2009 Trainings

Now that the final training of 2009 is completed, I can rest! I must say, this has been a lot of fun for me. Although I have worked hard on writing/preparing, the positive feedback from the classes/trainings were very inspiring and motivating.

In 2009, I providing three professional trainings on Sexual Addiction: August 7th, September 25th, and November 13, 2009. Although the trainings were oriented for mental health practitioners seeking continuing education credits (CEU's), they were also designed to be informative for the general public. Topics included: signs and symptoms, behavior types, levels of addictions, demographics, gender differences, cross addictions, co-sex addiction, assessment, and treatment of individuals with compulsive sexual behaviors and/or sexual addictions.

The August 7, AATP, training was on "Compulsive Sexual Behavior and Sexual Addiction. It was at Christ Hospital in Oak Lawn IL was a great success. I received favorable feedback and plan to continue with the message: this is a very important topic to understand as well as an under-served and under-recognized population that needs help. AATP is a not-for-profit training academy established to provide professional continuing education for mental health practitioners. To contact AATP (click on this link or go to http://www.aatpofillinois.com/.

On September 25 Arbor Counseling Center hosted a similar training, but only for three hours (3 CEU's). The training was at Indian Trails Public Library, 355 Schoenbeck Rd., Wheeling IL.

On November 13, Alexian Brothers Behavioral Center for Professional Education hosted 2 hour (2 CEU) training on Sexual Addictions: An Introduction. The training was posted on their websit: http://www.alexianbrothershealth.org/services/abbhh/professionaleducation/professional-education-programs.aspx

I am anticipating further trainings in 2010. Some of the topics I am considering include: ADHD, Codpendency/Co-Addictions, and/or Treatment and Assessment of Sexual Addiction.

Signs of Sexual Addiction

Signs of Sexual Addiction (Based upon Patrick Carnes work)

1. Loss of Control
• Out of control sexual behavior predominates
• The addicts cannot control the extent, duration and regularity of his/her sexual behavior
• Behavior excesses continue despite clear signs of danger (consequences)
-- Compulsive masturbation
-- Compulsive pornography use
-- Chronic affairs
-- Exhibitionism: intrusive "flaunting/showing"
-- Dangerous sexual practices, i.e., asphyxiation
-- Prostitution
-- Anonymous sex (at porn shops, bars, etc.)
-- Voyeurism: intrusive "watching"

2. Continuation Despite Consequences
• Social Consequences
-- Loss of marriage/primary relationship, friendships and social networks
-- Problematic relationships with spouse, family and/or significant others
• Emotional Consequences
-- Depression, anxiety, fear, etc.
-- Suicidal thoughts, plans and/or attempts (70% have thought about it)
• Physical Consequences
-- Injury due to frequency and type of behaviors
-- Sexually-transmitted diseases
-- Unwanted pregnancies or abortions
-- Sleep disturbances
• Legal Consequences
-- Arrests for sexual crimes (voyeurism, lewd conduct, etc.),
-- Loss of job, licensure, and/or professional status
-- Sexual harassment charges
-- Fines, legal fees, probation, or incarceration
-- Being on the Sexual Offender Database
• Financial Consequences
-- Costs of pornography, prostitutes, and phone sex can cause financial hardships
-- Loss of productivity, creativity and/or employment
-- Loss of career opportunities
-- Bankruptcy

3. Efforts to Stop
• Repeated specific attempts to the behavior, which fail
• Even after multiple life changing consequences, the sex addict cannot stop -- Leads to further frustration, anger, shame and depression
-- Frustration fuels further episodes of addictive behavior)

4. Loss of Time
• Significant amounts of time lost doing and/or recovering from the behavior

5. Inability to Fulfill Obligations
• The behavior interferes with work, school, family, and friends
• High-risk behavior is continued despite responsibilities and expectations
• A pattern of broken promises and failures

6. Ongoing Desire or Effort to Limit Sexual Behavior
• Repeated but futile attempts to change, limit or stop addictive behavior
• Breaking promises to change, limit or stop behavior
• Cross Addictions: substituting or transferring another addiction to aid in stopping or controlling sexual cravings
-- Workaholism
-- Overeating
-- Alcohol abuse
-- Illegal and prescribed drug abuse
-- Compulsive gambling
-- Religious Addiction
-- Romance addiction

7. Preoccupation (Obsession about or because of behavior)
• Sexual obsession and fantasy as a primary coping strategy
• Elevated levels of arousal are used to cover up feelings
• Sex becomes a primary drug to numb, "medicate" and/or regulate emotions
• Sex is used to block out painful and unpleasant memories
• Euphoric Recall or "Sex in the head" maintains the fix whenever needed
-- Secretive mental images of past sexual acting out, which is used to sexually act out again
-- Its like having a personal collection of pornography to be used at any time

8. Escalation
• Amounts of behavior increase because the current levels no longer satiate cravings
-- Higher "dosages" are needed to get the same feeling/excitement.
-- Can cause self injury
• Masturbation to the point of injury
• Asphyxiation
-- Increased levels create victims

9. Severe mood changes around sexual activity
• Depression, anxiety, anger, and other mood/affective states can result from repeated failures to stop or control the
addictive behavior
• 70% described chronic feelings of depression
-- Other chronic mood or affective states include:
• Anxiety
• Guilt and shame
• Anger at self and others
• Hopelessness and despair (monitor suicidal ideations)
-- Mood changes may be "medicated" (hidden) through the use of other drugs or medications

10. Compulsive Behavior
• Sexual behavior that you want to stop but you can't
• A pattern of out of control behavior over time
• Sex becomes the organizing principal of daily life
• Everything revolves around it
-- On sexual obsessions and fantasizing
-- On planning next event
-- On sexual acting out (some spend 8 hours a night on the internet)
-- On covering up or making up for lost time
-- Addressing consequences of sexual behavior

11. Losses
• Losing, limiting, or sacrificing valued parts of life
-- Hobbies, family relationships, and work
-- Loss of important personal, social, occupational or recreational activities
-- Loss of friends and family (loss of relationships)
-- Loss of long-term relationships
-- Loss of talents, goals, and personal and professional aspirations

12. Withdrawal
• Stopping behavior causes considerable distress, anxiety, irritability, or physical discomfort.
• Usually lasts for about 14 days, but can be as long as 10 weeks
-- Insomnia
-- Headaches and/or body aches
-- High or low sexual arousal and/or genital sensitivity
-- Increased appetite for food
-- Chills, sweats, shakes and/or nausea
-- Rapid heartbeat and/or shortness of breath
-- Intrusive dreams
-- High level of anxiety and irritability
-- Emotional lability (roller coaster feelings)
• Some sex addicts with a chemical dependency report that withdrawals are worse for sex addiction than for drug/alcohol addictions

Online Articles

I have decided to get some of my written work published online. So far I am have my written work published on Enzinearticles.com , Articlesbase.com, and SelfGrowth.com

I hope to get the word out about my passions to a broader audience.

Heaven (A Spiritual Poem)

Seven years ago I was asked by a friend if I was "religious and if I believed in God?" As a (formerly) practicing agnostic I quickly answered:"no." However, I defended myself by explaining that I lived my life according to universal principals of "right and wrong" (as I understood them). Because I believed that our deeds create a lasting effect on the world, I felt confident in my everlasting future. In other words, I wasn't worried about there being a heaven or not. I told my friend that when I die, I am banking on knowing that my impact on the world will be ever lasting. My "heaven" will ultimately be the creation of the the sum total of all my actions.

