Q. I suppose it's an ironic question to
ask a psychologist on the Internet, but do you think that it
is possible to be addicted to the Internet? Perhaps being a
compulsive user is a better phrase. In any event, in the
course of the day I am on the Internet for no less than eight
hours, in the chat rooms, on the bulletin boards, reading and
writing e-mail and general surfing.. I have lost sleep,
weight, friends and am in the process of losing my
significant other over my computer time. I have met people
from on-line for less than honorable purposes, which is
something I would have never done in real life. I do
regularly see a therapist but he admits he doesn't understand
the Internet.
A. Thanks for writing with a very
good question. I concur with you about calling it compulsive
use rather than addiction because there is obviously no
addiction in the physiological sense. Actually, even
substance abuse is a lot more than just the physical
addiction. After withdrawal, one is no longer physiologically
addicted, so why do people go back to using? You bring up
another good point, that many "addictions" don't involve
chemical substances, like sex, gambling and nowadays, the
internet. Getting back to your question, yes, I do think
internet use can become compulsive overuse. I think the key
would be if it is compulsive, in other words if it is
difficult to stop, and if it causes emotional distress and/or
life difficulties. If you don't get on the internet, how do
you feel? I would imagine, anxious and frustrated. Of course,
I can't diagnose anything without more information, but just
from what you have said, it certainly sounds likely that it
is a problem for you. What you might want to examine is your
emotional reasons behind the behavior. Are you escaping from
frustrations in your life? Does it relieve anxiety, stress or
depression? Are you angry at your significant other about
your use? Does the anonymity of the internet reduce feelings
of inhibition, guilt or shyness? You might want to check out
the addictive behavior section of my site for more
information and specific self-management techniques. It might
also be wise to "shop around" for a therapist that can help
you with this problem. See the section on finding a therapist
at my site. Let me know how it goes and take care.
Q. I'd appreciate any information you
could direct me to on Ausberger's or Apsberger's Disease
(including how it is spelled, so I can do some research on it
myself). My son was just diagnosed as possibly having this
and I'd like to get more info on it.
A. The condition you refer to is
Asperger's Disorder. This is considered a pervasive
developmental disorder because it occurs in childhood and has
profound effects, like autism. It is characterized by
impairment of social interactions and by restricted
repetitive and stereotypical patterns of behavior, like
nonfunctional routines or rituals, or physical mannerisms
like hand twisting or whole body movements. I have not had
any direct experience with this condition, so I can't tell
you much more from my own knowledge. I am sorry to hear that
your son has been diagnosed with this problem. It certainly
would be worth getting a second opinion about it and I think
you are wise to do research on it. This must be hard on you
too, so you might want to check out some of the emotional
management tools at my site. Thanks and good luck.
Q. Is a fee of $170.00 for a 50 minute
sessions w/ a psychologist (Phd) normal?
A. Sorry to say this, but it
depends. Probably the most important factor is location. I
imagine that in L.A. or New York, $170.00 per session may not
be unusual. In most parts of the country, this would probably
be high. In Houston, fees might range from $100 to $150 per
session for psychologists. Of course, it might also depend on
the psychologist. If the person is well known or has a very
busy practice, that fee may be quite reasonable. Just as a
point of information, though, fees for psychologists (and all
health professionals) are going down due to managed care.
Many managed care companies will only pay $70, $80 or $90
dollars a session. Medicare and Medicaid only pay $62.50 an
hour in the Houston area (I don't know if it might be more in
other locations, but it would certainly be less than $170).
The implication of this is that you might be able to
negotiate a lower fee. It doesn't hurt to ask. The other
issue when it comes to fees is how long will the treatment
last. In other words, what will the total cost of the
treatment be? Be sure to ask this of anyone you are
considering seeing. You might want to check out the section
on finding a therapist at my site. Hope this helped and
thanks for writing.
Q. I have 39 hrs. left to complete my
Master's degree in Clinical Medical Social Work. I have been
thinking about pursuing a thesis focusing on how exercise can
be used as a psycho-therapeutic treatment for people
suffering from anxiety, depression (certain type), self
esteem, etc. I would like any advice or information
concerning this issue you could give me. Thank you
A. Thanks for writing. Sounds like a good
subject. I certainly believe that physical and emotional well
being are synergistic. By that, I mean that when you are
physically healthy, it is easier to be mentally healthy and
vice versa. So exercise is very important to establishing
mental well being. I typically encourage clients to exercise
and eat healthy in addition to the emotional self-management
skills they are learning. Another important parallel between
exercise and emotional health is that both involve a lifelong
habit. For most people, emotional well being is not something
that involves being cured. Rather, it is something you learn.
Just like getting in shape, it can be difficult at first, but
it gets easier as you get into the habit of it. No matter how
practiced you get, though, it still takes a certain amount of
conscious effort to maintain physical conditioning. The same
can be said for healthy eating, and for mental well being
too. Anyway, I appreciate the question and wish you good luck
on your thesis. I would like to hear how it works out. Take
care.
Q. I have a question regarding
"scrupulosity". I would appreciate a complete definition for
this behavior, including a description and some information
as to which category it belongs to. Are there any treatment
regimes for it? Our entire family has been affected by my
husband's display of what could be symptoms of this
"disorder". I am wondering if there is any hope for
continuing the relationship, or any hope of help for him (and
us!). Family members consist of myself (the wife), and 4
children. The oldest 2 are out of the nest and have rejected
religion and family values due to their father's obsession
with rules and extreme religiousity. I appreciate whatever
information you can provide on this subject.
A. Thanks for writing. There is no
diagnostic category of scrupulosity per se. I imagine you are
referring to obsessive/compulsive personality traits. This is
a condition in which the person shows various behaviors like
preoccupation with rules, details, order; perfectionism;
reluctance to delegate; miserly spending habits; rigidity and
stubbornness. One of the defining characteristics of this
condition is being, "over conscientious, scrupulous and
inflexible about matters of morality, ethics, or values". Of
course, I can't diagnose without a lot more information.
There are other conditions that could result in scrupulosity.
Regardless, I think there is hope, although this can be a
difficult condition to treat. Some people respond well to
medications and psychotherapy may help, assuming he would be
willing to go. You might get some counseling yourself to help
you learn how to deal with your husband. See the section on
finding a therapist at my site. There is a book titled, "Stop
Obsessing" by Edna Foa and Reid Wilson which might be helpful
for you in understanding your husband. Hope this helped and
good luck with this tough situation.
