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Alcohol Awareness Month: How Does Alcohol Abuse Impact Families?

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ncadd alcohol awareness month 2013- logoEvery year, the National Council on Alcoholism and Drug Dependence (NCADD) sponsors Alcohol Awareness month in an effort to increase public understanding of alcohol, to reduce the stigma of alcoholism, and to draw attention to the impact that alcoholism can have on kids, families, couples and communities.

At The Family Institute, we believe that the family is the singular most significant factor influencing human identity.

In honor of Alcohol Awareness Month, we’re providing information on the ways in which alcohol abuse impacts the individuals within families, and the families themselves.

 


 

Alcohol abuse can impact family functioning in a number of different ways.

Routines
A likely consequence of problem drinking is that the drinker’s behavior becomes unpredictable, making it difficult for the family as a whole to plan anything in advance or to stick to familiar routines. Will he or she be okay to pick up the kids from school? What time will he or she come home, and in what state? This sort of constant uncertainty can be highly disruptive, and it helps to explain a commonly found paradox in the families of problem drinkers: that while the problem drinker may be withdrawing from the family by no longer playing the role within it that he or she did previously, he or she nonetheless appears to dominate it as the family starts to organize itself around the drinker and his/her behavior patterns.

Roles
Alcohol misuse tends to change the roles played by family members in relation to one another, and to the outside world. Most families operate with some form of division of labor – one person managing the family’s finances, the other supervising the children, one doing the gardening, the other doing the cooking, and so on. But as one member of the family develops more of a drinking problem, the other members are likely to find themselves having to take over his or her role themselves. Eventually, one member may be performing all the roles – finances, disciplining, shopping, cleaning, household management, and so on.

Communication
Another area of family functioning which is often affected by alcohol and alcohol misuse relates to the kind of communications that takes place between family members. It may be that the partner with the problem refuses to talk about it, even though it is clearly beginning to dominate his or her life, as well as the family’s organization. Or again, alcohol can itself become the main topic of conversation – has he/she been drinking again, if so how much and with what effect, and who is going to help the individual or the family manage the consequences of the family member’s drinking?

Social Isolation
Many people who have a parent or partner with a drinking problem find talking about it to others to be extraordinarily difficult. The problem is often simply seen as being too shameful to admit. As a result of their reluctance to discuss or expose their situation to the outside world, the family tends to withdraw into itself. The degree of social embarrassment and unpredictability associated with drinking problems constrains family members from extending invitations to others to visit the family home, accepting invitations to visit someone else’s home or other social gatherings. The family thus tends to become increasingly socially isolated.

The Family Institute offers affordable family, couples and individual counseling at our Evanston, downtown Chicago, Lagrange Park and Northbrook locations. Visit our website to learn more.

National Eating Disorder Awareness Week: How can parents help?

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NEDAwareness_2015_Shareable_ParentsThis week is National Eating Disorder Awareness week, a time to shine a light on the seriousness of these issues and raise awareness.

Last year, we received insights from Family Institute staff clinician Mallory Rose, LMFT, on the unique ways families and eating disorders interact, including one way in which parents can help in early intervention against disordered eating and/or body image issues:

Parents are also in a unique situation because they can demonstrate to their children healthy ways of coping with anxiety. Children are very perceptive and will notice even subtle signs of parents’ anxieties and insecurities. I encourage parents to really try to recognize and address their relationships with their bodies and food intake. Anxiety may be inevitable, but I encourage parents to work on healthy ways of coping for themselves and to also be healthy role models for their children.

Read Mallory’s full blog post here, and learn more about her services on our website.

 

To look for treatment for eating disorders or food-related issues, visit our Find-A-Therapist feature.

The Family Institute offers a wide variety of affordable counseling care that treats whole individuals and their loved ones. Find out more at our website.

Roadblocks in Therapy: The value of difficult moments in the client-therapist relationship

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RopeResearch shows that the relationship between client and therapist (the therapeutic alliance) is the most powerful predictor of success in therapy. But what happens if your relationship with your therapist gets rocky?