I will never forget my friend's response: he looked at me with glassy eyes, and told me how deeply spiritual I was. I didn't see it. It took five more years to see what he meant. Such was the inspiration of the following poem I wrote.

Heaven
The pebble is worn smooth
Made small over time
A product of a cataclysmic force of nature
A fragment of mountainous sheets of rock
An accidental offspring of a boulder
But just a very small stone.

The pebble's place in our world
Is neither understood nor appreciated
But when thrown into a glassy calm pond
Its insignificance is transformed
Its meaning and purpose is unleashed.

The instant the pebble kisses the pond
Its signature of concentric ripples
Spiral outwards
Moving far beyond itself.
Gently affecting everything in its wake
Forever altering the smooth placid surface.
 
The pebble creates its worth and meaning
By unleashing its unimagined power 
Into a dueling force of action and reaction
Creating karmic energy
Producing lasting and fluid impressions.

Aren't we all pebbles?
Feeling small and insignificant
But ultimately recognizing
That who we are meant to be
Can never be measured in isolation
on a path into ourselves.

It is true then:
Our everlasting future
Is created by the indiscriminate tossing of pebbles
Into the pond of life
Creating ripples
that leave unique mark on our world
Not because of thoughts
not because of well meaning plans
But because of actions.

Our life's prayers our answered
Because even the smallest pebble
No matter how seemingly insignificant
Changes the course of the lives
Of those we touch. 

And when the icy winds of death
beckon our lasting attention
We will gently leave this life
With the knowledge that
because of that one pebble
The world will never be the same.

And then we have heaven …

Ross Rosenberg
8/18/03

"My Name is Roger (Ebert), and I'm an Alcoholic"

Seldom have I been so impressed with an article about someone's experience with alcoholism (addiction) as I was when I read Roger Ebert's article on his own struggles. Mr Ebert writes beautifully, masterfully, and with incredible insight about the disease of alcoholism. As an addiction specialist I have a vested interest in "getting the word out" about the insidious and destructive nature of addictions (chemical and process addictions). Mr. Ebert has always been a favorite movie reviewer of mine because I always sensed he understood the human condition, spoke fairly and sensitively about issues, and reserved judgment about movies from a place of sensitivity, openness, and kindness. When a man with Mr. Ebert's personal and professional qualifications speaks out, then I listen. Unfortunately, not enough people actually have access to this article. So here it is. I hope you appreciate it and are inspired by it as I much as me.

I welcome anyone's reactions or comments. Feel free to comment on my blog or email me at Rossr61@comcast.net.

My Name is Roger, and I am an Alcoholic (click on title for the article)

Transformations (Victories of the Heart)

Once in a while, during a moment of apparent moment of personal insight and enlightenment, I am compelled to write a poem. These poems seem to have a life of their own; they almost write themselves. Until the poem is finished, the emotion I am feeling or the insight I have reached, won't subside. And when the poem is is completed, I then reach deep feelings of satisfaction--a moment of catharsis.

Five years ago, during a life changing Victories of the Heart (http://victoriesoftheheart.net/) retreat, I had one of those peak moment, which compelled me to write the following poem. It speaks to the part in me who decided to start a journey of healing and growth. Even though personal transformation take their toll on us, we know in our hearts and our minds that we really have no choice. Here is my "jewel" of a poem:

Transformations

I am a coarse stone.
Yearning to be touched
Dreaming of being smooth
rounded and glassy.

I am a colorless piece of rubble.
Wanting to be held and caressed.
Desiring to become
a cherished part
of a beloved rock collection.

I am a sharp edged rock.
Isolated and alone.
Needing to no longer be a tool
Used to cut and divide
a person from his own heart.

Today is the day
I allow myself to toss,
turn and tumble.
To be kicked around.
Stomped into the earth.
And dug up again.

The endless cycle of seasons take its toll
Autumn’s blustery winds
Winter’s freezing blizzards
Spring’s drenching rains
And Summer’s blanching sun
transform my surface
Forever alter what I look like.


After what seems like a lifetime
I find myself resting in a dry river bed.
To eventually be carefully chosen
by a boastful youth,
Who sublimely skips me
across the river’s tranquil
but rippled surface.

Because of honest youthful enthusiasm
I am reconnected to my destiny.
Plunging back back down
into the river's cold and dark waters,
I am carried further down-river.
Carried quickly
with a sense of urgency
Toward a tumultuous
raging white water river.


Violently crashing
grinding
into unforgiving boulders.
I begin to lose necessary parts of myself.

Pushed lower and lower
Submerged deep
at the bottom of the river,
I remain dormant
for years that stretch
toward no apparent endpoint.

With a torrential downpour
And hurricane-like winds,
I am moved from my murky
muddy and silted home,
to be wildly churned in stormy waters

With a tremendous gust of wind
and a resulting wave,
I am cast shoreward
To be perfectly placed on a path
where a wandering dreamy child
is exploring the river bank
seeking his perfect jewel of a stone.

And during this magnificent
bright summer day,
the shining rays of the afternoon sun
strike me so perfectly
that my surface explodes with
eye-catching glimmering sparkles.

Capturing the attention
Of this adventurous
and seeking child.
Who stops, notices, stares,
and picks me up.

With the excitement of a discovery,
The boy carefully examines
my glassy translucent surface,
Marvels at my rainbow colors,
Caresses my smooth contours.
And with a burst of pride
places me in his shirt pocket
to be forever close to his heart.

Ross Rosenberg
4/23/06

ADHD: An Overview

ADHD is neither a “new” mental health problem nor is it a disorder created for the purpose of personal gain or financial profit by pharmaceutical companies, the mental health field, or by the media. It is a very real behavioral and medical disorder that affects millions of people nationwide. According to the National Institute of Mental Health (NIMH), ADHD is one of the most common mental disorders in children and adolescents. According to research sponsored by NIMH, estimated the number of children with ADHD to be between 3% - 5% of the population. NIMH also estimates that 4.1 percent of adults have ADHD.

Although it has taken quite some time for our society to accept ADHD as a bonafide mental health and/or medical disorder, in actuality it is a problem that has been noted in modern literature for at least 200 years. As early as 1798, ADHD was first described in the medical literature by Dr. Alexander Crichton, who referred to it as “Mental Restlessness.” A fairy tale of an apparent ADHD youth, “The Story of Fidgety Philip," was written in 1845 by Dr. Heinrich Hoffman. In 1922, ADHD was recognized as Post Encephalitic Behavior Disorder. In 1937 it was discovered that stimulants helped control hyperactivity in children. In 1957 methylphenidate (Ritalin), became commercially available to treat hyperactive children.

The formal and accepted mental health/behavioral diagnosis of ADHD is relatively recent. In the early 1960s, ADHD was referred to as “Minimal Brain Dysfunction.” In 1968, the disorder became known as “Hyperkinetic Reaction of Childhood.” At this point, emphasis was placed more on the hyperactivity than inattention symptoms. In 1980, the diagnosis was changed to “ADD--Attention Deficit Disorder, with or without Hyperactivity,” which placed equal emphasis on hyperactivity and inattention. By 1987, the disorder was renamed Attention Deficit Hyperactivity Disorder (ADHD) and was subdivided into four categories (see below). Since then, ADHD has been considered a medical disorder that results in behavioral problems.

Currently, ADHD is defined by the DSM IV-TR (the accepted diagnostic manual) as one disorder which is subdivided into four categories:

1. Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type--previously known as ADD--is marked by impaired attention and concentration.

2. Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive, Impulsive
Type--formerly known as ADHD--is marked by hyperactivity without inattentiveness.

3. Attention-Deficit/Hyperactivity Disorder, Combined Type--the most common type--
involves all the symptoms: inattention, hyperactivity, and impulsivity.

4. Attention-Deficit/Hyperactivity Disorder Not Otherwise Specified. This category
is for the ADHD disorders that include prominent symptoms of inattention or
hyperactivity-impulsivity, but do not meet the DSM IV-TR criteria for a
diagnosis.

To further understand ADHD and its four subcategories, it may be helpful to illustrate hyperactivity, impulsivity, and/or inattention through examples.

Typical hyperactive symptoms in youth include:
• Often "on the go" or acting as if "driven by a motor"
• Feeling restless
• Moving hands and feet nervously or squirming
• Getting up frequently to walk or run around
• Running or climbing excessively when it's inappropriate
• Having difficulty playing quietly or engaging in quiet leisure activities
• Talking excessively or too fast
• Often leaving seat when staying seated is expected
• Often can't be involved in social activities quietly

Typical symptoms of impulsivity in youth include:
• Acting rashly or suddenly without thinking first
• Blurting out answers before questions are fully asked
• Having a difficult time awaiting a turn
• Often interrupting others' conversations or activities
• Poor judgment or decisions in social situations, which result in the child not being accepted by his/her own peer group.

Typical symptoms of inattention in youth include:
• Not paying attention to details or makes careless mistakes
• Having trouble staying focused and being easily distracted
• Appearing not to listen when spoken to
• Often forgetful in daily activities
• Having trouble staying organized, planning ahead, and finishing projects
• Losing or misplacing homework, books, toys, or other items
• Not seeming to listen when directly spoken to
• Not following instructions and failing to finish activities, schoolwork,
chores or duties in the workplace
• Avoiding or disliking tasks that require ongoing mental effort or
concentration

Of the four ADHD subcategories, Hyperactive-Impulsive Type is the most distinguishable, recognizable, and the easiest to diagnose. The hyperactive and impulsive symptoms are behaviorally manifested in the various environments in which a child interacts: i.e., at home, with friends, at school, and/or during extracurricular or athletic activities. Because of the hyperactive and impulsive traits of this subcategory, these children naturally arouse the attention (often negative) of those around them. Compared to children without ADHD, they are more difficult to instruct, teach, coach, and with whom to communicate. Additionally, they are prone to be disruptive, seemingly oppositional, reckless, accident prone, and are socially underdeveloped.

Parents of ADHD youth often report frustration, anger, and emotional depletion because of their child’s inattention, impulsivity, and hyperactivity. By the time they receive professional services many parents of ADHD children describe complex feelings of anger, fear, desperation, and guilt. Their multiple “failures” at trying to get their children to focus, pay attention, and to follow through with directions, responsibilities, and assignments have resulted in feelings of hopelessness and desperation. These parents often report feeling guilty over their resentment, loss of patience, and reactive discipline style. Both psychotherapists and psychiatrists have worked with parents of ADHD youth who "joke" by saying "if someone doesn't help my child, give me some medication!"

The following statistics (Dr. Russel Barkley and Dr. Tim Willens) illustrate the far reaching implications of ADHD in youth.
• ADHD has a childhood rate of occurrence of 6-8%, with the illness continuing
into adolescence for 75% of the patients, and with 50% of cases persisting into
adulthood.
• Boys are diagnosed with ADHD 3 times more often than girls.
• Emotional development in children with ADHD is 30% slower than in their non-ADHD peers.
• 65% of children with ADHD exhibit problems in defiance or problems with authority figures. This can include verbal hostility and temper tantrums.
• Teenagers with ADHD have almost four times as many traffic citations as non ADD/ADHD drivers. They have four times as many car accidents and are seven times more likely to have a second accident.
• 21% of teens with ADHD skip school on a regular basis, and 35% drop out of school before finishing high school.
• 45% of children with ADHD have been suspended from school at least once.
• 30% of children with ADHD have repeated a year of school.
• Youth treated with medication have a six fold less chance of developing a substance abuse disorder through adolescence.
• The juvenile justice system is composed of 75% of kids with undiagnosed learning disabilities, including ADHD.

ADHD is a genetically transmitted disorder. Research funded by the National Institute of Medical Health (NIMH) and the U.S. Public Health Service (PHS) have shown clear evidence that ADHD runs in families. According to recent research, over 25% of first-degree relatives of the families of ADHD children also have ADHD. Other research indicates that 80% of adults with ADHD have at least one child with ADHD and 52% have two or more children with ADHD. The hereditary link of ADHD has important treatment implications because other children in a family may also have ADHD. Moreover, there is a distinct possibility that the parents also may have ADHD. Of course, matters get complicated when parents with undiagnosed ADHD have problems with their ADHD child. Therefore, it is crucial to evaluate a family occurrence of ADHD, when assessing an ADHD in youth.

Diagnosing Attention Deficit Disorder Inattentive Type in youth is no easy task. More harm than good is done when a person is incorrectly diagnosed. A wrong diagnosis may lead to unnecessary treatment, i.e., a prescription for ADHD medication and/or unnecessary psychological, behavioral and/or educational services. Unnecessary treatment like ADHD medication may be emotionally and physically harmful. Conversely, when an individual is correctly diagnosed and subsequently treated for ADHD, the potential for dramatic life changes are limitless.

Psychologists, Clinical Social Workers, Licensed Clinical Professional Counselors, Neurologists, Psychiatrists, and Pediatricians/Family Physicians can diagnose ADHD. Only physicians (M.D. or D.O.), nurse practitioners, and physician assistants (P.A.) under the supervision of a physician can prescribe medication. However, psychiatrists, because of their training and expertise in mental health disorders, are the best qualified to prescribe ADHD medication.

While the ADHD Hyperactive Type youth are easily noticed, those with ADHD Inattentive Type are prone to be misdiagnosed or, worse, do not even get noticed. Moreover, ADHD Inattentive Type youth are often mislabeled, misunderstood, and even blamed for a disorder over which they have no control. Because ADHD Inattentive Type manifests more internally and less behaviorally, these youth are not as frequently flagged by potential treatment providers. Therefore, these youth often do not receive potentially life-enhancing treatment, i.e., psychotherapy, school counseling/coaching, educational services, and/or medical/psychiatric services. Unfortunately, many “fall between the cracks” of the social service, mental health, juvenile justice, and educational systems.

Youth with unrecognized and untreated ADHD may develop into adults with poor self concepts low self esteem, associated emotional, educational, and employment problems. According to reliable statistics, adults with unrecognized and/or untreated ADHD are more prone to develop alcohol and drug problems. It is common for adolescents and adults with ADHD to attempt to soothe or “self medicate” themselves by using addictive substances such as alcohol, marijuana, narcotics, tranquilizers, nicotine, cocaine and illegally prescribed or street amphetamines (stimulants).

There is no "cure" for ADHD. Children with the disorder seldom outgrow it.
Approximately 60% of people who had ADHD symptoms as a child continue to have symptoms as adults. And only 1 in 4 of adults with ADHD was diagnosed in childhood—and even fewer are treated. Thanks to increased public awareness and the pharmaceutical corporations’ marketing of their medications, more adults are now seeking help for ADHD. However, many of these adults who were not treated as children, carry emotional, educational, personal, and occupational “scars.” As children, these individuals, did not feel “as smart, successful and/or likable” as their non ADHD counterparts. With no one to explain why they struggled at home, with friends, and in school, they naturally turned inward to explain their deficiencies. Eventually they internalize the negative messages about themselves, thereby creating fewer opportunities for success as adults.