Q. ** High Priority ** What is the law
regarding the administration and scoring of psychological
testing by non-psychologists in Louisiana?
A. Thanks for writing. Actually, I don't
know the laws in Louisiana, but I can tell you what is likely
based on Texas and national guidelines by the American
Psychological Association. First off, someone could do so if
they work for an exempt agency, like a school or hospital.
Also, if they were supervised. In Texas, Licensed
Professional Counselors are not allowed to do projective
testing, but can do other kinds of testing. Most publishers
of psychological tests restrict the purchase and use of
psychological tests to those with appropriate licenses, i.e.
psychologists. There are all kinds of "tests" out there that
probably aren't restricted by psychology licensing laws. For
example, there are many tests used for personnel purposes
that were not developed by psychologists. These are not held
up to the rigorous research requirements for psychological
tests, although they may be psychological in nature. One
aspect of this is whether the person in question is calling
himself or herself a psychologist and what they are doing,
psychological testing. The laws governing professionals, like
psychologists, are strongest in regulating those
professionals because one's license can be taken away. There
are some remedies against people holding themselves out
inappropriately as psychologists, but this is a lot weaker.
If this didn't answer your question, you might want to tell
me a little more about the specifics. The only other thing I
can suggest is to contact the psychologist's license board in
Louisiana and report the questionable practices.
Q. My problem is that I'm afraid to tell
my therapist about my bisexuality and related problems. She
is hetero and assumes I am too. Recently we talked about me
wanting a hug from her. The compromise was that she holds one
of my stuffed animals and hugs it occasionally. I'm not
sexually attracted to her. I'm afraid she will feel alienated
from me and create a distance from me. In your _honest_
opinion, do you think therapists with same-sex bi or gay
patients feel "differently" toward them? Does giving and
receiving affection take on complications for them? Do they
worry about possible sexual tension even if the patient
denies it?
A. Thanks for writing. In all likelihood,
the answer is that it won't matter and your therapist will
not feel any differently about you regardless of your sexual
orientation. In fact, it is likely that an experienced
therapist will not be surprised and has probably worked with
many different kinds of people and is accepting of various
life styles. If you otherwise feel comfortable with your
therapist and feel therapy is helping, probably the best
thing is to discuss this issue with her, including your fears
about how it may affect the therapy. I suspect it will
actually help rather than hinder progress because then you
won't have to feel anxious about it. I think it is unlikely,
but if for any reason your therapist would not be comfortable
working with you after finding out, she should tell you that
and help you find another therapist. Either way, it is
usually better to be pretty much upfront with a therapist,
especially about any feelings you have towards the therapist
or the therapy process, like anxiety, hurt, frustration,
anger, attraction, etc. Working through such feelings is
essential to progress.
Q. I just wanted to know if you could
help me? My friends tell me that I need to talk to someone
and I was wondering if you could help me.
A. Thanks for writing. I think it is wise
for you to listen to your friends. I might be able to help
you in two ways. If you would be willing to have your
question posted publicly (without your name or other
identifying information), there is no charge. If you want a
more detailed, private answer, there is a nominal charge of
$25. We may want to continue with several questions and
answers, or I may suggest some other avenues for helping you
with your situation, like self-help materials you can use or
how to find a therapist in your area. You might want to check
out various sections of my site to get a start. Thanks again
and look forward to hearing from you.
Q. I have not idea what Toxic Shame is
but would like to get any information. Can you help. Thanks.
A. Thanks for writing. I believe there is a
book by that name, although I'm not sure about that. I guess
what it refers to is that shame and embarrassment can be
unhealthy, what I call "false" feelings. Shame often has an
element of self-downing, but also the disapproval of others.
It largely results from putting too much importance on what
others think of us and making unrealistic demands of
ourselves. I assume you are asking for yourself. If you
frequently have feelings of shame, you might want to work on
that, either through self-help or maybe even counseling.
Check out the self-help tools at my site and the sections on
depression and finding a therapist. If you let me know more
specifically as to what your interest is in this topic, I
could maybe answer you better. Anyway, I hope this helped and
take care.
Q. I have a young male friend who I am
very concerned about. He is 24 yrs old and has confided in me
( to a point ) about his feelings, etc. Some of the things he
has shared with me has me leaning towards the strong
possibiliy that he was abused ( emotionally & sexually)
though he has never come right out and said so. I have been a
soc. wkr. for 21 years and he knows this. I have shared with
him that my brother and I were phys. abused. I am very
concerned about my friend for the following reasons: A) he
goes off into space at times when we discuss mental health
issues, sometimes for no apparent reason at all. B) I am
starting to realize that what I used to consider being
irresponsibility on his part is actually memory lapse of
events. C) he says his lows are really low and he doesn't
have any highs. D) he says he has a reoccurring nightmare
about a car crash in which he survives but has no remorse or
guilt. I love this young man as a third son and will do
whatever it takes to help him get where he needs to be in
life. I am fearful of saying the wrong thing because I do not
want to lose his trust or close the door of communication.
Though I have never met his family, it appears that support,
love and nuturing are limited. My experience in counselling
is limited. Besides the fact that I am too close to this
young man and would prefer to be a loving and supportive
friend. Please help me find the right way to approach this
young man on my suspicions and concerns. Because of my love
and respect for him, I am in our friendship for the long
haul. Thank you
A. You are indeed a good friend and
he is lucky to have you for a friend. I think I understand
the delicate nature of your position and you are wise to
avoid trying to be a therapist to him. You didn't say
directly, but I gather that he is reluctant to seek help or
even talk about some of the things that are bothering him.
However, he apparently has mentioned feeling emotional
distress, like the lows and nightmares. This could provide an
opportunity to suggest he gets help without necessarily
bringing up your suspicions about his past. You might read
the section on finding a therapist because he may be more
open to this approach since he is apparently reluctant to
delve into his past. You might pick up the book "Feeling
Good" by David Burns and share it with him. It is about how
to get over depression. You could also show him some of the
self-help tools at my site, like the reality check and
exchange vocabulary to give him a sense of how this approach
works. In talking with him about this, reassure him that it
is perfectly normal to feel low like that, but not
necessarily healthy. He may fear that there is something
wrong with him if he seeks help. I suspect that he will take
it well coming from you. One other thought is to try to lead
him to the conclusion of getting help by asking him questions
about his feeling low and so on. For example, you might ask,
"What do you think you can do about feeling low?" Hope this
helped and good luck.