Family Institute staff clinician Jacob Goldsmith, PhD wrote a Clinical Science Insight white paper discussing this very thing. An avid researcher on the client-therapist relationship and what is known as rupture-repair, the process of fixing a weakened client-therapist relationship, Dr. Goldsmith gives an overview of the existing research on this phenomenon in his paper “The Value of Difficult Moments in the Client-Therapist Relationship.”

“The process of experiencing, discussing, and solving problems in the therapeutic relationship is important not simply because it rights the course of off-track therapy,” writes Dr. Goldsmith, “but also because it provides unique opportunities for learning and behavior change.”

Research also shows that moments like these can actually improve therapy: “Evidence also suggests that clients and therapists who successfully navigate difficult moments in therapy are rewarded with better outcomes.”

Read more about the importance of the therapeutic alliance, as well as how a moment of tension or discomfort can actually help the therapy process on our website.

Read Dr. Goldsmith’s full bio our make an appointment on our Staff Bio webpage.

The Family Institute offers counseling therapy for couples, individuals and families. Learn more about the work we do and the services we provide by visiting www.family-institute.org.

Interview With Institute Affiliate Therapist Larry Maucieri, PhD, ABPP-CN

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It is our pleasure to be able to catch up with some of our staff, alum, students and affiliates. Today we talk to Larry Maucieri, PhD, ABPP-CN about his practice and his new book, The Distracted Couple.


 

TFI: Tell us a bit about your career, and about your affiliation with The Family Institute.

 LM: My undergraduate majors at University of Illinois were in music theory and economics (very math focused!) so I was not even involved in psychology until after college. I was introduced to psychological assessment and therapy methods when I worked at an insurance company and that prompted a career change for me. I earned a MA degree from NYU and a PhD in clinical psychology from Fordham University in the Bronx. My clinical internship was at Yale and then I did a neuropsychological postdoctoral fellowship at Northwestern Memorial Hospital with Drs. Sandra Weintraub and Robert Hanlon.

By training I am an adult clinical neuropsychologist, and I just recently completed my ABPP board certification in neuropsychology, which is the highest credential for the sub-specialty. Early on, my clinical work consisted of just assessments of adults for dementia, the effects of stroke, tumors and head trauma, and sometimes learning disabilities and ADHD. I first joined the Family Institute in 2008 and my early clinical work was focused in assessment of these areas. Within a few years though I took more of an interest in individual psychotherapy and in particular the applications of CBT within a relational context to help adults impacted by ADHD.

Simultaneous to my Family Institute position, I was a faculty member at the Adler School and as of 2011 a tenure track professor at Governors State. In recent years I have had a much more active – though still part time – therapy practice at Family Institute focused on adults who have ADHD or who are impacted directly or indirectly by neurological events, such as disabling strokes. I find the blending of neuropsychological knowledge and therapeutic techniques to be a really powerful combination. I love working with adults with ADHD for both assessment and therapy. I still do neuropsychological assessments regularly, but I am interested in developing more skills in cognitive rehabilitation as well to implement some of those tools in my work with adults and significant others impacted by ADHD, head trauma, stroke, or other neurological events.

 

TFI: The description of your book addresses how the focus of ADHD treatment and diagnosis has historically focused on children, and that adult ADHD and its impact on couples has not been sufficiently explored. Why do you think this has been the case? In what ways is adult ADHD different than that of children’s?

LM: Right, the concept of ADHD symptoms lingering on into adulthood is a relatively new one. The history of ADHD in America and other countries, by a number of different names and diagnostic criteria, has always been focused on the impact of the condition in children. And with good reason. It is first and foremost a neurodevelopmental disorder, and so there cannot be new onset for ADHD after age 12 or so by DSM-5 criteria. However, the previous wisdom was that ADHD only impacted children and adolescents, so that by adulthood the symptoms were significantly minimized if not gone. Part of the reason for this is because there was always so much focus on ADHD in childhood. If you skim the DSM-IV and DSM-IV-TR criteria for ADHD the behaviors described in the symptoms are obviously geared more toward childhood experiences. Also, the nature of ADHD in the adult lifespan is different than it is in children and adolescents. In some ways it is more subtle in adults than in children, and that is why the DSM-5 reduced the symptoms needed for each cluster of ADHD (inattentive and hyperactive-impulsive) from 6 to 5 for individuals over age 17.

