Parents know their children best. That is why in the case of a divorce, the working out of a parenting arrangement and schedule is best left to parents – not courts or litigating lawyers. Even when the hurt, animosity, and fear involved in divorce feel overwhelming, many parents can come together and make decisions about how to set up the post-separation life of their children.

Ruth Bettelheim, a marriage and family therapist suggests a simple change in the law would have a huge positive impact on families. She writes in the New York Times Op-Ed, No Fault of Their Own, family law could “defuse tension by requiring parents to enter mediation to find a custody solution that best meets the needs of all concerned…In an adversarial custody battle, no one wins, but children are the biggest losers of all. Intelligent legislation could promote the one thing that children of divorce need most: peace between their parents.”

For years, divorcing families have come to Soho Parenting to talk about their conflicts and to find solutions to questions about their children. Even in the most contentious situations, it is amazing to see that parents can pull together and talk through, negotiate and decide on arrangements. When you step out of the archaic divorce court system and away from the sometimes combative advice of lawyers, parents do a great job agreeing about their kids with a strong but supportive mediator in the room.

Now we will be able to offer Divorce Mediation services at Soho Parenting in a more formal way.  The process includes helping couples to decide on financial matters and parenting arrangements. The completion of an agreement becomes a binding legal document. In addition to mediation, couples can meet with a child development specialist, individual therapists if needed.  Our goal, as always, is to support parents through the transitions in family life with complete regard for the care of the emotional needs of their children. Mediation provides an opportunity for parents to rise up to their best selves to make good choices for their families.

People ask all the time, “How can you sit there hour after hour listening to people’s problems?” Here’s how. Imagine that you get to spend an hour or two a week with someone who has entrusted you with their most delicate, personal and honest thoughts. You learn the story of their lives. You know what hurt them, you know what they wish for. You figure out together what trips them up, what keeps them from enjoying what they have, or from doing something new. And in those hours you get to put your heads together and work to help them know themselves more deeply, challenge themselves and change things for the better.

Some are issues you have dealt with or are working on in your own life. Other issues are new and different from your own experience or training so it inspires you to read more and push yourself to change your way of thinking. You get to learn about the intricacies of many different kinds of careers–things you will never study but are fascinating, from writing poetry and design, to finance and surgery.   To understand how each individual takes their talents and struggles and turns them into their life’s work.

As a therapist, you get to watch a family grow, especially if you bring in other family members which is a part of our approach. You get to go through losses and celebrations, glitches and breakthroughs. You watch people unfold and become strong.

Sounds like a good job? All in all it is an honor.

The story of the adopted eight year-old boy who was sent back to Russia evokes a lot of  judgment towards his adoptive mother. The New York Times Style Section, oddly enough, covers this story in the article In Some Adoptions Love Does Not Conquer All. The piece explores the perspective of other adoptive parents whose children have severe psychiatric problems due to trauma early in life.  Many parents had torturous experiences trying to love, heal and raise their children.  Ellen McDaniels’ struggle is one such experience:

Finally, two months ago, after what Ms. McDaniels described as nine years of frightening, exhausting and heartbreaking efforts to cope with her daughter’s behavioral problems — including, she said, her sexually abusing and threatening other children, threatening to burn down the house, hiding knives in her trundle bed, refusing to take medication and running away — she terminated her parental rights.

Just so painful. But what of the parents whose biological children have serious illnesses like the children in the story?  They have the added guilt and worry that they caused the disorder through bad parenting or genetics.  They can’t send them back. Imagine terminating rights to your biological child. The reality is that any parent, adoptive or biological, whose child is suffering so greatly and is out of control, is in desperate need of help. These families need comprehensive medical, psychological and educational support in raising their children and keeping everyone in their family safe. Only the richest in our society can afford the therapeutic schooling and wilderness programs that address these children’s issues.  Even then it is hit or miss in terms of the quality of care.

Maybe if enough of us pay attention to this serious crisis it will be “in style” to have comprehensive psychiatric care for troubled children.

http://www.nami.org/

http://www.who.int/en/

http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

The recent essay  In Therapy Cell Phones Ring True by psychiatrist Barbara Schildkrout talks of the snippets of context she gets as her clients take short cell phone calls in her office.