Q. DEAR DR.SARMIENTO, I HAVE JUST BEEN
THROUGH THE MOST HORIBLE EXPERIENCE WHICH INVOLVED A
THERAPIST THAT I HAD TAKEN MY 20 YEAR OLD DAUGHTER TOO. MY
DAUGHTER WAS DATING A YOUNG MAN FOR ABOUT 8 WEEKS, AND ONE
EVENING HE TRIED TO TONGUE KISS HER. MY DAUGHTER IS A VIRGIN
AND NOT EXPERIENCED AT ALL , AND THIS EXPERIENCE REPULSED HER
SO, TO THE EXTENT WHERE IF SHE DATES SOMEONE MORE THAN ONCE
SHE IS TERRIFIED THEY WILL TRY TO KISS HER AND SHE WILL
EXPERIENCE THAT REPULSIVE FEELING AGAIN. WHEN SHE TOLD THIS
TO ME I WAS VERY CONCERNED BECAUSE I FELT HER REACTION WAS
JUST NOT NORMAL FOR A GIRL HER AGE. SOMEONE COULD TURN YOU
OFF AND YOU JUST FORGET ABOUT IT AND GO ON TO SOMEONE ELSE. I
DECIDED TO TAKE HER FOR THERAPY, BECAUSE I FELT, WITH THESE
TYPE OF FEELINGS SHE COULD NEVER GET MARRIED AND HAVE A
HEALTHY LIFE. SHE WAS SEEING A FEMALE THERAPIST WHO WAS A CSW
FOR FOUR MONTHS AND AFTER THE 4 MONTHS SHE STILL HAD THE SAME
FEELINGS SO I DECIDED TO LOOK FOR A NEW FEMALE THERAPIST. I
PHONED THIS NEW THERAPIST, AND SHE TOLD ME SHE IS A
PARTICIPATING PROVIDER WITH MY INSURANCE COMPANY, WHERE I PAY
A COPAY AND SHE GETS PAID THE REST FROM THE INSURANCE
COMPANY. SHE DID EXPRESS FEELINGS THAT THIS CO. DOESN'T PAY
WELL, BUT SINCE SHE IS IN NETWORK SHE MUST EXCEPT WHAT THEY
PAY.WELL SHE BEGAN WITH MY DAUGHTER SEEING HER WEEKLY , AND
DURING THAT TIME SHE WOULD CALL ME AND TELL ME THAT SHE
HASN'T RECEIVED PAYMENT AS OF YET, THEN SHE PHONED ANOTHER
TIME SAYING THEIR NOT PAYING ENOUGH AND COULD I PAY THE
DIFFERENCE. I EXPLAINED TO HER AS LONG AS SHE IS A
PARTICIPATING PROVIDER I COULDN'T PAY MORE THAN ALLOWED.
AFTER SEEING MY DAUGHTER 7 TIMES SHE LEFT A MESSAGE ON MY
DAUGHTERS MACHINE SAYING SHE CAN NO LONGER SEE HER. MY
DAUGHTER WAS DEVASTATED. SHE CRIED IN DISBELEIF, THAT SHE WAS
DUMPED BY HER THERAPIST WHOM SHE TRUSTED AND CONFIDED IN.
THIS WAS A WEEK AGO, AND I AM SO DEPRESSED BY THIS WOMANS
ACTIONS. ONE THING I WOULD LIKE TO RELATE TO YOU IS THAT THIS
THERAPIST ONE TIME TOLD ME THAT MY DAUGHTER IS THE WAY SHE IS
(CONCERNING HER FEELINGS ABOUT INTIMACY) IS BECAUSE SHE
WASN'T KISSED AND HUGGED ENOUGH AS A CHILD. SHE WAS NEVER
ABUSED, BUT SHE WAS A DIFFICULT CHILD IN THE WAY WHERE SHE
WAS ALWAYS JEALOUS OF HER YOUNGER BROTHER AND SISTER. SHE
ALWAYS SAID I LOVED THEM MORE , AND FOR THAT SHE DISLIKED
THEM AND ALWAYS PICKED FIGHTS WITH THEM. ALL IN ALL I WANT MY
DAUGHTER TO BE HAPPY , AND I WANT TO GET OVER THE HURT, THAT
THE SECOND THERAPIST DID NOT HAVE MY DAUGHTERS WELL BEING AS
A PRIORITY INSTEAD SHE HAD MONEY HAS THE NUMBER 1 PRIORITY. A
DAY LATER SHE PHONED AND ADMITTED THE MONEY WAS HER PRIORITY,
AND SHE SHPOULN'T OF DROPPED MY DAUGHTER BY LEAVING A MESSAGE
ON HER MACHINE. I AM SO UPSET FOR MYSELF AND MY DAUGHTER THAT
I WANT THIS WOMAN TO SUFFER AS I HAVE. I DON'T KNOW WHERE TO
TAKE MY DAQUGHTER NOW, I'M AFRAID TO TRUST ANY THERAPIST.
PLEASE HELP. THANKS
A. I am very sorry that you have had
such bad experiences with therapists. Unfortunately, in any
profession, there are some bad apples. The important thing is
that one bad apple doesn't mean the whole lot is spoiled.
Most therapists I know are very caring people who are much
more concerned about helping their patients than in just the
money. The other sad thing about your situation is that
managed care has forced health professionals to be much more
concerned about the money. Managed care is a very business
oriented approach to health. That makes a certain amount of
sense, but it often comes at the expense of the patients. I
have always seen my practice as a practice first, then a
business, but I guess nowadays the managed care companies are
turning that around. Nevertheless, from what you have said,
it sounds like the therapist acted inappropriately. I don't
know what kind of license this therapist has, but there is
undoubtedly a state agency that provides the license and
regulates those holding that license. One thing you might
consider is to let the state board know of your concerns and
let them investigate. As for you and your daughter, the most
important thing is to continue "shopping around" for another
therapist. You might want to read the section on finding a
therapist at my site. Cognitive-behavioral therapy might be
useful for your daughter. It doesn't focus on what might or
might not have caused her to be the way she is, but rather on
what she can do now to change. I don't think every problem
people have is caused by something their parents did or
didn't do. There is a lot of biology in personality, as
implied by your saying that your daughter was a difficult
child. I also think you are wise in taking your daughter to
therapy because it sound like it will be quite beneficial for
her once she finds a therapist she can work with. I hope this
helped and that you find someone who can help your daughter.