A more accurate conceptualization of ADHD in adulthood is that it tends to manifest in a different way. It is more evident through symptoms of inattention, reduced focus, disorganization, and poor planning. Children are more likely to have the hyperactive elements of ADHD, but both children and adults can have impulsivity in their behaviors. Interestingly in adults ADHD commonly co-occurs with other problems, such as depression, anxiety, substance use, learning disabilities, and Tourette’s syndrome. The lack of impulse control and/or diminished self-esteem common in adults frequently may lead to problems with anger, and almost always relationship and/or work performance problems.

 

TFI: In addition to noticing the gap in exploration of adult ADHD (and its impact on relationships), how did you develop the topic of your book? Why did you decide to focus on couples as opposed to only individuals dealing with adult ADHD?

LM: Not long after I joined Governors State, Dr. Jon Carlson (who is a professor there) and I discussed a book that might overlap in both of our areas of interest. Most people know him through all of the APA videos that he hosted with well-known therapists who demonstrate therapeutic techniques in a specific modality. However, he has also published over 50 books primarily on couples and families and he works clinically with couples as well. My interests, as noted above, include ADHD.

So we conceptualized a book written specifically for therapists and counselors on unique problems and interventions for couples impacted by adult ADHD, and specifically where one partner or both had ADHD, rather than parenting children with ADHD. As we researched the literature we found that there were a few general public advice books on the topic but little if anything for clinicians. Certainly there was no handbook to address the topic. So we contacted several publishers with our ideas and ultimately decided to publish with Crown House.

The publisher and both of us realized that it was a sorely needed area to address. A few individuals were looking at the impact of ADHD on couples in articles, popular press books, and workshops, like Melissa Orlov, but it was a really under-represented area in the professional literature, and to have a book with a number of different contributors each providing their conceptualizations about the core problems and interventions for ADHD in couples was really something totally unique. So we were very hopeful it would be a very valuable contribution.

 

TFI: Editing a book of this nature is a big undertaking. Tell us a bit about the process of putting the book together—were there any surprising insights along the way? Any unexpected hiccups?  Are there ways in which editing this book has impacted your practice and/or teaching?

LM: Yes, I had never edited or written a book before so it was all new to me. The Hollywood conceptualization of sending in a finished manuscript and it getting published immediately was challenged pretty early on, as we needed to provide a fairly detailed chapter by chapter account of each topic in the book, the authors associated with each chapter, and the justification for why this book should be accepted for publication right from the start. The publishers we talked with each used a peer-review process of sorts, not as rigorous as a journal article, but something similar to that approach. I find it incidentally kind of hilarious that the academic setting does not hold edited books in as high regard as peer-reviewed journal articles considering the work involved and the scrutiny at multiple levels, but that is a long-standing tradition that is not going to change.

Early on I contacted numerous authors who had published or were known to work with ADHD and/or couples. Interestingly, they tended to fall into one of these areas or the other, not both. At that point it was really all networking and explaining what our project was about. Responses were generally positive, and even the biggest names in ADHD, like Russell Barkley, while not available to write a chapter for us, was very encouraging of our project. After the project was completed Ned Hallowell, whom almost everyone knows from his best-selling book Driven to Distraction, loved our book and eagerly endorsed it very favorably. Despite his reputation he was extremely approachable and supportive.

In some ways I struck gold when I contacted Dr. Ari Tuckman who does a lot of work with ADHD in Philadelphia and who publishes on ADHD often as well. Ari was an absolute treasure trove of networking connections in ADHD and was so in support of our project that he used his own feelings about the book to help recruit a number of other authors as well. The other contributors we found through personal connection or scoping the literature on couples work and ADHD.