Similarly to youths, adults with ADHD have serious problems with concentration or paying attention, or are overactive (hyperactive) in one or more areas of living. Some of the most common problems include:
• Problems with jobs or careers; losing or quitting jobs frequently
• Problems doing as well as you should at work or in school
• Problems with day-to-day tasks such as doing household chores, paying bills, and organizing things
• Problems with relationships because you forget important things, can't finish tasks, or get upset over little things
• Ongoing stress and worry because you don't meet goals and responsibilities
• Ongoing, strong feelings of frustration, guilt, or blame

According to Adult ADHD research:
• ADHD may affect 30% of people who had ADHD in childhood.
• ADHD does not develop in adulthood. Only those who have had the disorder since early childhood really suffer from ADHD.
• A key criterion of ADHD in adults is "disinhibition"--the inability to stop acting on impulse. Hyperactivity is much less likely to be a symptom of the disorder in adulthood.
• Adults with ADHD tend to forget appointments and are frequently socially
inappropriate--making rude or insulting remarks--and are disorganized.
• They find prioritizing difficult.
• Adults with ADHD find it difficult to form lasting relationships.
• Adults with ADHD have problems with short-term memory.
• Almost all people with ADHD suffer other psychological problems-particularly depression and substance abuse.

While there is not a consensus as to the cause of ADHD, there is a general agreement within the medical and mental health communities that it is biological in nature. Some common explanations for ADHD include: chemical imbalance in the brain, nutritional deficiencies, early head trauma/brain injury, or impediments to normal brain development (i.e. the use of cigarettes and alcohol during pregnancy). ADHD may also be caused by brain dysfunction or neurological impairment. Dysfunction in the areas in the frontal lobes, basal ganglia, and cerebellum may negatively impact regulation of behavior, inhibition, short-term memory, planning, self-monitoring, verbal regulation, motor control, and emotional regulation.

Because successful treatment of this disorder can have profound positive emotional, social, and family outcomes, an accurate diagnosis is tremendously important. Requirements to diagnose ADHD include: professional education (graduate and post graduate), ongoing training, supervision, experience, and licensure. Even with the essential professional qualifications, collaboration and input from current or former psychotherapists, parents, teachers, school staff, medical practitioners and/or psychiatrists creates more reliable and accurate diagnoses. The value of collaboration cannot be understated.

Sound ethical practice compels clinicians to provide the least restrictive and least risky form of therapy/treatment to youth with ADHD. Medication or intensive psycho-therapeutic services should only be provided when the client would not favorably respond to less invasive treatment approaches. Therefore, it is crucial to determine whether “functional impairment” is or is not present. Clients who are functionally impaired will fail to be successful in their environment without specialized assistance, services, and/or psycho-therapeutic or medical treatment. Once functional impairment is established, then it is the job of the treatment team to collaborate on the most effective method of treatment.

All too often, a person is mistakenly diagnosed with ADHD, not due to attention deficit issues, but rather because of their unique personality, learning style, emotional make-up, energy and activity levels, and other psycho-social factors that better explain their problematic behaviors. A misdiagnosis could also be related to other mental or emotional conditions (discussed next), a life circumstance including a parent’s unemployment, divorce, family dysfunction, or medical conditions. In a small but significant number of cases, this diagnosis of ADHD better represents an adult’s need to manage a challenging, willful and oppositional child, who even with these problems may not have ADHD.

It is critical that before an ADHD diagnosis is reached (especially before medication is prescribed), that a clinician consider if other coexisting mental or medical disorders may be responsible for the hyperactive, impulsive, and/or inattentive symptoms. Because other disorders share similar symptoms with ADHD, it is necessary to consider the probability of one mental/psychological disorder over that of another that could possibly account for a client’s symptoms. For example, Generalized Anxiety Disorder and Major Depression share the symptoms of disorganization, lack of concentration, and work completion issues. A trained and qualified ADHD specialist will consider differential diagnoses in order to arrive at the most logical and clinically sound diagnosis. Typical disorders to be ruled out include: Generalized Anxiety, Major Depression, Post Traumatic Stress Disorder, and Substance Abuse Disorders. Additionally, medical explanations should be similarly sought: sleep disorders, nutritional deficiencies, hearing impairment, and others.

When a non-medical practitioner formally diagnoses a client with ADHD, i.e. a licensed psychotherapist, it is recommended that a second opinion (or confirmation of the diagnosis) be sought from a psychiatrist. Psychiatrists are medical practitioners who specialize in the medical side of mental disorders. Psychiatrists are able to prescribe medicine that may be necessary to treat ADHD. In collaboration, the parents, school personnel, the referring psychotherapist, and the psychiatrist, will monitor the effectiveness of the medical component of the ADHD treatment.

In summary, ADHD is a mental health and medical disorder that has become increasingly more accepted and consequently treated more effectively. To achieve high professional assessment, diagnostic, educational, and treatment standards, it is important that trained and qualified practitioners understands the multidimensional aspects of ADHD: history, diagnosis, statistics, etiology, and treatment. Training, experience, a keen interest for details, a solid foundation of information, and a system of collaboration creates the potential for positive outcomes in the treatment of ADHD.


References
1. Genetic factors, not necessarily sex of child, influence ADHD by Jim Dryden
http://record.wustl.edu/archive/1999/04-15-99/articles/ADHD.html
2. What are the risk factors and causes of Attention Deficit Hyperactivity
Disorder
http://www.adhdissues.com/ms/guides/adhd_risk_factors/main.html
3. What Causes ADHD?
http://add.about.com/od/adhdthebasics/a/causes.htm
4. History of ADHD by Keith Londrie
http://EzineArticles.com/?expert=Keith_Londrie
5. Taking Charge of ADHD, Dr. Russell Barkley
http://www.healthcentral.com/adhd/c/1443/13716/addadhd-statistics/
6. ADHD Facts by Dr. B, Murray, Ph.D.
http://www.upliftprogram.com/bob_murray.html
7. Cause ADHD
http://www.myadhd.com/causesofadhd.html
8. ADHD.org.nz (New Zealand ADHD Support GroupP
http://www.adhd.org.nz/cause1.html
9. Understanding the Causes of ADHD Keath Low, About.com
http://add.about.com/od/adhdthebasics/a/causes.htm
10. Interventions for ADHD: Treatment in Developmental Context By Phyllis Anne Teeter 1988
11. Diagnosis of AD/HD in Adults
National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder
http://www.help4adhd.org/en/treatment/guides/WWK9S
12. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.
13. The Numbers Count: Mental Disorders in America
The National Institute of Mental Health Website
http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml#KesslerPrevalence
14. Historical Development of ADHD Margaret Austin, Ph.D., Natalie Staats Reiss, Ph.D., and Laura Burgdorf, Ph.D.
http://resources.atcmhmr.com/poc/view_doc.php?type=doc&id=13848
15. ADHD, Alcoholism and Other Addictions by Wendy Richardson, M.A., LMFCC
Soquel, CA—1998
http://www.addresources.org/article_adhd_addictions_richardson.php
15. National Institutes of Neurological Disorders and Stroke
NINDS Attention Deficit-Hyperactivity Disorder Information Page
http://www.ninds.nih.gov/disorders/adhd/adhd.htm

Sexual Addiction Behavior Types

I thought I would give a preview to an upcoming training. Otherwise, it is important information when working with sexually addictive clientele. As you will see, sex addiction comes in many forms and types. Anything from the lone web surfer who spends 5 hours a night looking at pornography, to the patron of a prostitute, to the exhibitionist (man in the raincoat), the voyeur, and others.