Q. Could someone PLEASE tell me where I
can go or who I can write to to get more information about
psychology? I am a psych. major in Southern California and I
need all the help I can get. Thank you!!!!
A. Check out the general psychology
questions on my site in the question and answer forum, but
probably the best place to get more information is the
American Psychological Association site at www.apa.org. Take
care.
Q. I would like any information on
counseling SMI Native Americans. What, if any, cultural
characteristics does one take into account? Where can I find
more information?
A. That is a good question, but
unfortunately, I can't answer it. There certainly are
cultural factors in working with anyone, even if it is just
the subculture of their family background. However, I also
think the commonalities amongst people are much greater than
the differences. In counseling, the most important thing is
to respect and accept each person for who they are and make
an effort to join them in their conceptual world. I'm sure
there are books, articles and probably even web sites that
deal specifically with your question. You might try the
American Psychol. Assoc. site, which is at: http://www.apa.org
Q. I was wondering what the psych term
is for people that pull their hair out? Also what causes this
condition and how is it treated? I think I know someone with
this.
A. The term for this is
Trichotillomania. To be a diagnosable problem, it has to be
recurrent and result in noticeable hair loss. It also is
associated with tension before hair pulling or when trying to
resist the behavior as well as pleasure or relief when
pulling out hair. There may be other conditions which could
lead to hair pulling that must also be ruled out before a
diagnosis can be made. Finally, the behavior has to cause
significant impairment of functioning or emotional distress.
Psychotropic medications can help this condition as well as
psychotherapy. As you know if you have explored my site, I
favor cognitive-behavioral forms of therapy. These can be
helpful with hair pulling, but so can other forms of
counseling. As usual, I recommend that you encourage this
person to seek help. Thanks for the question and I hope this
helped.
Q. Where can I obtain information about
establishing a trust for a mentally ill family member so that
an estate does not become turned over to the state for
hospital care, etc.
A. Thanks for your question, but I'm
sorry I can't help you much with this one. Sounds like you
need a lawyer who specializes in such matters. There are many
web sites dealing with legal issues, so you might run through
a search engine for your question. Hope this helped a little
and good luck!
Q. I am an intelligent, pleasant 27-year
old woman with a humanities degree from a major university.
Over the past 3 years, I have had 5 jobs. All of them are
low-pay, clerical work, which didn't bother me in the
beginning, but now it seems that, due to my behavior at work,
I will never move any higher. When I am at these jobs, I do
the very minimum to get by, and I find myself hating everyone
I work with, and finding reasons to call in sick so I don't
have to face them. I think constantly about running out the
door and never coming back. As a result, all of my jobs have
ended badly, and I have virtually no good references from
former employers. Now I am unemployed AGAIN, and the burden
is on my husband to make ends meet until I find another. He
is upset with me, I know. It is definitely my fault that I do
this, but WHY do I do it? How do I stop it?
A. Thanks for writing. Sounds like
there may be three elements to your situation. First, you are
probably in the wrong type of job. It is difficult to keep up
motivation with a job that is boring and doesn't really fit
you. It's like being married to someone you don't love - it
gets old fast. It would be beneficial for you to get some
career counseling to help you look at career options. Most
colleges and universities will have a career counseling
center. I help people with that in person and through the
internet. You might want to check out my site for the career
and work issues.
The second issue may be office politics. I
know a lot of my clients have trouble at work because they
don't know how to play politics or chose not to for various
reasons. While I can certainly understand why many opt out, I
think this is a mistake. Self-promotion is a key element to
success, in my experience. Fortunately, you can learn to play
the politics in an ethical and professional way. This will be
useful to you no matter what career you go into. Again, the
career section of my site has some more information on this
topic.
The third issue is about emotional
self-management. You didn't say this directly, but I would
assume that you have probably been upset about your work
situation - like frustrated, angry, uptight, maybe even
depressed. Such feelings, while normal, are not particularly
healthy nor effective. If you are in a job, whether you like
it or not, you can learn to be patient and un-upset (if there
is such a word). The worst of both worlds is to be in a
situation and be upset. The alternative is to get out of the
situation or not be upset. Anyway, it might be helpful for
you to work on some of the self-management and emotional
management skills that I present at my web site. Look at the
self-help tools section, like the "reality check", "exchange
vocabulary" and "coping statements" techniques.
A suppose a fourth issue is the marriage,
so check out the relationship section of my site for some
ideas on handling that part of the situation.
The most important thing, seems to me, is
to take the initiative to find a more satisfying career. I
find most people have many more options than they think and
usually without near as much difficulty or expense as they
believe. Let me know if I can help and please let me know how
it works out. Thanks again and take care.
Q. My youngest child is having problems
in school , he tests high so we know it isn't a problem
understanding the material, but he never turns in homework.
Because of this he has failed 8th grade once already. Failed
summer school, not due to grades, he had a b average but due
to attendance. And he is about to fail it again. His teachers
have suggested he is Passive aggressive. I can't find any
information on the subject at all and would like to form my
own opinion. They have used the example ..that he will bring
a pen to math and a pencil to English. They all agree he is
not a behavior problem. I know you can not tell me whether he
is or isn't Passive aggressive, nor would I want you to,
never having met him, I would just like to know what it is
and where I can look for some information on the subject.
Thank you
A. Thanks for the question. As you
mention, I can't diagnose your son, but I can certainly tell
you about what passive-aggressive means. This term refers to
a pattern of behavior in which anger is expressed in passive
or indirect ways, rather than directly or aggressively. It
results from the individual being afraid to openly express
anger or act defiantly. This creates a conflict which is
resolved by showing the anger indirectly. For example, if a
child is angry about cleaning his room, he may seem outwardly
cooperative, but sabotage his parents by dawdling, doing a
poor job, "forgetting" it, procrastinating or making a
sarcastic comment. If he is called on it, he can make an
excuse, like, "I forgot", so that retaliation is less likely.
Another word for this kind of behavior is "oppositionality",
or doing the opposite of what is wanted. These kinds of
behavior are very common because children are relatively
powerless against adults. It is like guerrilla warfare, in
effect. The picture I get in my mind is of a stubborn mule.
The more you pull on the rope, the harder the mule resists.
