatfield, Ph.D., New York, New York: Penguin Group (USA).

Marital/Relationships

  • After the Affair (1st ed., 1997) by Janis Abrahms Spring, Ph.D. with Michael Spring, HarperCollins Publishers.
  • After the Honeymoon (2008) by Daniel B. Wile, Ph.D., Oakland, CA: Collaborative Couple Therapy Books.
  • The Dance of Anger: A Woman's Guide to Changing the Patterns of Intimate Relationships (1985) by Harriet Lerner, Ph.D., Harper and Row Publishers Inc.
  • The Five Languages of Love (1996) by Dr. Gary Chapman, Northfield Publishing.
  • The Love Dare (2008) by Stephen & Alex Kendrick, Nashville, TN: B&H Publishing Group (Christian).
  • The Seven Principles for Making Marriage Work (1999) by John M. Gottman, Ph.D. and Nan Silver, New York: Three Rivers Press.
  • We Can Work it Out (1993) by Clifford Notarius, Ph.D. and Howard Markman, Ph.D., New York: Berkley Publishing.
  • Why Marriages Succeed or Fail (1994) by John Gottman, Ph.D., New York: Simon & Schuster.

Mood Disorders

  • Control Your Depression (1996) by Peter Lewinsohn, Ricardo Munoz, Mary Ann Youngren and Antoivette Zeiss, Englewood Cliffs, NJ: Prentice-Hall.
  • Feeling Good, The New Mood Therapy (rev. ed. 1999) by David Burns, New York: Avon.
  • Mind Over Mood: Change How You Feel by Changing the Way You Think (1995) by Dennis Greenberger, Ph.D. and Christine A. Padesky, Ph.D., New York: Guilford Press.
  • Overcoming Depression One Step at a Time (2004) by Michael E. Addis, Ph.D. and Christopher R. Martell, Ph.D., ABPP, Oakland, CA: New Harbinger Publications, Inc.
  • The Feeling Good Handbook (rev. ed. 1999) by David Burns, New York: Plume.
  • The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness (2007) by Mark Williams, John Teasdale, Zindel Segal and Jon-Kabt-Zinn, New York: The Guilford Press.

Self Esteem

  • Ten Days to Self-Esteem (1993) BY David D. Burns, M.D., New York, New York: Harper Collins Publishers, Inc.
  • The Self- Esteem Workbook by Glen R. Schiraldi, Ph.D. Oakland, CA New Harbinger Publications, Inc.

Special Education

  • Parent and Educator Resource Guide to Section 504 in Public Elementary and Secondary Schools - a detailed guide published by the US Department of Education (2016).  It can be downloaded here.

Trauma

  • The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Dr. Bessel van der Kolk (2015)
  • The Courage to Heal and The Courage to Heal Workbook (3rd ed. 1994) Childhood Sexual Abuse, by Ellen Bass and Laura Davis, New York, New York: HarperCollins Publishers, Inc.
  • Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, by Dr. Judith Herman (2022)

Articles written by WRPA clinicians

  • Getting Prepared for College and Life beyond the Home WRPA

    Getting Prepared for College and Life beyond the Home


    We live in an era where college performance is declining for many students while tuition costs are steadily increasing. Over 55% of college students do not graduate within the first six years of college. Eighty percent of college students do not know what their major should be when they enter college, and almost 50% of college students change their majors at least once. Half of those who change majors do so two to three times. Employment rates for college graduates under the age of 25 are less than 50%, with many of those employed being underemployed in jobs that are not well paid and do not utilize the knowledge the students gained in college.


    School Place Assessment should be the first step in planning for a successful transition to college, to career success, and to life happiness. It takes a comprehensive look at variables of personality and emotional well-being because personality variables are predictive of career interests. This important information is used to make decisions such as college major, matching of learning environment to the teenager's learning styles, and emotional preparedness to leave home and go to a college. The goal is to assist students in making better decisions so as to complete college in four years and to reduce the frequency of students not completing school/college. This assessment goes far beyond the conventional career interest inventory.


    Young adults and their parents will learn from the School Place Assessment customized study strategies based upon their personalities, college/career selection, and increased self-awareness related to talents and goals.


    The School Place Assessment can be used with students between the ages of 12 to 22. Dr. Whitmore has worked with these age groups for 20+ years. She has been trained and nationally certified to administer and provide valuable feedback to students and their parents.