Sexual Addiction Behavioral Types

1. Fantasy Sex – Sexually charged fantasies, relationships, and situations
• “Sex in the head” - arousal depends on sexual possibility
• The fantasy is preferred over sex
• Fantasies can be all-consuming
• Rarely is sex the goal (unless it’s necessary to control an outcome)

2. Seductive Role Sex – Seduction of partners
• Being sexual without being truthful about intentions
• Arousal is based on conquest
• Arousal diminishes after initial contact
• Seduction equals power and control
• Can results in multiple relationships, affairs and/or serial relationships

3. Anonymous Sex -- High-risk sex with unknown persons
• Arousal involves no seduction or costs and is immediate
• Cruising, one-night stands, public baths, peep shows, Craigslist ads, etc.
• No emotional connection

4. Paying for Sex – Purchasing of sexual services
• Arousal is connected to payment of sex
• With time, the arousal is connected to money itself
• Prostitution, phone sex, sexual massages

5. Trading for Sex – Selling or bartering sex for power
• Arousal is based on gaining control of others by using sex as leverage
• Receiving money or drugs for sex
* Making explicit movies/videos, stripping, pimping, and/or drugs for sex

6. Voyeuristic Sex - Visual Arousal
• The use of visual stimulation to escape into an obsessive trance
• Secretive looking or “peeping” to obtain sexual gratification
• Use of pornographic photos, magazines, computer and/or videos to obtain a fix

7. Exhibitionistic Sex – Attracting attention to the body or sexual parts of the body
• Sexual arousal stems from the viewer’s reaction, whether it is shock or interest
• Exposing oneself to obtain sexual gratification and/or power
• Exposing oneself in public places, at home, in a car
• Wearing clothes designed to expose and titillate

8. Intrusive Sex – Boundary violations without discovery
• “Stealing sex” without the possibility of getting caught
• Sexually touching people in crowds
• Surprising unsuspecting individuals with sexual comments, jokes, and/or observations

9. Pain Exchange – Being humiliated or hurt as a part of the sexual arousal
• Aroused by sadistic activities, hurting or degrading another sexually
• Or both
* Bondage sex or “S & M” (Sadomasochism)

10. Object Sex – Masturbating with objects
• Cross-dressing
• Uncontrolled use of masturbatory objects: blow-up dolls, latex vaginas, dildos
• Fetishisms

11. Exploitive Sex -- Exploitation of the vulnerable
• Arousal patterns are based on target “types” of vulnerability
• Force, intimidation, or manipulation may be used
• 30% of male and 14% of female sex addicts have had sex with minors
• Pedophiles are not necessarily sex addicts
• Sex addicts can be pedophiles

Definitions of Sexual Addiction

The best place to start in understanding sexual addiction is to begin with a definition. Here are three of my favorites:

An unhealthy relationship to any sexual experience (thoughts, fantasies, experiences, etc.) that an individual continues to engage in despite adverse consequences.

Sexual Addiction is a state of compulsion, obsession, or preoccupation that enslaves a person's will and desire. It is an attachment to lust, which is the process that enslaves desire and creates the state of addiction. This leads to disordered thinking and fantasies and the acting out of unwanted or improper sexual behavior no matter how intensely and sincerely one wants to stop.

The “athlete’s foot of the mind. It never goes away; it is always asking to be scratched, promising relief. To scratch, however, is to cause pain and intensify the itch.”

Three Upcoming Professional Sexual Addiction Trainings

I will be providing three professional trainings on Sexual Addiction this year: August 7, September 18, and on September 25. Although the trainings are oriented for mental health practitioners seeking continuing education credits (CEU's), they also will be informative for the general public. Topics to be included: signs and symptoms, behavior types, levels of addictions, demographics, gender differences, cross addictions, co-sex addiction, assessment, and treatment of individuals with compulsive sexual behaviors and/or sexual addictions.

On August 7 Friday, AATP, will hosting my training on "Compulsive Sexual Behavior and Sexual Addiction" at the Auditorium in Christ Hospital, 4440 W. 95th Street, Oak Lawn. This will be a 6 CEU (6 hour) training, which will cost $95. To register, contact AATP. AATP is a not-for-profit training academy established to provide professional continuing education for mental health practitioners.

On September 18, AATP will again be "Addicted to Sex: Compulsive Sexual Behaviors and Sex Addiction Assessment and Treatment" on Friday, September 18 at Prairie Heart Institute, 619 E. Mason St., Springfield, IL. This also will be a 6 CEU (6 hour) training, which will cost $95. To register, contact AATP.

On September 25 Arbor Counseling Center will host a similar training, but only for three hours (3 CEU's). The training will at Indian Trails Public Library, 355 Schoenbeck Rd., Wheeling IL. The training starts at 9:30 and ends at 12:30 pm. Registration begins at 9:00 am. A registraton form is posted on Arbor's website. http://www.arborcounselingcenter.com," The cost of the training will be $45.

The Teen Commandments (For Parents)

THE TEEN COMMANDMENTS(FOR PARENTS)

1. THOU SHALT GET THY ACT TOGETHER AND BE CONSISTENT.
Consistency is the heart and soul of effective parenting. Your inconsistency teaches your teen to misbehave. Teens need to know what to expect. No meaningless threats, no false promises, no random discipline. Mean what you say, say only what you mean and follow through!

2. THOU SHALT BE INDIVISIBLE.*
(* not to be confused with invisibility or birth control.)
Solidarity between parents (even if divorced) is a must. Teens are experts at singling out the weaker parent or playing one against the other. Its “united we stand, or divided we fall.” Don’t be uncool and fight about the teen or his issues in front of him – he’ll feel responsible or see one of you as the hero and one as the villain. Do you negotiating behind closed doors.

3. THOU SHALT LET CONSEQUENCES BE THE HEAVY.
Consequences, not bossy parents, are what make a teen responsible. They are extremely powerful tools to change or modify behavior. Responsibility can’t be taught; it must be given. Consequences can be a payoff for rebellion or an almighty deterrent.

4. THOU SHALT LOVE AND RESPECT THY TEENAGER AS THYSELF.
Your teen is a separate person of equal human worth, not chattel. Treat him the way you’d want to be treated or at least as good as your friends. They who are not busy fighting are busy not fighting (enjoying each other).

5. THOU SHALT ACCEPT THY PARENTAL LIMITATIONS.
Change what you can or should change, and accept what you can’t change (or control). And pray you’ll be wise enough to distinguish which is which for your teen’s sake and your own. (Think of the money you’ll save on aspirin and antacids.)

6. THOU SHALT NOT COVET THY TEENAGER’S RESPONSIBILITIES AND PROBLEMS.
Its enough of a hassle to run one life (your own) much less try and run your teen’s life, too. Your duty to yourself and your teen is to allow him to become increasingly responsible for the consequences and headaches of running his own life.

7. THOU SHALT NOT PRETEND TO BE INFALLIBLE.

Who are you kidding? You’re human. You know it, and your teen knows it. Make your mistakes but be a role model. Own up to mistakes and apologize. Your teen will admire you and overlook your flaws (hopefully)!