Unfortunately, human beings make mules look good when it
comes to stubbornness. You may want to watch for such
behaviors and confront your son about them in a firm but kind
way. Reflect his feelings by saying something like, "You seem
angry, is that right?" Then provide a more appropriate
alternative, as for example, telling him it is all right to
tell you when he is angry, but it is not okay to do whatever
he is doing. It may take some repetition and determination,
but with work, he can learn to express any resentments in
appropriate ways. It may be worth getting a few sessions of
counseling just to give you some more ideas of how to handle
this and counseling may be useful for your son. Check out the
section on how to find a therapist. Also, on the suggested
readings there are some books on parenting. By the way, at
his age, he has not solidified his personality yet, so these
behavior would not constitute a personality disorder. If he
continues to act in this way, it can become incorporated into
his habitual patterns of behavior and become more entrenched
in adulthood. This is not a serious problem, but it is
certainly worth addressing now at his age. Hope this helped
and good luck!
Q. I was diagnosed 6yrs ago wuth DID. I
go back and forth believing I could be multiple because of my
mood swings and extreme behaviors to not believing it at all
because the thoughts (memories) cannot possibly be real. How
do I find out for sure. ihave taken the ddis.
A. Thanks for your question. As you
probably know, the whole concept of multiple personalities is
controversial. I have evaluated thousands of people and seen
just about every kind of problem, but I don't think I have
seen a true multiple personality. (I have seen some of the
other dissociative disorders.) At the same time, one of my
colleagues works regularly with multiples. The debate is
about whether the process of therapy inadvertently "causes"
the condition by the therapist subtly encouraging the
dissociation. As to how do you determine whether you have it
or not, I would suggest an in depth, full psychological
evaluation, if you haven't had one already. Even if you have,
a second (or third) opinion is usually wise. Perhaps a more
important question is what do you do about it? Regardless of
what label is put on it, the solution may be the same. Have
you tried cognitive-behavioral therapy? You may want to check
out the section on finding a therapist at my site. The
various methods I present may help give you a sense of this
approach. If you are already in therapy, I would discuss your
concerns with your therapist. Hope this helped and good luck.
Q. I am a freshman in high school and I
am doing a research paper for my English class on careers,
and i choose psychology. One of our requirements is to have
an interview of some kind as one of our sources, so could you
answer my questions? What are some of the advantages and
disadvantages of your job? Are there any class I could take
in high school that would help me? What is a good location
for this job? And if you have any additional information that
would help me, that would be greatly appreciated.
A. Hi! Thanks for writing.
Psychology is a broad field ranging from research on human
behavior to industrial psychology, child psychology, and of
course, clinical psychology. One big advantage for me of this
field is that it is very challenging and rewarding. It is
gratifying to see people make improvements in their lives. I
believe that a scientific understanding of the mind will be
very beneficial for the whole human race. Right now, the main
disadvantage is all the changes being brought about by
managed care. As one of my colleagues said recently, this
means working more and getting less. Most high schools have
classes on psychology and human behavior. I would also
recommend all the science you can get, especially biology.
For more information, check out the "Question and Answer
Forum" at my site under the category of psychology. I
answered a very similar question for someone else a while
back and you can check it out there. Hope this helped and
good luck. --
Q. My wife has what I had been thinking
was a really weird bad habit. Every time she sits down to
watch TV she will start picking her feet or ankles to the
point of lots of blood almost every time. Or, she will pick
up her pair of really sharp pointed tweezers and really go
after her cuticles so much that they are always very red and
swollen, but only occassionally bloody. I now believe that
this is a self-mutilation form of obsesive compulsive
disorder. Am I correct? What can be done about this? If I nag
her she quits when I am around but makes up for lost time
when I am not. Does she need a psychiatrist, medication or
what? I have heard that this is very hard to treat and as
long as it doesn't get any worse I don't want long term
psychriatric or psychological treatment, but are those the
only options? Any suggestions would be appreciated.
A. I think you are correct in being
concerned about your wife's behavior you describe. It seems
like a rather extreme form of nail biting, which is common,
of course. Such behavior could very well be an
obsessive/compulsive type problem and/or it could be a
problem of impulse control. However, before any diagnosis can
be made, other pertinent information would have to be
considered, including her medical history and condition as
well as other kinds of symptoms or behaviors that might be
present. It would be important to know what her feelings are
about this behavior. Does she feel compelled? Does she do it
in a certain, rigid way? Is there tension before or if she
tries to stop? Does she feel relief or pleasure when she
engages in this behavior? I would strongly recommend that you
encourage her to seek professional help. Medications may be
helpful, of course depending on the final diagnosis. As for
therapy, it may not take long term treatment for her to get
over this, especially if this is a fairly isolated problem
and she is otherwise reasonably well adjusted. As you know if
you have browsed my site, I favor cognitive-behavioral
therapy. Other kinds of therapy can be helpful too, but one
of the real advantages of cognitive-behavioral therapy is
that it often produces relatively quick results. You might
want to read the section on picking a therapist. It sounds as
though it may be difficult to convince her of getting help,
but if you are persistent in a kind, nonjudgmental way, she
will probably go along eventually. You might want to share
this information with her, especially about finding a
therapist. Often people are afraid that going to a therapist
means there is something wrong with them, but in
cognitive-behavioral therapy, we see therapy as a skill
learning task, not curing a disease. Hope this helped and
good luck.
Q. I have been in therapy for a little
over 4 years now with the same psychologist (male, if that
matters) for repressed incest with both of my parents and
have come to the conclusion that I am a lesbian. I used to
think that I had become one because of the incest but now
believe that I always was one but that the incest screwed up
my sexuality so much that it's orientation never got to
present itself. Anyway, what I'm wondering is if it would be
a good idea to change therapists after this length of time of
going to the same one all the time or is that an appropriate
length of time for such a case? I still dissociate some but
my psychologist said that I wasn't MPD. I am still living in
the same house as my husband although a divorce is in
progress. My husband doesn't know that I'm a lesbian. For the
past 10 months I have been attending a weekly "coming out"
group and have made some lesbian friends there. Would you
please give me an opinion on my question? Thank You.
A. After four years, I think it may
be wise to try another therapist, perhaps with a different
approach. However, I would also recommend that you discuss
this first with your present therapist. A frank discussion of
your goals and progress is quite appropriate. Perhaps after
that talk, you and your therapist can decide on the best
course of action. You might want to check out the section on
my site about how to pick a therapist.