    For more information, please contact Western Reserve Psychological Associates, Inc. in Stow, Ohio.


    Western Reserve Psychological Associates

  • Scary Clowns: The Fear of Clowns by Eve F. Whitmore, Ph.D.

    Scary Clowns: The Fear of Clowns


    Clowns have been around for ages. Traditional clowns were comic relief in the circus after the thrills and chills of daring circus acts involving acrobatic feats. Even though most clowns are trying to be silly and sweet, many children do not like them. Young children have a fear of strangers, and when they encounter a clown at a birthday party, or even the circus, they can react with fear. Some people develop an extreme fear of clowns, referred to as Coulrophobia, which causes a person to experience mental and physical stress reactions and limits functioning due to anxiety; although this term has not been popular due to the infrequency of actual clown encounters. Interestingly, the classic, sweet, funny clown has been found to have a therapeutic effect on sick children in the hospital, decreasing a child's pre-operative anxiety and decreasing the length of respiratory illness. Sadly, there are fewer professional clowns seen these days because clowns have gone out of fashion.


    So why are some teenagers and adults (only 2% of the adult population) so afraid of clowns? If a parent experiences a specific fear of clowns, this often gets conveyed to a child or teenager, who is then more likely to become afraid. Modern horror movies have portrayed clowns as bad or evil and are not considered sweet or funny at all. In addition, pranks are currently being played by mischievous people dressed in clown costumes. Because one is unable to read a clown's emotions due to their heavy face paint, their display of manic-like behaviors can be terrifying to some, and this increases the idea that clowns are to be feared. In addition, clown fear is being exacerbated by social media. People develop fears by what they read and see in the media, like Facebook, Instagram and YouTube, where information goes `viral,' and rumors of murderous clowns and `clown sightings' spread quickly.


    As Halloween is fast approaching, you need to have your wits about you to enjoy the annual ritual of Trick-or-Treating. If you encounter a clown along the way, do not be intimidated or show fear, especially toward the sweet, nice looking clowns. Use rational thinking: "Clowns are typically good, sweet, soothing figures who make people laugh and feel happy." Consider the source of the viral message on social media, and make sure you note the source providing information about a `clown sighting'. Think logically and rationally before reacting to vague information, and do not let it become an unrealistic fear. If you continue to experience anxiety, then you should consider further consultation with a psychologist in order to better assist with minimizing your fears. Happy Halloween!


    Eve F. Whitmore, Ph.D.

    Staff Psychologist

  • Disability and the Family by Virginia Fowkes Clark, Ph.D.

    Disability and the Family


    Having a family member with a medical or psychiatric disability places unusual stresses on the family. Family members who provide care giving more than 36 hours weekly are at increased risk for anxiety, depression, sleeplessness, and back pain. For elderly caregivers with a chronic illness themselves, there is a high mortality rate than for those who are not in a care giving role.


    When the disability first occurs, extended family, friends and community members tend to flock to help the family. However, as disabilities become more chronic, people fall away and distance themselves from the family and the person with the disability. The resources of the family become stretched.


    Financial stress often arises. Sometimes a two-income family has to cut back to one income either because an earner has to stop work due to the disability or with an elderly parent or a child one earner has to stay home to care for the one with the disability. Sometimes a stay at home mother has to return to work so her disabled husband can stay home. The changes in finances also change the roles taken in the family.


    When a child becomes disabled or is born with a disability, if there are other children, they often receive less attention. Sometimes this can lead to behavioral or emotional problems in the child without the disability.


    Strain on the marriage is common among parents of a child with a disability. Often the mother becomes very involved with the child and pays less attention to the husband and the marriage. As mentioned above, finances can be strained which is a source for common arguments.


    Often it is difficult to admit one is angry with a family member for having a disability and its impact on the family. Acknowledging the possible or inevitable future losses is important but it is also important to not overemphasize the loss. A shift needs to be made toward strengths, interests, and abilities. One needs to find meaning and hope beyond the physical progression of the disease. Challenges can be viewed as opportunities for learning and change. Furthermore one needs to be flexible and adjust future major goals.


    Community support and psychotherapy can help. Support groups sometimes exist for families with certain disabilities, although more are needed. Respite services are available for families in some cases. Psychotherapy focusing on stress management and support can provide both an outlet for frustrations but also can improve coping.