8. THOU SHALT NOT BEAR FALSE GUILT.
Don’t buy any tickets for any guilt trips, and don’t let anyone sell you any, either. Don’t blame yourself for things you can’t control or aren’t responsible for. (That’s your teen’s job.)

9. THOU SHALT TAKE TIME OFF TO SMELL THE ROSES.
Ease up. You’re taking this job of parenting far too seriously! Feel free to be yourself. Punch out on the parenting time clock once in awhile. Let your teen see the real you.

10. THOU SHALT NOT BE A SOURPUSS.
You can catch more teenage flies with honey and humor than vinegar and sour grapes. Look for every appropriate opportunity to avert or diffuse a situation through love and authentic humor (but not hidden anger via sarcasm). Let love and humor be your first resort. The family that hugs and laughs, lasts!

Beverly Gual, Teenage Years, A Parents Survival Guide, 1989

Guilt

Guilt

Guilt signifies when we did something wrong and helps us to be accountable for it. Thus, the bad feeling we identify as guilt, is a gift- one that teaches us what to not to do wrong doing again. To feel guilty because of what others believe as "wrong or bad" is waste of energy and time. Insist on feeling guilty when a real mistake has been made. Cast aside "guilt trips" as they are judgments of right and wrong and someone else's mandate to feel bad. However, own your mistakes and make your guilt a sweet reminder of your human vulnerability. Let your self feel bad only long enough to grow and learn from your mistake.

Sayings

These are a few saying I wrote over the years:

Don't work so hard to get people to like you. Instead, work hard to become your true and authentic self. People will like you for who you really are, not the person you are trying so hard to be. Stuart Smalley (aka Al Franken) had it right: "You really are good enough, smart enough, and doggone it, people will like you!"

In marital or relationship therapy, often the two main goals are to first "fall back into trust" and then "fall back into love." To be in love again requires the foundation of trust to be rebuilt.

Life is like an unfinished puzzle: we are unable to see the complete picture until the seemingly random mismatched pieces come together, creating something whole out what was once chaos and disarray.

Depression can be a natural result of being honest with a feeling.

After healing occurs (hard work in therapy for instance), it is difficult to go back to where you started. It would be like turning a diamond back into a piece of coal. I can't happen.

Therapy is like a train ride: to get to where you need to be, you have to stay on track. With each "stop," you are brought increasingly closer to your desired destination. If a train could jump forward from point A to point G, then it would be a plane. Don't be in a hurry, take a train.

You cannot get back what you lost. But you can create what didn't have.

When you are happy while life is tough, then you are living a worthwhile life.

Communicating Well with Your Teen Presentation (download)

I have uploaded the audience handout for my training at Stevenson High School on April 3o, "Communicating Well with Your Teen." Also up loaded in the complete version of the training, which will be used at a future time, when there is more time.

This link will take you to the document:

Training Document

Stevenson High School Presentation: Communicating with Your Teenager

On Thursday April 30, Hal Fillian and myself (both from Arbor Counseling Center) will be presenting "Communicating with Your Teenager" to an audience of 75 parents at Stevenson High School. The presentation will start at 8:30am and last for an hour and half. To register, call Lisa Franz of Stevenson High School: (847) 415-4000

Don't Dance (Codependency)

The "dance" of codependency requires two people: the pleaser/fixer and the taker/controller. This inherently dysfunctional dance can only happen with one partner who is a codependent and another partner who is a narcissist (abuser or addict). Codependents do not know how to emotionally disconnect or avoid significant relationships with individuals who are selfish, controlling, and harmful to them. They find partners who are experienced with their dance style: a dance that begins as thrilling and exciting, but ends up rife with drama, conflict, and feelings of being trapped.

When a codependent and narcissist come together in a relationship, their "dance," unfolds flawlessly: the narcissistic partner maintains the lead and the codependent follows. Because the codependent gives up their power, the dance is perfectly coordinated: no one gets their toes stepped on.

Typically, codependents give of themselves much more than their partners give to them. As a "generous" but bitter partner, they seem to be stuck on the dance floor, always waiting for "next song," at which time their partner will finally understand their needs. The codependent confuses care-taking and sacrifice with love and responsibility. Although they are proud of their self-described strength, unselfishness, and endless compassion, they end up feeling deflated, empty, and yearning to be loved, but angry that they are not. They are essentially stuck in a pattern of giving and sacrificing, without the potential of receiving the same from their partner. When they dance, they often pretend to enjoy the dance, but usually hide their feelings of bitterness, sadness, and loneliness.

The codependent's fears and insecurities create a sense of pessimism and doubt over ever finding a healthy partner, someone who could love them for who they are versus what they can do. Naturally, the narcissist is attracted to the codependent's lack of self-worth and low self-esteem. They intuitively know that they will be able to control this person and be able to choose and control the dancing experience.

All codependents want balance in their relationships, but seem to consistently choose a partner who leads them to chaos and resentment. When given a chance to stop dancing with their narcissistic partner, or comfortably sit out the dance until someone healthy comes around, they choose to continue to dance. The codependent dares not to leave their narcissistic dance partner because their lack of self-esteem and low sense of self-worth manifests into the fear of being alone. Being alone is equivalent to feeling lonely, and loneliness is an intolerable feeling for a codependent.

Without self-esteem or feelings of personal power, the codependent does not know how to choose healthy (mutually giving) partners. Their inability to find a healthy partner is usually related to an unconscious motivation to find a person who is familiar…someone who reminds them of their powerless childhood. Many codependents come from families in which they were children of parents who were also experts at the dance. Their fear of being alone, compulsion to control and fix at any cost, and comfort in their role as the martyr who is endlessly loving, devoted, and patient, is a result of roles they observed early on in their childhood.

No matter how often the codependent tries to avoid "unhealthy" partners, they find themselves consistently on the dance floor dancing to different songs, but with the same dance partner. Through psychotherapy and, perhaps, a 12-step recovery program, the codependent begins to recognize that their dream to dance the grand dance of love, reciprocity, and mutuality, is indeed possible. Through therapy and/or change of lifestyle, they build self-esteem, personal power, and hope to finally dance with partners who are willing and capable to share the lead, communicate their movements, and pursue a shared rhythm.

Ten Rule for Being Human

Ten Rules for Being Human

by Cherie Carter-Scott

1. You will receive a body. You may like it or hate it, but it's yours to keep for the entire period.

2. You will learn lessons. You are enrolled in a full-time informal school called, "life."

3. There are no mistakes, only lessons. Growth is a process of trial, error, and experimentation. The "failed" experiments are as much a part of the process as the experiments that ultimately "work."

4. Lessons are repeated until they are learned. A lesson will be presented to you in various forms until you have learned it. When you have learned it, you can go on to the next lesson.

5. Learning lessons does not end. There's no part of life that doesn't contain its lessons. If you're alive, that means there are still lessons to be learned.

6. "There" is no better a place than "here." When your "there" has become a "here", you will simply obtain another "there" that will again look better than "here."

7. Other people are merely mirrors of you. You cannot love or hate something about another person unless it reflects to you something you love or hate about yourself.

8.What you make of your life is up to you. You have all the tools and resources you need. What you do with them is up to you. The choice is yours.

9. Your answers lie within you. The answers to life's questions lie within you. All you need to do is look, listen, and trust.

10. You will forget all this.

Is Sex Addiction Real?