Q. you know maybe there are some of us
who can't afford to have a major credit card, but still need
a little advice now and again. I was all excited to bounce
some stuff off a real dr. but no i can't ask because i don't
hav a visa, mastercard, or an amx!
A. Sorry about the credit card
thing, but that is certainly not the only way to do it. The
question and answer forum is free, with the only hitch that I
ask to be able to post it at my site (without your identity,
of course). For a more detailed, private answer, you could
pay by check or money order if you don't have a credit card.
I hope this cleared it up and I look forward to hearing from
you. Thanks.
Q. My grandfather seems to be going
through a personality change. He is becoming more agressive
and is fighting(verbally) with his neighbors. He is also
becoming more stubborn than ever. Is a personality change an
indication of a possible problem such as Alzheimers or
senility?
A. Personality change certainly
could be a sign Alzheimers or other aging dementias. However,
it could also indicate other conditions or problems, such as
alcohol or drug abuse, depression, marriage problems,
paranoia and other possibilities. Does he also show memory
problems, confusion, disorientation, repeating stories and
thing like that? If so, that makes it more likely that it is
Alzheimers. You didn't mention his age and general health
condition, but those would obviously be factors to consider.
The important thing is to get your grandfather in for an
assessment by his doctor. If warranted, the doctor may also
refer him to a psychologist for a psychological assessment.
Whatever it is, checking it out and getting him into
treatment is the best way to deal with it. It may be hard to
motivate your grandfather to go for help, so it could take
some subtle persuasion. Try to find something that bothers
him that he may be willing to acknowledge, like for example,
if he gets stressed or has problems sleeping. Good luck and
thanks for the questions.
Q. HOW CAN YOU TELL IF SOMEONE IS A
PATHLOGICAL LIAR? WHAT ARE SOME WAYS TO HELP A PATHOLOGICAL
LIAR STOP?
A. Good question. I suppose the main
thing is if the person lies frequently and when it isn't
really necessary. Anyone might lie to get out of a spot or
avoid unpleasantness, but it they lie when there is no
advantage, it has probably gotten to be a habit. Actually,
pathological lying is not in of itself a diagnosable
disorder. It is usually a sign of a character or personality
disorder, such as antisocial or psychopathic, histrionic, or
borderline personality disorders. Your second question is a
tough one. These kinds of patterns of behavior are hard to
get people to change because they sort of work and there is
often not much motivation to change. Therefore, the first
step would be to help the person establish some motivation.
You might check out the addictive behavior section of my site
for some specific suggestions. Also, you might want to
examine your own relationship with this person. Are you
inadvertently contributing to or "enabling" this behavior?
Often by putting up with it, we give the implicit message
that it is all right, even if you verbally say you don't like
it. Hope this helped and thanks for writing.
Q. I had a head injury in a car accident
six years ago. I lost many years of memory and have had
emotional problems and personality changes since then. I have
regained much memory with little help from the professionals
I have dealt with. Do you have any suggestions?
A. Probably the best person to seek
help from is a neuropsychologist, if you haven't seen one
yet. They specialize in helping people with brain injuries.
That's what I think of as a "hardware" problem, which is not
in my area of expertise. However, the emotional problems you
mentioned may be in my line. You didn't mention what these
are, but I imagine there is a lot of frustration, anger,
anxiety and possibly depression. Some kinds of brain injuries
can certainly affect emotional reactivity, but some of your
emotional problems may be "software" based. You might want to
check out the self-help tools and suggested readings at my
site as well as the "finding a therapist" section. I can
imagine how difficult this has been for you, but learning how
to manage your feelings would probably make it a little
easier. Take care.
Q. Just wondering about the "Homework
assignments". I don't know how this works so maybe someone
could write back and give me some info.
A. The homework assignments page is
something I give my clients when I work with them in therapy.
Cognitive-behavioral therapy is largely a matter of learning
how to manage your feelings and the best way to learn
something is to practice it! Therapy sessions are helpful,
but working at developing self-management and emotional
management skills on a day to day basis is the most
beneficial way to practice. These assignments can take many
forms, as mentioned. I am putting together an emotional
management skills interactive training program for my web
site in which I will have students doing such homework
exercises from my web site. Until this is online, you might
just try coming up with your own homework exercises using
some of the self-help tools at my site and information from
the suggested readings. Hope this clarified it for you.
Thanks for writing.
Q. Could you please give me the
definition of a nervous breakdown??? thank you for for time.
A. Thanks for writing. The term
"nervous breakdown" doesn't really have any technical
meaning. It is an everyday term for any intense emotional
reaction that interferes with day to day functioning. Most
commonly, this would be a temporary stress and/or depressive
reaction that has built up to a crisis level. Unfortunately,
most of us put up with dissatisfaction and stress until the
proverbial straw that breaks the camel's back comes along. If
you think you or someone you know might be headed for a
crisis like that, it would be wise to take action before it
gets to that point. The most important thing is to talk to
someone. Please check out the "finding a therapist" section
of my site. If you want to talk to me more in depth about the
situation, you can go to the "ask the doctor" section. Also
check out the suggested readings and the "self-help tools".
The vast majority of "nervous breakdowns" are temporary and
can be treated readily. Thanks again and take care.
Q. What is your stance on lifestyle?
A. I'm not sure I understand your
question, but I guess I would say that lifestyle is a matter
of personal choice. There are certainly consequences of your
choices, but each person decides what their approach to life
will be. The problem from a mental wellness standpoint is
that some of our lifestyle choices are based on "unhealthy"
emotional agendas or reasons. For example, smoking cigarettes
is a lifestyle choice. Everyone has a right to make this
choice, certainly, but is is probably unwise. I don't think
too many people choose to smoke because they think it is good
for them. More likely they like the brief burst of pleasure
and relaxation they get from smoking, then con themselves
into thinking they won't have to pay the price for their
actions. Aside from the possibility of making self-defeating
lifestyle choices due to coming from "false" feelings, I
don't really have any professional stance on lifestyle,
although I certainly have some personal feelings on this
issue. As a psychologist, though, I don't try to impose my
personal preferences on others. I hope this answered your
questions, which was an interesting one.
Q. What is your stance on lifestyle?
*grin* Actually, Robert, that wasn't what I meant if it was
all I asked. What I meant to ask was: "What is your stance on
BDSM as a lifestyle?"
A. Well that makes more sense, but
actually, my answer is pretty much the same. Thanks for
clarifying it.