    References:


    1. John S. Rolland, M.D. "Mastering Family Challenges with Illness & Disability: An Integrative Model" 3rd Annual Ortho Summer Symposium, 2008.
    2. Froma Walsh, Ph.D. "Spiritual Wellsprings for Resilience: Living and Loving Fully with Disabilities." 3rd Annual Ortho Summer Symposium, 2008.

    Virginia Fowkes Clark, Ph.D.

  • Relationships and "the New Infidelity" by John S. Schell, Ph.D.

    Relationships and "the New Infidelity"


    Dating back to biblical times, infidelity has been a threat to committed relationships and is certainly one of the issues that bring couples into therapy. Today, infidelity does not have to involve a sexual indescretion to destroy the very nature of trust that holds two people together. "The new infidelity is between people who unwittingly form deep, passionate connections before realizing that they've crossed the line from platonic friendship into romantic love." According to Dr. Shirley Glass, a psychologist and renowned expert on infidelity, "infidelity is any emotional or sexual intimacy that violates trust."


    Of course, Dr. Glass is describing what we have come to know as an emotional affair, an affair that excludes sexual intimacy but involves primarily emotional intimacy. In reality, to call this a new form of infidelity is a bit of a misnomer. Evidence of these types of emotionally charged relationships date back in history as well, but it seems safe to say that the frequency with which people are having emotional affairs is certainly on the rise. Dr. Glass identified this trend in her 2003 book, Not Just Friends, citing her data which suggested that approximately 60% of the men and women she had counseled had been involved in an emotionally unfaithful relationship. Furthermore, 82% of sexually unfaithful partners had had an affair with someone who was at first "just a friend."


    David Moultrup (1990), author of Husbands, Wives, and Lovers, has broadly defined an extramarital affair as "a relationship between a person and someone other than (the person's) spouse or lover that has an impact on the level of intimacy, emotional distance, and overall dynamic balance in the marriage-the role of the affair is to create emotional distance in the marriage." By this definition, sexual involvement is neither a necessary ingredient in defining the presence of an affair, nor in understanding its impact on the committed relationship. Of course, for the emotionally unfaithful partner, citing the absence of sexual activity may be a way to neutralize the sense of extramarital wrongdoing. "But we didn't have sex" is somehow supposed to make the betrayal of an emotional affair less painful. In fact, because infidelity means different things to different people, those involved in an emotional affair might not even consider their behavior as inappropriate or hurtful. Men in particular often seem to hold this view, but for women who stereotypically put more emphasis on emotional rather than sexual intimacy, an emotional affair may prove to be even more destructive to a relationship than a one night stand or casual sexual encounter.


    It's important also to remember that most people who become involved in an emotional affair were not intending to be unfaithful, were not looking to have an affair, and in many cases did not think they were vulnerable to such behavior. Sharing your deepest thoughts and feelings in an ongoing interaction with someone will typically generate a feeling of closeness that then stimulates even more disclosure and more intimacy. Eventually this type of relationship can become extremely close causing an emotional attachment to develop thereby potentially causing serious damage to a marriage or committed relationship, regardless of whether or not the affair ever becomes sexual in nature.


    It's important also to remember that most people who become involved in an emotional affair were not intending to be unfaithful, were not looking to have an affair, and in many cases did not think they were vulnerable to such behavior. Sharing your deepest thoughts and feelings in an ongoing interaction with someone will typically generate a feeling of closeness that then stimulates even more disclosure and more intimacy. Eventually this type of relationship can become extremely close causing an emotional attachment to develop thereby potentially causing serious damage to a marriage or committed relationship, regardless of whether or not the affair ever becomes sexual in nature.


    Signs that a close friendship may really be an emotional affair include: Inappropriate emotional intimacy: Are you sharing more with your friend than you are with your partner? Do you think your friend understands you better than your partner? Do you look forward to being with your friend more than your partner? Sexual and emotional chemistry: Are you sexually attracted to your friend? Is it more exciting to be with your friend than your partner? Deception and secrecy: Does your partner know about your friendship or is it a secret? Are you saying and doing things with your friend that you wouldn't do with you partner present? Denial and minimization: Is the phrase "we're just friends" your way of rationalizing your close friendship?


    In general, infidelity happens for a variety of reasons, but emotional affairs seem to be on the rise because of increased opportunities, both in the workplace and online. What may start out innocently enough, may quickly spiral out of control, and result in a relationship that is inappropriate in terms of the emotional intimacy involved. Individuals involved in these types of relationships may experience the same biochemical rush that occurs when two people fall in love, creating a "high that becomes almost addictive" according to Dr. Frank Pittman (1990), psychiatrist and author of Private Lies: Infidelity and the Betrayal of Intimacy. This makes the developing pattern of inappropriate intimacy all the harder to break.