Editing was a fairly arduous process in terms of the volume of work (the book runs about 360 pages I think), the organization of the deadlines, providing feedback, and multiple revisions. Content was generally not a major problem as the contributors were all so well acquainted with the topics and had very well developed ideas. In some instances there were differences in opinion regarding editing but these were worked out easily. Ironically, a few contributors themselves had ADHD which impacted their meeting deadlines for the book, so they needed a little more support but all did fine with it.

I would not say that editing itself really altered the way I teach or practice, but one of the real perks of the editing process was how much I learned from the contributors of the book about couples work and ADHD!  They are all so knowledgeable and skillful on the topic, and it was great to be part of a team that was working together to contribute something rather new to both ADHD and couples therapy.  Also, several of us, including myself, now have a monthly blog we contribute on topics related to adult ADHD through the Psychology Today website.

 

TFI: In your expert opinion, what are a few of the ways an issue like ADHD can impact a relationship? Are there any pervasive misunderstandings/myths when it comes to adult ADHD, and/or about its impact on relationships?

LM: These sorts of questions are what really makes the book so useful for clinicians. As our contributors note there are a number of specific dynamics and interpersonal interactions that develop over time in a relationship in which one or both partners has ADHD. Each of the authors had a slightly different take on these concerns and how to best address them, from Ari Tuckman’s focus on executive impairments in relation to ADHD, to Melissa Orlov’s unique model for working with ADHD-impacted couples, to the contributors who examined the unique elements of ADHD in couples in certain socially marginalized groups. One contributor (Susan Tschudi) even shifted the focus in the relationship from the individual with ADHD to his/her partner who did not have ADHD but was nonetheless still impacted by.

In general though, the types of issues that tend to recur in relationships impacted by ADHD involve breakdowns in communication and compensatory behaviors that become untenable. Over time, the partner with ADHD almost always develops personal shame about his/her incapacity to meet the demands of the relationship, home life, or work. Nearly every individual I have worked with in a therapy or an assessment capacity with ADHD has some sense of deep personal shame or self-loathing about how ADHD has derailed them in a major aspect of their adult lives. Given the feedback they have received over time and society’s skepticism about the condition, there is almost always a question in their minds about whether they really have ADHD or if ADHD is even real. In my opinion this is actually fueled in part by some of the sloppy diagnostic practices of clinicians in not adequately assessing for ADHD and/or ruling out all other possible explanations when initially making the diagnosis of ADHD in children and adults.

So, the partner without ADHD may nor may not voice distress about missed chores and undone tasks immediately but it comes out eventually in some form. Another interesting component in this mix is that the partner without ADHD often begins to then compensate for the behaviors of the one with ADHD – completing the laundry when its left undone, picking up the kids forgotten at school – but this breeds resentment and over time the relationship begins to resemble more of a parent-child dynamic rather than a relationship of equals. Once that begins the cycle is further reinforced. There is really no way out of it at that point without intervention.

Finally, another interesting component of the ADHD-impacted couple is that much of the time the partner without ADHD also feels skeptical about ADHD or at least ADHD in his/her partner. This means that the interpretation of task failures becomes one of character rather than as a symptom of the disorder. Instead of procrastination, distraction and unfinished tasks seen as an inevitable consequence of ADHD that is not well controlled, it is interpreted as laziness, not caring, or selfishness. This of course leads to another set of problems for the couple.

Finally as you might guess, adult ADHD often has a devastating consequence at work as well. However, that is not always the case, particularly if the individual with ADHD is in a highly structured work environment, is in a work environment where there is not a lot of attention to detail required, or really enjoys the work and so it can draw his/her attention for long periods of time (what is sometimes referred to as hyperfocus). ADHD in the workplace is a whole different book but I mention it here because off concurrent with the relationship issues is difficulty maintaining or finding work, and so financial stress or at least difficulty managing money is often an additional stressor for couples already impacted by adult ADHD.

 

To learn more about the Institute, visit our website.

 

Ask A TFI Clinician: Transitioning to Fatherhood with Mallory Rose, LMFT

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As Father’s Day approaches, we’re thinking about the important roles fathers play in family systems, as well as some of the issues surrounding fatherhood. Mallory Rose, LMFT provides today’s tips on the transition to fatherhood.