Q. What is self actualization???
A. This term was coined by Abraham
Maslow, a psychologist. It is at the top of a pyramid called
the hierarchy of needs. Maslow's idea was that when lower
order needs are met, like food and shelter, then we are
motivated by higher order needs. Self-actualization is the
highest motivation. It is the drive to become well rounded,
fulfilled and effective in many areas of life. My only
quibble with Maslow is that these are not "needs", but wants
or preferences.
Q. My 63 year old mother has just been
diagnosed with Dementia. Could you please provide me with any
information you may have on this disease and what I can do to
help her.
A. Dementia is really more of a set of
symptoms than a disease because it can arise from various
conditions. It has to do with multiple difficulties in
thinking, including language disturbances, movement
difficulties, failure to recognize objects and/or difficulty
in planning, organizing, sequencing or abstracting. In other
words, dementia is a severe impairment in a person's ability
to think and use their mind. It is generally the result of
damage to the brain, what I think of as a "hardware" problem.
Alzheimer's disease is a common cause, but it can also be
caused by strokes, head trauma, substance abuse and various
other diseases. The specific cause would, of course, be
important to know. The first thing I would suggest is talking
to your mother's doctor to find out more details. As always,
a second opinion is probably wise. It is important for all
the family members to be patient and supportive of her and
each other. There may be support groups in your area which
could be useful for you. There may be ways of simplifying
your mother's environment to help her maintain as much
independence as possible. It might also be worthwhile for you
to check out the sections on depression and anxiety at my
site to help you keep your spirits up. Counseling may also be
worth considering because you and your family face a very
trying situation. You and your family have my sympathy and I
hope this helped.
Q. Hi, this is probablly the dumbest
problem you will ever hear. I have this problem, when I feel
nervous or am stressed out I tend to pull my hair out of my
head. It is so terrible, I can't find a way to stop. Lately
it has been happening more and more, it as if I can't stop.
A. Believe it or not, I have gotten quite a
few questions about hair pulling, or Trichotillomania. This
is not as uncommon as one might think. One study showed 1% to
2% of college students had this condition. In children, hair
pulling may often just be a passing habit, so it is a good
idea not to make too big a deal out of it unless it is quite
persistent. In adults, it is more common in women than men,
which may just mean that women are more likely to admit it
and seek help. Many people will pull their hair during times
of stress or frustration and we even describe something as
frustrating enough to pull your hair out. When it gets to be
a habitual pattern, there is usually an element or relief and
pleasure associated with the hair pulling. This suggests that
hair pulling can become an addictive behavior, a "drug of
choice", in effect. Fortunately, this condition can be
treated. It is important, of course, to get professional help
(see the Finding a Therapist section). Many methods that work
with other addictive behaviors can help, like recognizing and
resisting the urge and learning better ways of relieving
stress and frustration (see the Addictive Behaviors section).
It is also important to deal with the shame or embarrassment
that often accompanies this condition. For some people,
medications can prove beneficial. Thanks for your question
and take care.
Q. My question is about the
Manic-depressive illness. I know it is thought to be
geneticlly passed to children. What are the odds of the
daughter who is the 8th child and only girl to be geneticlly
predisposed for Manic-Depression? This adult has already been
tested and has two personality dissorders. Those being
Antisocial and Borderline, this individual also has schizoid
thought processes, and dystima.
A. Thanks for your question. As you know,
there is evidence for a genetic component to bipolar disorder
(manic-depressive illness). Children of individuals with
bipolar disorder are from 4% to24% more likely to suffer a
major mood disorder. The gender of the offspring probably
doesn't enter into the picture, as it is equally common in
men and women. Although genetics is obviously a factor, it is
by no means the only factor, as suggested by the relatively
low probabilities quoted above. The most important thing is
whether or not any particular person has such problems, so if
there is any concern, the person should probably see a
psychologist or psychiatrist. Apparently this person already
has. I hope she is also receiving treatment, both medical and
psychological. You might want to look at the section on
"finding a therapist" at my site. Personality disorders are
hard to treat, but cognitive-behavioral therapy can help if
the person is really motivated. Dysthymia is often very
successfully treated with cognitive-behavioral therapy. One's
genetics simply set the parameters for one's life, so for
some people emotional well being and personal effectiveness
is more difficult to achieve. No matter what your genetics,
however, with work, most of us can learn to run ourselves
better.
Q. Good morning, Dr. Sarmiento. I looked
at much of your material and found that your thinking goes
very much in line with that of Dr. (James?) Burns. He put out
a book called "Feeling Good" which I have given to a number
of family members and friends. You might find it very useful
in your work.
I am fortunate in that I can usually
help myself in matters pertaining to my mental state.
However, refreshing one's knowledge on the subject of state
of mind is very helpful. We all can improve our life by
realizing that thoughts precede feelings and therefore we DO
have the control.
Thanks for sharing what you know so
freely. I have book marked your pages. I shall read them from
time to time just to make sure I am psychologically healthy.
A. Thanks for your comments. Your remarks
will be encouraging to many people. I especially like that
you share what you have learned with others. I call that
"sharing the health". When my clients tell me they are
pointing out what they have learned to others, I know they
are progressing very well.
Sorry it's taken so long to get back to
you, but I have been spending a lot of time relocating and
updating my site. The "Feeling Good" book is by David Burns
and I agree, it is excellent. I refer to it in the suggested
readings section of my site. It is based on cognitive
therapy, which is closely related to Rational-Emotive
Behavior therapy. Thanks again and drop by any time. I will
be adding new material and new features.
Q. 1. How did you get started in your
profession?
2. What made you decide to want to be a psychologist?
3. How many years of college is required to be a
psychologist?
4. What courses are required?
5. What kind of people do you deal with?
6. About how much do you make a year?
7. What are some disadvantages of your profession?
8. Do you enjoy your work?
9. Do you use hypnosis in your work?
10. How do you stay untouched emotionally from your patients
problems?
A. I got interested in psychology when I
took an introductory course in psych my first year in
college. I was fascinated by the mind and by the theoretical
task of trying to understand the mind. It usually takes four
years of college and four or more years of graduate school,
as well as supervised experience and passing an examination
to become a psychologist. Coursework depends on what areas
you specialize in, but psychologists have a broad basis of
courses, including psychopathology, but also conditioning and
learning, statistics, child development, and many other
subjects relating to psychology, biology and neural sciences.