    Over the past few years, I have seen more and more couples who are struggling with trust issues and a sense of betrayal that has come from one of the partners having had an emotional affair. In many of these cases, the lack of sexual involvement has not mitigated the negative effects of the affair, and the deception involved was clearly destructive to trust and the relationship in general. Of course, friendships are important and can provide us things that we sometimes cannot find in our relationships, but allowing them to fulfill important needs at the expense of your partner and your relationship can certainly be destructive and is a sure sign of an emotional affair.


    John S. Schell, Ph.D.

    Clinical Psychologist

  • Oppositional Behavior in Children by Virginia Fowkes Clark, Ph.D.

    Oppositional Behavior in Children


    Every year thousands of children are evaluated and treated by clinicians because their parents or teachers complain that these children frequently disobey, argue, lose their temper, deliberately annoy others or in other ways are disruptive. Some research suggests that psychosocial factors such as family conflict and parent mental health problems are related to oppositional behavior in children. Treatment hinges on assessing both the child and the family setting.


    How do you know if your child has Oppositional Defiant Disorder? According to the DSM-IV-TR, to meet the criteria a child must have four of the eight symptoms more frequently than is typical for the child’s age and developmental level and lasting at least six months. These symptoms are: often loses temper, often argues with adults, often actively defies or refuses to comply with adults’ requests or rules, often deliberately annoys people, often blames other for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful and is often spiteful or vindictive.


    A good clinician will help clarify whether your child has these symptoms in addition to another set of symptoms which may better explain why your child is oppositional. For example, many children with Attention Deficit Hyperactivity Disorder have these symptoms but when both are treated, the prognosis is much better. It is important to recognize that sometimes children develop these symptoms in reaction to some stress in their life. Some children with depression develop many of these symptoms. In that case, the depression needs to be treated as well as the oppositional behavior in order for your child to get better. Some children with autism spectrum disorders develop these symptoms and treatment has to be tailored with that in mind otherwise there will be little progress. Sometimes these symptoms can be stemming from a bipolar disorder.


    Assessing factors in the family are especially important. When parents are under stress due to their own mental health problems, financial stress or marital conflict, it is more difficult to be an effective parent. Helping parents be the best that they can is an important component of treating oppositional behavior. Parent training should be a vital part of the treatment. Furthermore, treatment of oppositional behavior in a child may lead to the detection of mental health problems in a parent or serious marital problems. In these situations, when all the problems in the family are addressed, the outcome is the best.


    Virginia Fowkes Clark, Ph.D.

  • Extraordinary Events and Psychological Resilience by John S. Schell, Ph.D.

    Extraordinary Events and Psychological Resilience


    Life is hard. For some people, life may be extremely hard. Often we face circumstances that threaten our well-being and challenge our most basic coping skills, leaving us feeling overwhelmed and distraught. Whether we are dealing with the recent hurricanes and their devastating aftermath, or the damage that comes from a lifetime of poverty, abuse, or trauma, we are all called upon at times to contend with significant adversity. Some of us may cope very well, while others may not. What separates these two groups?


    Our ability to tolerate distress depends on a number of factors-the nature of the stressful situation, the intensity of the emotion that is generated, the amount of stress we are already experiencing, our overall physical and psychological health, and the effectiveness of our coping style. Research on children raised in hostile, abusive environments suggests that there may be another factor that buffers us from the otherwise deleterious effects of stressful life events-psychological resilience.


    Individuals who are more psychologically resilient seem to share certain qualities or characteristics that inoculate them against stress and enable them to survive, even in the face of extreme adversity. Psychologically resilient individuals are typically intelligent, self-confident, and able to recognize their own competencies. They have the ability to appreciate the "big picture" and see beyond their current life circumstances. They can control their impulses, think through the ramifications of their life choices, and avoid some of the more maladaptive coping strategies utilized by so many. Furthermore, they refuse to blame themselves or take responsibility for circumstances beyond their control. And perhaps most importantly, they are able to remain optimistic and hopeful, even in very trying times.


    In short, these individuals have perseverance and hardiness. They are not easily overwhelmed, and have the mental flexibility to adapt to difficult life circumstances, adjusting their tactics rather than trying to apply a more rigid problem-solving approach that has limited utility. Simply stated, they are able to stay positive.