While transitioning to motherhood is often talked about, dads experience some growing pains as well that can sometimes go unrecognized. Mallory is an expert in this transition, both professionally as a marriage and family therapist, as well as personally, as she and her husband recently went through it themselves. In addition to her therapy practice at the Institute, Mallory runs the workshop Staying Connected After the Birth of Your Baby, a one day workshop where couples learn about how to handle the transition to parenthood.

Read Mallory’s insights about the transition to fatherhood, and consider her workshop (the next one is June 21st) as a Father’s Day gift for the new dads in your life.

Conflict is normal.

“While it can be a truly bonding and special time when couples become parents, once the new born glow wears off and the reality of sleep deprivation and new parent anxiety kicks in, most couples can unfortunately take out their frustrations and exhaustion on each other.

However, I think it is really important that people know this conflict can be normal and expected.

A healthy relationship is not the absence of conflict, but rather how the conflict is handled. However, when parents are sleep deprived and exhausted, they are not at their best to fight fairly. Also, what new parents disagree about can also change and be unique with this situation: Issues may come up that couples hadn’t thought about before their baby, such as how to handle in-laws, values around parenting and conversations about sex.”

Love takes time.

“I think it is crucial to label and name that often, for both moms and dads, it takes some time to completely fall in love with your child.

I think there is this societal myth or notion that once you have your baby, you should (and will) instantly fall in love with her/him. While I feel that most parents have an instant attachment and need to protect their child immediately, I don’t think it is really talked about that parents often need some time to get to know their child before they really fall in love with them. I want parents to know it’s okay and normal if it takes some time for that love to develop.”

Dads get baby blues too.

“I think it’s very important for fathers in particular to recognize the signs of baby blues in themselves. Most women have a hormonal baby blues period after having a baby, but it can be very common for men to experience this as well. However, I don’t think men know this is common, and therefore are not able to have the words or skills to ask for help and to talk about their feelings. Just as new mommy support groups are essential to help with this transition, so are new dad support groups.”

It happens to everyone.

“When my son Jeffrey was born, everyone was so wonderful and mindful of how I was doing, but I definitely thought it was important to check in on my husband Matt. However, every time I asked him how he was doing, he would always say fine and deflect it back to me. It took him falling asleep on the train and ending up in the wrong town, and then the very next day, backing his car into a ditch and needing to be towed out, for him to finally feel he had a right to share his struggles with me.

I want fathers to know that it isn’t a competition—that they can have a hard time too and to let support in when it’s offered. It’s okay for dads to let their wives take care of them and check in on them, even though they are also taking care of a newborn. The couple needs to take care of each other.”

A few tips:

  1. Consider joining a dad support group to connect with other men going through similar transitions
  2. Don’t be afraid to tell your spouse your needs, and try to find some quality time with them. Research shows that when dads are feeling connected to their spouses, they have an easier time connecting to their infant.
  3. Take advantage of the first three months when the baby can sleep in the car seat. Go out to restaurants and go on dates with your baby. It gets much harder to do this when they become mobile.

 

Mallory Rose, LMFT, is a staff therapist at The Family Institute. She holds a Master of Science degree in Marriage and Family Therapy from the Family Institute at Northwestern University, and completed a two year clinical fellowship at the Family Institute as well. She received her Bachelor of Arts degree in Psychology and Women Studies at the University of Michigan.

In May of 2014, Mallory was named Mom of the Month in Chicago Parent. Read her interview here.

To learn more or make an appointment, visit our website.

Ask a TFI Expert: Dealing with Job Loss and Unemployment with Lesley Seeger, LCSW

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In today’s economy, more and more families and individuals are dealing with issues of job loss and unemployment. Today Lesley Seeger, LCSW, provides some insights and tips on how to deal with the stress.

 

Why me and not the person in the cube next to me?

Job loss and unemployment can have a profound effect on a person’s psychological state. Losing a job and dealing with prolonged unemployment can impact self-esteem—thoughts like “what did I do wrong?” or “am I not good enough?” can affect someone’s confidence in his/her ability and can also bring about feelings of sadness, anger or shame.