“A mother receives a call from her teenage daughter. One theme of our sessions has been how to deal with the daughter’s “demanding behavior.” The volume is up; I hear both sides. The daughter is insistent about something trivial; mother is endlessly patient, even solicitous. Now I see that this child hasn’t been getting consistent feedback that her behavior is problematic. Guilt has driven my patient to conceal her anger. She is surprised to learn from me how successful she has become at this deception and how counterproductive it is…When another patient’s husband calls to learn the results of her medical tests, I sense his tenderness; this counterbalances my knowledge of their sexual difficulties…A calliope blares from the coat pocket of another patient, a young man. “I bet a hundred dollars it’s my sister!” he says. Clearly she calls him a lot, and he kind of loves it. Oddly, he rarely mentions her in therapy. Now I learn why. He had been afraid to disrupt the sweetness of his sibling relationship by uncovering its competitive core…In trying to grasp the infinite complexity of an individual’s mind, it helps to narrow the focus by closing out the world and creating a place of privacy. But, for understanding the context — the life a patient inhabits outside the office — it helps to let in some of the sights and sounds.”

Schildkrout is on to something – the importance of understanding a person’s outside world to really help them make progress. So why are we protecting the sanctity of the one-on-one therapist client relationship when it obscures so much crucial information? Loyalty to theory? Narrow mindedness on the part of the therapist? Fear on the part of the client? While there is certainly a place and time for individual work, we feel that bringing in the spouse, children, sister, mother of the client -in an ongoing way or even just for sessions here and there- provides critical insight that speeds the therapeutic process and makes therapy much more honest and useful. Though the essay is funny and sweet I wonder why Dr. Schildkrout would just wait for the cell phone snippets– expedite the process and invite those people into the room. You will be much more helpful to your clients!

Judith Warner, author and columnist on parenting issues, has just published We’ve Got Issues: Children and Parents In The Age of Medication. She began her project with the commonly held mindset that children are over-medicated through a collusion between parents, who want their childrens’ behavior to change, and psychiatrists, who are more than happy to whip out the prescription pad.  What Warner discovered, and what our experience at Soho Parenting has been over the last two decades, is actually the opposite. Parents go through excruciating conflict, ambivalence and worry about using medication with their children who are suffering from a psychiatric or neuro- biological illness.

Contrary to the “over-medication” hype, parents often have a hard time accepting that their child’s symptoms are an indication of a serious departure from typical development. When a children have depression, bipolar disorder, ADHD, or autistic spectrum disorder it is unbearably painful to accept. Decisions to use medicine to treat, or ameliorate symptoms is a huge choice.  The known risk of leaving these problems untreated sometimes feels less risky than taking medicine. This is often the wrong call.

In our clinical practice, we have seen a rise of developmental delays as well as a rise in mood disorders, behavioral and emotional struggles in children. The causes are most likely multi-determined. The impact of toxins in our food supply and environment, the unhealthy pressured culture our children must conform to, and the marriage of genetics in parents who also may struggle with significant levels of anxiety and depression all lead to more vulnerable systems in our children.

Having this awareness allows parents to make healthier choices about their lifestyles and practice preventative care.  Acknowledgment that your child struggles with mood or reactivity issues is necessary to fight stigma, advocate for kids and to counter the feelings of failure that parents and children alike experience if these issues arise. Treating such childhood problems with effective therapies, and yes, many times, with medicine, can be the difference between utter suffering and a calmer, more productive and functional experience for affected children, their siblings and parents.

In almost 25 years we have met only one family that seemed blithe about using medicine to maintain a child’s enrollment in a high pressured and “prestigious” school.  All other parents have approached the diagnosis, starting therapy, and possibly medicating their children as a truly serious decision–usually leaning toward under-treating. The stories of children being helped by a combination of therapy and medicine abound. The relief and hopefulness is always tempered by worry over the long-term effects, but children who need medicine and receive the correct medicine are freed from a dark place. Kudos to Warner for her open-minded research, her hard work on the book, and her contribution to parents –to help them make the best choices for their children and their families.

Clinicians at Soho Parenting have been providing the therapuetic technique of EMDR for nearly a decade.  We are constantly awed by the results. EMDR is one of the most important discoveries in the field of psychotherapy in the last twenty years.  It is hard to describe EMDR without sounding like a “new age” nut, so first the results-and then the description of the process.

A two year old child who had seen the twin towers fall on 9/11 experienced intense tantrums ever time she heard sirens for weeks afterwards. Her mother was desperate to help her. The little girl came for EMDR, and after one session the tantrums stopped.

An adult man having trouble controlling his anger and sarcasm does EMDR in regards to losing his father when he was eight years old. In the EMDR therapy he discovers that he has been angry at himself for saying something to his dad before he died. His entire anger-ridden exterior melts and he reports two months later that he has not felt that constant agitation anymore. His wife expresses a gigantic change in their relationship.

A woman who had been in talk therapy for 15 years does EMDR for 10 sessions about childhood sexual abuse and finally feels forgiveness for herself and even for her father. She is able to move ahead in her life – opens a business, maintains a stable relationship – things she had not been able to do before.