    As we come to better understand the genetic and biological underpinnings of these characteristics, it seems clear that only an unfortunate few are born genetically pre-programmed to experience great distress and develop psychopathology in the face of adversity, while on the other hand, only a select few are born with a genetic make-up that truly buffers them from such even in the worst of circumstances. Most of us fall somewhere between these two genetic extremes, and specifically where we fall along the continuum can change over time.


    For example, research has empirically demonstrated the importance of social support. Specifically, being able to turn to someone who cares about us and who can help us shoulder life's burdens can positively affect our ability to cope with even the most difficult of stressors. Having and utilizing social support can positively impact our overall psychological resiliency.


    Furthermore, developing a life philosophy or perspective that enables us to remain positive, even in the face of adversity, is also critically important. Perhaps this has to do with the ability to find meaning in our lives, and by extension, in our suffering. As Nietzsche so aptly pointed out, man can survive any how if he has a why. Finding some way to understand and accept life's difficulties is also consistent with greater psychological resiliency.


    In the end, it is clear that we all face adversity, big or small, in our lives. We may have an easier or more difficult time adjusting, depending upon our genetics and our life histories, but we all have to do what we can to increase our psychological resiliency. When we find ourselves overwhelmed, when we experience symptoms of depression, anxiety, or another mental health ailment, or when we turn to maladaptive coping skills, this is the time to step back and examine what else we can do to face the adversity in a more adaptive fashion-what else we can do to cope when life is particularly hard.


    John S. Schell, Ph.D.

    Clinical Psychologist

  • Making Friends by Virginia Fowkes Clark, Ph.D.

    Making Friends 


     Some children have difficulty making and keeping friends. This can lead to sadness, worry, isolation, being bullied and even depression. One psychologist, Fred Frankel, Ph.D., has looked at what children do or do not do that contributes to their problems making friends. He has then addressed each individual behavior and developed a program to train children how to make and keep friends by learning specific new behaviors. In his book Good Friends are Hard to Find, he teaches these methods to parents in an easy to read fashion. 


    For example, in playing a child might tend to clown around, frequently break the rules, and not let others get a turn. He might also frequently get in arguments and stop playing when losing. After a while other children will not want to play with him. You as a parent can learn to teach the rules of being a good sport. Dr. Frankel gives very specific directions that are clear and easy to follow. 


    Some of the topics he covers are finding friends, making friends, keeping friends, dealing with teasing, bullying and meanness and helping your child out of trouble. More specific topics range from stopping rumors to how to deal with having friends stolen. 

     

    This book is recommended reading for the parents of children with any of the above problems. Therapists are also educated in friendship training. Some work individually with children, others work with children in groups. 

     

    Reference: Frankel, Fred, 1996. Good Friends Are Hard To Find. Los Angeles, CA: Perspective Publishing 

     

    Virginia F. Clark, Ph.D. 

    Clinical Psychologist 

  • Driven to Distraction: ADHD by John S. Schell, Ph.D.

    Driven to Distraction: ADHD 


    As the long days of summer begin to wane, parents begin to anticipate and prepare for their children's return to school. What they are often unprepared for, however, are the notes that may soon be sent home by teachers indicating that their child “cannot sit still,” “is having trouble concentrating,” and “is disrupting other students.” Such remarks are certainly concerning, and for many parents, mark the beginning of a journey designed to distinguish normal childhood behavior from a true problem. 


    In these instances, sometimes too quickly, teachers and parents alike are willing to speculate about attention-deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder that can cause hyperactivity, impulsivity, and difficulty with attention and concentration. ADHD, the newer term for ADD, affects between 4 and 12 percent of school-aged children, and is 2 to 3 times more likely to be diagnosed in boys than in girls. Epidemiologically, ADHD has become much more prevalent within our society over the past several years, causing many to consider it epidemic. Needless to say, this has elicited much controversy, not only amongst educators, psychologists, and physicians, but in the general public as well, and has led many to consider ADHD to be over-diagnosed and over-treated. 


    While there may be some truth to this, it is probably more accurate to say that ADHD is too often misdiagnosed—missed in certain situations, and too often confused with other problems. For example, distractibility as a symptom is not specific to ADHD—it may be caused by depression, anxiety disorders, or interpersonal difficulties such as peer conflict and family stress. Furthermore, ADHD often co-occurs with other disorders, making it all the more difficult in some situations to establish an accurate diagnosis. Although these reasons may, in part, account for the increase in the number of cases of ADHD, more clearly articulated diagnostic criteria, as well as increased awareness and a greater willingness to seek treatment, may also explain the rise in numbers. 