Unlike for alcohol or drug addiction, there is no formal diagnosis for Sex Addiction in the American Psychiatric Association’s Diagnostic Statistic Manual (DSM IV). According to Chester Schmidt, chair of the DSM-IV Sexual Disorder Work Group, there is “no scientific data to support a concept of sexual behavior that can be considered addictive. (1)” Schmidt believed that what is called sex addiction is more likely a symptom of other psychological problems like depression, obsessive-compulsive disorder, or bipolar disorder.

According to Benoit Denizet-Lewis (2), "Believers in a sex-addiction diagnosis point out that for many years, doctors and psychiatrists similarly dismissed alcoholism, refusing to accept that it was a serious problem in itself, not merely a symptom of something else." Many of practitioners in the sexual addiction field are hopeful that the DSM V, which is due out in 2012, will include expanded diagnostic choices for process addictions, including sex, gambling, spending, eating, and/or religion addictions. According to Elizabeth Hartney, "a working group of professionals has recently suggested diagnostic criteria which may be considered for the next edition of the manual, due to be published in 2012."

According to John M. Grohol, Psy.D. (3) "What is both amazing and a little disturbing, however, is to see entire professional societies, such as the Society for the Advancement of Sexual Health, spring up around a disorder that isn’t even officially recognized as such. And despite no clinical agreed-upon criteria for sex addiction, the Society estimates that 3 to 5% of Americans have it." According to the Mayo clinic, sex addiction is estimated to affect 3 to 6 percent of adults in the United States.

Because sex is a part of normal human functioning, it is difficult and at times a scientific challenge to compare sexual addictions to chemical addictions. Both "normal" or pathological (addictive) sexual patters are open to diverse and often controversial definitions. Clearly, factors such as personality, psychopathology, gender differences, sexual preferences, cultural differences, socio-economic status, and other "filters" have made a clear consensus for a definition of sexual addiction that much more challenging. Making matters even more complicated is the fact that topic of sexual deviance and/or sexual pathology remains as one of the most taboo topic in our society. Individuals with a sexual addiction are often the subject of ridicule and harsh judgment, whereas others suffering from drug/alcohol or other more accepted process addictions, ie gambling, spending, elicit more social acceptance.

Another ironic twist is that the co-founder Alcoholics Anonymous, Bill Wilson, was considered a sex addict. According to biographers and Alcohol Anonymous historians, Bill Wilson not only was an alcoholic, but was also a sex addict. Wilson was flirtatious, had multiple affairs, and according to biographer, Susan Cheever (4), "had an inability to regulate his behavior with women” and was “often accused of groping and unwelcome fondling,” However, he was married to the same woman for 53 years.

Until sex addiction is formally included in the DSM V, we currently derive a "diagnosis" through assessments protocols specifically designed for this addiction. Such protocols are provided by specially trained qualified mental health practitioners. Clinicians, such as myself, utilize uniquely designed instruments that are designed to collect relevant information necessary for a diagnostic conclusion. Information collected during the assessment includes: sexual history, drug/alcohol history, psychosocial assessment, mental health history, and other relevant information. Additionally, an assessment involves interviews with the client, affected partners, i.e. spouse or partner, and if possible, mental health providers who have or who are providing services to person being evaluated.

According to data collected by Patrick Carnes, many sex addicts also have other addictions. For example, in Carnes' research, of the individuals who were diagnosed with a sex addiction, 42% were chemically dependent, 38% had an eating disorder, 28% were compulsive workers (workaholics), 26% were compulsive spenders, and 5% were compulsive gamblers. Ruling out cross addictions is an important component of the assessment. Because of the high prevalence of cross addictions, the sex addiction evaluator must have a background in the general field of addictions.

When a cross addiction is present, it is important to identify which addiction requires attention first. This is crucial when it is determined that the sex addict is also addicted to a drug/alcohol. In these cases, detoxification (detoxing) of the drug may require medical services in order to ensure that the client physical health is not compromised. The experience of physical withdrawals can potentially create medical risks.

As many practitioners and sex addicts know, that despite a formal recognition of this disorder, it is indeed very real. Lets the intellectuals battle out what is and what is not a diagnosis. In the meantime, lets provide the much needed services to those who are suffering from this disorder.


(1) (http://psychcentral.com/blog/archives/2008/09/30/is-sexual-addiction-real/)
(2) www.americaanonymous.com
(3) psychcentral.com/blog/archives/2008/09/30/is-sexual-addiction-real
(4) http://nymag.com/nymetro/arts/books/reviews/n_9880/
(5) http://edition.cnn.com/2008/HEALTH/09/05/sex.addiction/index.html
(6) http://addictions.about.com/od/sexaddiction/a/sexaddiction.htm

Life Is A Series of Choices

Fortune cookies are true…so I now believe. Two days before our Friday December 2008 wedding, my wife to be ate at a Chinese restaurant, where, at the end of a good dinner, her fortune cookie read: "A lifetime of happiness lies ahead of you." The next day, on Thursday, she went out for Chinese again and the (next) fortune cookie read: “The coming Friday will be an exciting time for you." Was this a coincidence or was a specific message brought by the Universe to my lovely bride-to-be?

The fortune cookie story doesn’t end here. Last night I shared my career ambitions, goals, and dreams for my life with my wife. I explained why I believe I have been blessed with a wife and son who I adore, a wonderful family, great friends, and a successful career. I explained to Korrel that I have achieved such riches because of my growing capacity to love, commitment to personal growth, dedication to my career, belief in my dreams, and most importantly, my ability to make the right choices at the right time. An hour after that discussion, at a Chinese restaurant, my fortune cookie read, “Life is a series of choices, today yours are good ones." I knew then, I had to write something.


Life is a Series of Choices

Life comes from the right choices at the right time, as well as the willingness to pursue the goals inherent in these choices. Robert Frost nailed the “choices” challenge in his poem The Road Less Traveled. In this poem, he saw the value of ending up at a “crossroads” in life.

“Two roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could”

At this crossroad, we face two distinctly different paths, which have two equally distinct different outcomes. Perhaps, at this crossroad, we are brought to the biggest choice of our life: in which direction do we proceed? Do we take the path that is more familiar to us, the one that we can navigate in the dark—with our eyes closed; or do we take the path that is unknown, frightening, and strewn with obstacles and unpredictable outcomes.

The familiar path offers predictability and safety, but only a limited version of "success." However, the “road less traveled” is risky in nature, but has the possibility of ultimately changing your life. When you travel down the road less traveled, there is no turning back; life is forever changed and you can never return to the old life of safety and predictability. This risky path is where choices manifest into dreams, and dreams manifest into reality.

“Two roads diverged in a wood,
and I took the one less traveled by.
And that has made all the difference."

Paul Coelho, the author of “The Alchemist,” believes that we all have the ability to achieve our “personal legend,” which is the best possible version of ourselves: the person of our dreams. Mr. Coelho believes by pursuing your personal legend you have then chosen “the path God has chosen for you here on Earth.” It is a path toward the life you believe in, goals that you have chosen, and dreams that you know belong to you. Through difficult choices, a commitment to moral and ethical principals, the courage to see mistakes or bad outcomes as gifts, and the humility to not lose yourself in moments of success, one can achieve their “personal legend.”

Similar to taking the “road less traveled,” achieving one’s personal legend may come at a cost. Life consists of a series of “mini crossroads,” where good choices, despite one’s best intentions, can result in failure and disappointment. For those of us who are pursuing our personal legend, we know that life’s loftiest and most heartfelt goals can sometimes end in failure and disappointment; but still we persevere. By dedicating ourselves to the pursuit of our very best version of ourselves, we are able to transform our moments of disappointment, disillusionment, or embarrassment, into achieved goals and dreams.