Interested? EMDR (Eye Movement Desensitization and Reprocessing) is based on the knowledge that the two hemispheres in our brain have very different functions. Simply put, the left hemisphere is the logical, analytical, verbal part of the brain. The right hemishere governs our bodily processes like breathing, heart rate, and our “fight or flight” response –it is the more “emotional side” of the brain. When we experience something frightening or upsetting, our right brain goes into high gear and our left brain quiets down. So the experience is “held” in the right brain. Talking (left brain) about the experience can be helpful in understanding the narrative, but it does not release the emotions, bodily experiences and interpertiatons of the event that the right brain holds…still following?

EMDR makes a connection between your left and right brain by alternately sending a small signal to the right and left brain while focusing on the exact memory or feeling. You can listen to beeps on head phones or hold onto small pulsars that buzz alternately, right, left. It is a very targeted and specific protocol. As the session proceeds, the tangle of emotions, thoughts and sensations becomes untangled and integrated and the person experiences distinct relief.

Here is another way to understand it.  For those of you who run–often times when you go out for a jog there is something on your mind that you are chewing over – a fight with someone, a problem you need to solve, etc. You notice after your run that you feel better, that something felt figured out or you have even forgetten what you were obsessing about.  Endorphins are important, but think about running-left, right, left, right – feet hitting the ground. Alternating signals to the right and left brain. Something about that bilateral stimulation seems to help you resolve or move on from upsetting thoughts.

Those are the basic mechanics of EMDR. It is a well-researched, effective method for dealing with PTSD and trauma:

“The Department of Defense/Department of Veterans Affairs Practice Guidelines have placed EMDR in the highest category, recommended for all trauma populations at all times. In addition, the International Society for Traumatic Stress Studies current treatment guidelines have designated EMDR as an effective treatment for PTSD (Foa, Keane, Friedman, & Cohen, 2009) as have the Departments of Health of both Northern Ireland and Israel (see below), which have indicated EMDR to be one of only two or three treatments of choice for trauma victims. The American Psychiatric Association Practice Guideline (2004) has stated that SSRI’s, CBT, and EMDR are recommended as first-line treatments of trauma.”

We can attest to undergoing EMDR ourselves and have practiced it for years.  It is a fast, useful and results-oriented therapy that has made a tremendous difference in many peoples lives.

A recent article in The New York Times features a mother-infant psychotherapy program for low income mothers at high-risk for attachment difficulties with their babies. It highlighted the long-term powerfully beneficial effects of this intervention both psychologically for the mother/baby pair and the financial fall out from waiting to intervene.

It is in this type of program that Jean and I met, oh so may years ago, at Bellevue Hospital.  These intimate and powerful experiences with families fighting poverty, histories of abuse and neglect are the core of our ideas about Soho Parenting.  We’d like to think these serious issues are reserved for the poor, but we all know this in not true. Post-partum depression, alcoholism in the family of origin, sexual, physical abuse and neglect occur in well to do families as well. Education, success at work and financial comfort may seem like a protective immunity–but the deeper issues that get triggered in family life are blind to these accomplishments.  What these resources do give you is the opportunity to privately work on some of these problems early on in life as a parent.

Some of the most rewarding work we do at Soho Parenting is to provide that same kind of infant/parent support in our mother infant groups and in psychotherapy with a mom and baby together in individual sessions. We always tell mothers–you are the CEO and Secretary of Mental Health of your family. If you have a nagging sense that the connection with your baby seems particularly fraught, or you have a history of high conflict divorce, alcoholism or any kind of abuse in your family of origin get support now. The brains of new mothers and babies are so open for new connection and change–it is the perfect time to get a little support–it goes a long way.  And kudos to the practitioners at parents at the Montefiore program. Our future depends on the work we do today.

There have always been self-righteous meddling parents. Parents who can’t believe that their child would ever do anything wrong.  Our modern technology has taken it to a new level. Parents in groups have reported receiving angry emails with complaints about their child.

Subject:  Sallie’s food issues!
“Your child mentioned the word diet at my house, what is going on in YOUR house that your 7 year old would be talking about food like that?”

Subject: Joey’s Party
“Joey  didn’t invite my Charlotte to her birthday party. I can’t believe you were so insensitive”

No birthday party had even been planned. The birthday wasn’t for another 2 months. The two girls had just had a typical five year-old fight culminating with the age old refrain, “You can’t come to my birthday party!”

There is a lot of focus on bullying these days and cyberbullying, specifically.  We do need to be concerned about our kids being bullied or being bullies, but maybe we need to look in the mirror first.