 

Its you against a beast.

It’s a loss when we lose a job, and it’s a process, but the economic factors that make job loss and unemployment realities for so many aren’t controllable. When an individual loses a job, he/she may enter into a crisis state. However, as unemployment drags on, then depression can set in. Trying to get back into the workforce in today’s economy can take a toll on self-esteem—even with individuals who have otherwise healthy self-confidence.

 

The stress reverberates.

In addition to its effect on individuals, the strain of job loss and unemployment can impact entire families. The financial stress of unemployment is one thing—but unemployment also can impact families on the emotional level. If you’re feeling angry or scared about your situation, you may become short with your wife or husband, or you may become isolated and withdrawn and not able to be with your family at all.

There is also a shift when a parent is out of a job—Mom or Dad may be home when she/he used to be gone all day—which can create confusion or fear with younger children. Use the opportunity as a teaching moment for your kids and talk to them about what’s going on while also reassuring them things will be okay.

 

Be on the lookout for more serious issues.

While a certain amount of stress and/or sadness is expected when dealing with job loss and unemployment, be aware of the warning signs that there may be a more serious mental health issue going on. If you and/or your loved one(s) are experiencing any of the following, contact a professional:

  • Decrease in self-care (less sleep or significantly more sleep; significant weight gain/loss; lack of personal hygiene)
  • Uncharacteristically withdrawn or on-edge behavior
  • Loss of interest in activities one normally finds enjoyable
  • Loss of motivation or a sense of giving up

 

Combat the psychological strain.

While dealing with job loss and unemployment can be difficult, there are ways to ease the stress:

  1. Structure Your Day: It helps to maintain a similar schedule you had in the working world and to still be present in your life and relationships.
  2. Garner Support: Setting up networking and/or informational meetings takes courage. If you’re not feeling courageous, talk to someone you trust who will support you and remind you of your credentials, qualifications and skills and ‘coach’ you back out there.
  3. Reflect, Breathe, Chat: Take time to reflect and check the facts and remember that some things are out of your control. It’s important to take a step back from the situation, breathe, and reach out to your support people.
  4. Have Compassion for Yourself: It’s hard to be unemployed—there’s financial and emotional stress. Remember to have compassion for yourself as you deal with these issues.
  5. Do Something Different: In addition to the tasks you need to do—job hunting, networking, etc.—take the opportunity of being off work to be creative with your time: See a movie in the middle of a weekday; go to a museum. It’s important to find ways to balance the stress with some fun and normalcy.

Lesley Seeger, LCSW, is a staff therapist at The Family Institute at Northwestern University. She sees clients at the Chicago location and is a member of the Mindfulness and Behavior Therapies Program.

To read Lesley’s full bio or make an appointment, visit our website.

TFI’s Child & Adolescent Program

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As part of our Mental Health Month commemoration, TFI Talks will spotlight some of our innovative and specialized services. Today’s post focuses on our Child & Adolescent Program.

 

When children and adolescents need help maximizing their potential, our Child & Adolescent Program (CAP) can help them thrive.

This program includes Family Institute psychotherapists who specialize in working with families with children from birth through adolescence to help navigate and reduce the challenges that may interfere with a child’s and family’s development.

Why develop a program specifically for children and adolescents?

The Family Institute is committed to strengthening and healing families from all walks of life. We are well known for our devotion to family and couple therapy. Over the years the need for specialty services for children and adolescents grew within the Institute—we developed the Child & Adolescent Program to address this need.

The goal of the program is to develop empirically based clinics to provide the most cutting-edge therapy for children and adolescents—and their families.

The Child and Adolescent Program serves a wide range of issues.

Our staff consists of experts in a number of issues children and adolescents (and their families) face, including:

  • Anxiety
  • Depression
  • Adoption Issues
  • Adjustment to divorce
  • Neurobehavioral issues
  • Emotional and behavioral regulation

CAP also offers a number of specialized groups for children, adolescents and their families, including:

For more information, visit our Child and Adolescent Program webpage.

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