     Symptoms 


    Although inattention, hyperactivity, and impulsivity are the hallmarks of ADHD, the disorder can manifest itself differently across individuals. Very often, children with ADHD will be easily distracted and unable to stay focused, making it difficult for them to read and to pay attention in class. They may have trouble staying organized, may be prone to procrastination, and may often have difficulty following through on tasks, making it difficult to both start and complete projects. In children where hyperactivity is also a concern, parents and teachers often report excessive restlessness or fidgety behavior, an inability to sit still, and increased impulsivity (e.g., difficulty taking turns, more interruptive behavior, acting without thinking through the consequences). Furthermore, children with ADHD may have problems with short-term memory, may be more careless and accident prone, and may report more emotional distress and interpersonal difficulties. 


    While this is not an exhaustive list of symptoms, it covers the basics and explains why so many children with ADHD have difficulty in academic settings. However, it is worth noting that the symptoms must cause significant impairment in more than one area of functioning to warrant the diagnosis. Furthermore, the symptoms must be present before the age of seven, and must not be better explained by some other condition such as depression or a learning disability. 


     Assessment 


    Again, because ADHD is so easily confused with other disorders, a thorough assessment is absolutely necessary in establishing an accurate diagnosis. Other explanations, including intellectual giftedness and being bored in class, need to be ruled out. Although clinical interviews and behavioral observations are the cornerstone of a good evaluation, psychological testing, in most cases, is also an integral part of the assessment process. There are a handful of questionnaires that directly assess ADHD symptoms, but an intelligence test to evaluate cognitive strengths and weaknesses is perhaps even more important. Additional tests of memory and neuropsychological functioning are also usually included in a comprehensive test battery. 


     Although many clinicians rely solely on clinical interviews to establish an ADHD diagnosis, conducting a more thorough evaluation would certainly reduce the number of misdiagnosed cases and potentially reduce the controversy around this often misunderstood condition. 


     Treatment 


    While there has been much research into the etiology of ADHD, the cause remains unknown. ADHD seems to run in families, therefore it seems likely that there is some underlying genetic contribution. At the same time, a variety of additional factors, including dyes and preservatives in food, a history of head injury, and premature birth, have all been considered in the onset of ADHD. 


    Because the exact cause remains undetermined, there is no specific cure at this time. While many children seem to outgrow the condition by adolescence, or at least find ways to adaptively work around the symptoms, many adults remain affected. Epidemiologically, it is estimated that as many as 50% of children affected by ADHD will continue to have difficulties as an adult, and more attention is being paid to adults who may never have been diagnosed as children. 


     In terms of treatment, a parent's initial reaction may be to seek a pharmacological answer, although medications remain a controversial subject. Parents may turn to their pediatricians or primary care physicians for answers, but many feel that psychostimulants such as Ritalin, Adderall, and Concerta are over-prescribed, especially in mild cases. And as with any medication, the side effect profile needs to be carefully balanced with the therapeutic gains of the medication. 


     Of course, many parents prefer psychotherapy as an alternative to medication. In this realm, providing parents with education and support may be most critical in enabling them to coach their children through difficult situations. Children also often respond well to behavior therapy, which focuses directly on symptom management and the establishment of effective coping skills. At the same time, children with ADHD often benefit from cognitive therapy aimed at improving self-esteem and minimizing any secondary distress, as well as social skills training to improve interpersonal relationships and minimize the negative impact ADHD often has on peer relationships. 


    Again, although there is no specific cure for ADHD, medication and psychotherapy, which are often used together, are both effective in the reduction of symptoms and distress, and the minimization of impact on the child's life. More broadly speaking, it may also be helpful to consider the fact that ADHD is culturally defined, and as such would cease to be a relevant diagnosis if we lived in a society where learning could actually be tailored to each individual child thereby taking advantage of his or her strengths and weaknesses. Then children would be encouraged to work with their ADHD, rather than fight against or be controlled by it. 


     

    John S. Schell, Ph.D. 

    Staff Psychologist 


     

  • Spring Time by John S. Schell, Ph.D.