We know that when our children are hurt, we hurt. There is no way around that. But if we can contain, control and tolerate our vicarious pain then we can be much more helpful to our kids.  We can help them figure out how to solve the problem, sometimes by saying or doing something and sometimes by letting it go. If we act outraged when  our child reports a slight, we escalate their pain and the child’s sense of self-importance. If we actually send an email attacking another parent and child we are crossing boundaries, behaving rudely and inflating our self-importance.

Email is so wonderful but so dangerous. Tone can be misunderstood, text can be misinterpreted and messages can be copied to others, dragging other parents and teachers into a personal conflict with the click of a mouse. If we want our children to grow up being respectful of other people’s boundaries, which is no small task, then we have to model that behavior.

All the little fights, exclusions, and insults between children are part and parcel of growing up.  Tolerating social bruises is one of life’s big lessons.  So here’s your lesson.  Write your emails complaints about other people’s children and save them as a draft. Then press delete. If the problem is repetitive, or really serious, please call. Like in the olden days.

Anyone who has felt the leaden weight of depression for any amount of time can only have the greatest empathy for Daphne Merkin, as she bravely writes about her lifelong battle with depression in “A Long Journey in the Dark”, the cover story for the New York Times Magazine (May 10). I approached reading the article assuming it would be moving and honest. I have been a fan of her writing for years. But as I read the article I found myself feeling annoyed and then angry about two things. One is her implication that electro-convulsive therapy be avoided at all cost.  The other is the narrowness of large swathes of the psychoanalytic community.

As a therapist and as a friend I have seen absolutely miraculous recoveries from intractable depression with ECT. The idea that ECT is the treatment of last resort and a shameful capitulation to a barbaric practice is just dead wrong. Merkin has her right to her own fears and biases, but when I reading her dramatic and sensationalistic imagery I winced imagining a client of mine reading the following paragraph.

“What if ECT would leave me a stranger to myself, with chopped-up memories of my life before and immediately after? I may have hated my life, but I valued my memories-even the unhappy ones, paradoxical as that may seem… The cartoonish image of my head being fried, tiny shocks and whiffs of smoke coming off it as the electric current went through, haunted me even though I knew that ECT no longer was administered with convulsive force, jolting patients in their straps.”

This is what keeps ECT recipients from sharing their success stories with others and from feeling proud about taking a very big step to heal themselves despite all the negative judgements.  Merkin may be able to take months to either recover or languish because of financial security, a free-lance career and only one 17 year old daughter but other people have young children to raise, jobs to do, and bills to pay. They can’t afford to take months of being in a “neuro-vegetative” state.  Merkin just set ECT back years in that one article.

My second negative reaction (that is an understatement) to the piece came when she described her therapist, “a modern Freudian analyst whom I had been seeing for years and who had always struck me as only vaguely persuaded of the efficacy of medication for what ails me.”

This is what gives psychoanalytic talk therapy the image of being self-indulgent and not that helpful to many. Helloo, Mr Analyst! You are her guide in treatment. If you are dubious about using medicine for depression you haven’t done your homework. Have you then recommended that she do EMDR (trauma processing therapy), cognitive-behavioral therapy, dialectical behavior therapy, meditation, somatic experiencing, neurofeedback, yoga or a combination of these treatments? Have you read and studied about all the incredible brain research that is out there? Or have you just rested on the elitist, narrow notion that any alternative or modern therapeutic modality is “below” the standards of analysis? Sure, I remember thinking that way because that’s what I was taught thirty years ago, too.

One should evolve as a therapist. Would a heart patient visit a cardiologist who utilized only techniques they were taught in medical school thirty years ago? No – they would choose a doctor with a breadth of knowledge, whose methods are completely current. A therapist should build on what they know. And what we know is that are an array of well-researched therapeutic tools to treat depression that can work in conjunction with the traditional forms of talk therapy. If I had been honored to be consulted by Daphne Merkin, that is what I would have said.

Now, I could be wrong. Merkin’s therapist may have suggested all of these things to her. And she may have tried them all and still have been left with paralyzing depression and a strong impulse toward suicide. But I bet it’s not true. I have heard story after story with individual and couples who endure ten, fifteen, thirty years of treatment without the transformative results that are the goal of therapy.

Here’s bottom line. If your client is not getting better, bring in other professionals, research other modalities – get more effective help for him or her. If ECT is really called for, consider helping to reduce their fear by escorting your patient — get out of your comfort zone.

Almost everyone I know, myself included, has felt the weight of depression or anxiety. It seems to be a big part of the human condition now. Fighting depression is an everyday battle for some of us, and we should use all the tools at our disposal.