Salaries depend on work setting, like in an agency versus
private practice, ranging from $50,000 to over $100,00 per
year. Recently, the main disadvantage is that managed care is
changing the practice of psychology (and medicine). There is
a lot more paperwork, lower fees and a great deal of
competition to get on managed care panels. I greatly enjoy my
work. It is both stimulating intellectually and gratifying
personally. I wouldn't say I was untouched by client's
problems, but usually not upset. This comes from keeping
clear boundaries and not "owning" clients problems. Also, the
reward comes from helping people find new solutions, not
dwelling on the negative. I work with all kinds of people,
from those wanting a career change, to police officers,
people involved in litigation, couples having marriage
problems and people suffering from depression, anxiety and
other mental problems. Most of them are "normal" people with
normal problems of life. I do occasionally use hypnosis, but
it is not my primary modality.
Q. What is the lux level (intensity of
light) that switches off the production of Melatonin? I heard
that your eyes need to be exposed to intensity of light above
1500 lux to stop melatonin. Can you verify or clarify??
Good question. However, I do not know the
answer. I'm sure it's available on the web, but this is out
of my areas of expertise. Good luck in finding an answer and
sorry I couldn't help.
Q. Dear Robert, your page
CyberPsychologist is really good deed, I think it can be very
helpful to those in crisis. It is really inspiring to see the
work of such a comitted professional like you! I am
interesting in psychology and self-change and I will
appreciate the possibility to sometime ask your opinion if
you don't object. I live in Moscow, Russia. Best regards and
thank you.
A. Thanks for your comments. I really
appreciate them and am glad to know my work is helpful.
Please feel free to ask any questions. If you allow me, I may
publish your question and the response on the Question and
Answer forum. That way, others can also benefit from your
question. I am exploring the possibility of having an online
newsletter and/or a maillist service, so check back with my
site from time to time. I would be interested in learning
more about you and your life in Russia. Thanks again.
Q. What are the legal issues involving a
patient/therapist relationship? Is the waiting time period
for a patient/therapist 2 years from the last date of therapy
before the two can become intimate? I'd like to say that I
need the information for a friend, but I'd be lying. It's for
me. If possible, I'd like the law number too.
A. The answer to your question depends on
what state you live in and what type of therapist. There are
different laws for each state regulating such matters and
each type of therapist (psychologist, counselor,
psychiatrist, social worker, etc.) probably is regulated by
different laws. In Texas, the law regarding psychologists
(which I am familiar with) restricts sexual relations with
clients for five years after the end of therapy and even
then, it would depend on various circumstances as to whether
it would be ethical. One consideration would be if the
therapist stated or implied that such a relationship would be
possible after a period of time. The reason for these laws is
to prevent "dual relationships" where the therapist would
have a conflict of interest and also to prevent taking
advantage of the patient's vulnerability. If you are in
therapy, or have been, and have feelings towards the
therapist, it would be wise to discuss these with your
therapist. Such feelings are not uncommon in therapy. They
are called transference. These are not usually about the
therapist as a person, but rather reflect illusions being put
on the therapist. OF course, the therapist can develop
counter-transference feelings. For the client, such feelings
are not unusual and working through them in therapy can be
quite helpful. For the therapist, such feelings are much more
inappropriate. Unfortunately, the media has not helped people
understand this. It seems most shows or stories about therapy
routinely depict therapists getting involved with their
clients. By the way, as I understand it, in Texas it is not
only unethical but illegal for a therapist to get sexually
involved with a patient. It might be wise to get a second
opinion by seeing another therapist if this issue is not
resolved fairly quickly. I am making some assumptions in
responding, so I hope my answer is relevant to your
situation. Hope this helped. Let me know if you have any
further questions.
Q. In January of 96' I began seeing a
"therapist" who practices , "hypnotic regression therapy". At
first the results seemed satisfactory and I felt that real
progress into some of my emotional hang ups was being made.
But lately I get the feeling that my so called "Therapist" is
introducing new material into our sessions which just don't
"Ring True". I get the feeling that he is trying to lead me
towards some pre concieved notion of his own and the details
are beginning to sound like a bad tabloid "I was abducted by
aliens " Headline. Any thoughts on both Hypnotic Regression
Therapy and My specific case would be greatly appreciated.
Thank you for your time and expertise in advance, (a skeptic)
A. First off, let me say that there are
legitimate differences of opinion on these matters, so it is
not an issue of right or wrong, but of opinion. That said, I
am also very skeptical about hypnotic regression therapy. It
is important to understand that memories, especially through
hypnotic suggestion, are constructs of the mind, not like a
videotape. Thus, it is quite possible to construct or implant
false memories. There is a big debate now in the field about
"false memory syndrome". The idea is that a therapist can
knowingly or unknowingly lead a person to have "memories"
that are false, exaggerated or distorted. I would also add
that the broader idea of analyzing and re-experiencing early
traumas as a way of making changes now is suspect, in my
opinion. This is the old Freudian idea of insight and
catharsis. While it may work, it is very indirect, expensive,
painful and time consuming. Modern cognitive-behavioral
therapy focuses more on what you can do now to make changes,
not trying to discover the presumed historical origins of a
problem. Not to say it is never helpful to think of past
traumas, but rather that the goal is change, not necessarily
insight. Please see the "Therapy for People Who Don't Believe
in Therapy" at my CyberPsychologist site. I would recommend
shopping around for another therapist, or at a minimum,
discussing your concerns with your therapist.
Q. Does you have any information
whatsoever on Hypnosis Therapy? From education requirements
and locations, to general opinions on its usefulness, to
sources for more information? I would deeply appreciate
feedback. Thanks :)
My sense of it is that hypnosis is a tool.
It is a mental state of internal absorption rather than the
external focus of the typical waking mind. Everyday examples
of hypnotic states are watching a movie or reading a good
book. The interesting thing about this state is that people
are often more open to suggestion, which can have therapeutic
utility. In REBT, hypnosis can be used to focus on the "C",
the emotions, or to tune in to the "B" or beliefs. It can
also be useful to dispute irrational beliefs, rehearse and
replay events and so on. There is a tape available through
the Institute of REBT, I believe by William Golden, on how to
use hypnosis in REBT. Because it is emotionally evocative,
hypnotic type methods can be an important part of the
"emotive" in REBT. A lot of the public view of hypnosis is
just pure show business, but it can be a useful tool for
helping people make constructive changes.