    Spring Time 


    With the arrival of the crocuses and the promise that the daffodils and tulips are not far behind, spring has finally reached Northeast Ohio. Soon the trees will bud, and those buds will quickly be replaced with green leaves, just as nature's palette of winter grays is replaced with the vibrant hues of new life. 


    Although spring may have personal meanings for each of us, it is typically considered a time of rebirth and renewal-naturally, aesthetically, spiritually, and symbolically. As we begin to enjoy the warmer weather and the longer days, we may notice that our mood seems elevated and our spirit somewhat rejuvenated. 


    But spring is more than this--it is a time for a fresh start. For many, the changing of seasons and the beginning of spring marks a time for reflection. A time to look inward, to reassess our lives, and to reevaluate our needs and our wants as well as the direction we have taken in our own lives. 


    As we do this, it is important, not only for our happiness but our overall well-being, that we be honest with ourselves, that we listen to our inner voice, and that perhaps we take the opportunity, personally, for a fresh start once again. 

     

    John S. Schell, Ph.D. 

    Staff Psychologist 

  • August by John S. Schell, Ph.D.

    August 


    For many people, it is the first indication of summer winding down. Although arguably such a viewpoint may reflect a "glass is half empty" perspective, August certainly does signal back-to-school time for children and parents alike. Some children may be getting bored or antsy at home and may be looking forward to seeing their friends again, while others may dread the upcoming academic year. Parents may also be experiencing mixed emotions, perhaps feeling a bit antsy themselves, but also lamenting their children's return to school and the changes that will have on the family. 


    Obviously this much anticipated time of year may be experienced as exciting or stressful, depending on the situation and one's perspective. This is true regardless of whether your child is heading off to kindergarten for the first time or leaving to finish his or her last year in college. Contextually, when the new school year is met with a positive framework, the stress is tolerated well, and everyone adjusts accordingly. However, of course, these types of transitions do not always go so smoothly. 


    Some children do experience apprehension and anxiety as they face returning to the classroom. Of course, there are a number of different factors that may be disconcerting to children, and they tend to vary depending upon the age and the developmental level of the child. Young children, as well as college students leaving home for the first time, are often concerned about separation issues-separation from Mom and Dad, the family itself, or friends and peers. They may wonder if they will be able to fit in and make new friends, if they will succeed academically. All of these concerns may be normal, but how well each child navigates them can have a potentially profound impact on their sense of self, their self-esteem, and ultimately their interpersonal and academic success. 


     Parents should pay attention for signs of anxiety that may be associated with back-to-school concerns. These may include direct expressions of fear or worry, physical signs of anxiety (e.g., stomachaches, headaches, loss of appetite, difficulty sleeping), or changes in behavioral routines. Again, some children may be self-aware enough to raise their concerns, while others may not, and may even deny them or be avoidant of discussions around the topic. Because of individual differences, these concerns may manifest in a variety of ways. 


    Regardless, the task of the parent is to help children cope effectively and adaptively, and to find ways to be supportive of the transitional process. This may mean talking to children directly about their concerns, or simply letting them know that it is okay to feel the way that they do. A more hands-on approach might involve helping children prepare for the upcoming school year, academically as well as emotionally. Not just shopping for school supplies, but helping children anticipate what other resources they might need to be successful; perhaps helping children to anticipate their difficulties and to be proactive in addressing them. This might mean helping children develop insight and awareness to the underlying reasons behind interpersonal problems or academic difficulties. If nothing else, this is an important time for parents to be empathic-to give children the opportunity to talk and to be heard. Asking questions and actively listening to the answers helps parents move past their own assumptions and really see things from the child's perspective. 


    While parents have the task of trying to help their children navigate these challenges, they also have the added responsibility of being attentive to their own feelings. For example, they may be sad if a son or daughter is heading off to college, but at the same time may feel pressure to be happy and excited. Sometimes the sadness does not hit until well after the fact-September or October when the kids have been gone for a few months. Regardless of the situation, parents should attempt to be self-reflective, acknowledge their feelings, and find productive and effective ways of working through them-perhaps finding ways to stay connected with children through visits or e-mails, maybe pursuing other interests or hobbies that had been previously shelved because of lack of time, spending more time with your spouse or reconnecting with old friends. 


    Again, August is a time of transition in many ways, and change can often mean stress. By attending to one's feelings, back-to-school can be an exciting time of year and the start of another school year filled with good memories. 

     

    John S. Schell, Ph.D. 

    Staff Psychologist 


     

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