The words of Robert Frost and Paul Coelho have inspired me to understand that because life is truly a series of choices, we can achieve our dreams. We all come into this imperfect world, in imperfect families, and as imperfect versions of ourselves. All of us have our stories of dysfunctional families, economic hardships, medical limitations, self esteem challenges, etc. God intended us to all be able, through conscious choices, to grow and develop into something special. Without committing to a path less traveled or path toward our personal legend, we live our life, at best, in mediocrity: never quite knowing how far we could have progressed, who we could have become, and what effect on the world we could have made.

It is through a series of choices and the perseverance to pursue the goals inherent in these choices that we achieve our God given potential. Choices bring us to dreams.

Domestic Violence Is Not Just About Physcial Abuse

Over the course of my career, I have helped many clients pursue a sense of personal power and emotional health sufficient enough to be safe, strong, and healthy while working through relationships with aggressive and/or abusive partners.

Generally speaking, these aggressive/abusive partners flourish in relationships in which they are given the power to control a person. To maintain power and control in their relationships, they need to be in relationships with individuals who typically have poor boundaries, low self esteem and who have little to no self confidence (a sense of no personal power). Similarly, codependent or co-addictive individuals fall within the abusive partner's "radar," especially when they are an addict.

To retain power and control in the relationship, the abusive partner has to control the relationship in order to create an environment of fear, insecurity, and perceived powerlessness. Consequently, a complicated dynamic of domination and submission is created; one in which power and control is perpetuated by physical, emotional, and/or verbal abuse, or the fear of the recurrence of such abuse.

Being afraid, not feeling like you have the power to stop the abuse, and secretly believing they couldn't find anyone better (being brainwashed), the victim partner believes they are powerless and therefore, trapped in a perpetual cycle of emotional, verbal, and/or physical violence. The cycle is maintained by frequent episodes of abuse which ultimately "brainwash" the victim partner in believing that they do not have any recourse (or resources) to stop the abuse. The cumulative effects of the cycle of abuse create further feelings of powerlessness, which further immobilizes the victim partner.

Contrary to what most people think, the most common mode of maintaining power and control is not through the use of physical violence. Most abuse is either done emotionally or verbally. Most victims of both physical and emotional/verbal abuse attest that the verbal/emotional wounds are deeper, hurt more, and take longer to heal.

The following list illustrates the tactics that the abusive partner uses to exert power of their victim partner that does not include physical violence.

1. Intimidation
2. Emotional abuse
3. Blaming, denying, and minimization
4. Financial control
5. Isolation
6. Turning their children and/or friends against them
7. Coercion and threats

The victim partner keeps "tied" into the abusive relationship due to their lack of experience and knowledge with relationships based upon mutuality, respect, and fairness. Often, the victim comes from a family in which they either experienced harm or neglect as children or witnessed harm or neglect to one of their parents. Often one or both of their parents were either an abuser or a victim of domestic violence. Therefore, the victim partner gravitates toward what is familiar, or unconsciously reminiscent of what they experienced as children. Although strange and paradoxical: what feels familiar is also seemingly safe.

Individuals, who are assertive or aggressive, bold, and/or edgy, seem to be the partners that the victim partner finds as "attractive." Although this prospective "attractive" partner seems safe, there are lurking red flags that are, at this point invisible. Likewise, the aggressive person is unconsciously attracted to a kind, forgiving, accommodating, and understanding individual, who they unconsciously recognize as someone they can control and who won't leave them when there abusive side emerges.

The relationships between these two types of people often start off with a bang: high levels of attraction/infatuation, poor boundaries, and intense and frequent sexual activity. Unfortunately, after the "chemistry" wears off, the unconscious elements come to the surface. The abuser establishes domination and the victim feels trapped and consequently falls prey to a role of passivity, fear, and powerlessness.

The saddest part of this relationship dynamic is that the victim partner unwillingly and unknowingly repeats the same patterns of their parents and their parents-parents-- all of whom incorrectly believed love and commitment supersedes respect, fairness, mutuality, and most of all, safety. "Love" is maintained at any cost.

There is help out there for the victims of domestic violence. Therapists like me offer a way out.

For further information: www.helpguide.org/mental/domestic_violence

Rebuilding Trust

For the math aficionados, I provide you with a mathematical formula for building trust. A client game me this one:

Trust =

Consistent behavior
___________________

Time

Healthy Anger

Why is happiness any better than anger, especially when it represents how someone feels in a given moment? We are all created to experience the whole spectrum of emotions/feelings. One feeling is not necessarily better than another. Each emotion represents our internal reaction to a given situation. It was we do with our feelings that matters.

When someone you love expresses their anger well, they are giving you a gift. They are allowing you to see who they are in that given moment with the possibility of connection, understanding, and if possible resolution. Conflict and the healthy resolution of it, creates the foundation of a loving and lasting relationship

Embrace your anger as a positive aspect of yourself. Let it be a feeling that brings you closer to authentic relationships. Shape your anger into the an energetic force that resolves conflict nurtures healthy relationships, and creates higher levels of emotional and spiritual health.

Be angry as long as it is good for you; let it serve a purpose...let it empower you.

Who is Really Smart?

The "smartest person" isn't really the person that knows the most about any given subject. Actually, the person who seeks out "smart" people to find out what he/she doesn't know, ends up "smarter" than most.

The Choice: Ending or Mending?

Yesterday during a session with one of my clients who is a sex addict, I explained the difference between recovery and abstinence. While explaining this difference, I came up with a simple play on words to drive the concept home: "recovery is to mending as abstinence as to ending."

My intention was to illustrate that just by stopping a drug or choice, the addict is still at risk for relapse. In the recovery field, we consider those who just stop as "dry drunks." These individuals are prone to all the same psychological, emotional, and behavioral maladaptive patterns that preceded the development of their addiction. In fact, many clients use the drug that they eventually become addicted to to "medicate" a history of trauma, loss, grief, low self esteem, etc. Therefore, stopping, or ending, is just not safe. However, starting a recovery program, while remaining sober, creates opportunities to mend those "hurts" that made the addict seek the drug in the first place.

The question then is: to end or mend? I am in the mending business.

Golden Truths 73 Years Later

73 years later and we are still using Dale Carnegie's wisdom. His book, "How to Win Friends and Influence People, has changed many a life. Personally, I learned much from this book during a time when my people skills were less than what I wanted. Periodically, I recommend this book to clients with poor social skills, lower self esteem, or those with social anxiety. i find the the wisdom in this book to be helpful and timeless. Enjoy!

Fundamental Techniques in Handling People
1. Don't criticize, condemn or complain.
2. Give honest and sincere appreciation.
3. Arouse in the other person an eager want.

Six ways to make people like you
1. Become genuinely interested in other people.
2. Smile.
3. Remember that a person's name is to that person the sweetest and most important sound in any language.
4. Be a good listener. Encourage others to talk about themselves.
5. Talk in terms of the other person's interests.
6. Make the other person feel important - and do it sincerely.

Win people to your way of thinking
1. The only way to get the best of an argument is to avoid it.
2. Show respect for the other person's opinions. Never say, "You're wrong."
3. If you are wrong, admit it quickly and emphatically.
4. Begin in a friendly way.
5. Get the other person saying "yes, yes" immediately.
6. Let the other person do a great deal of the talking.
7. Let the other person feel that the idea is his or hers.
8. Try honestly to see things from the other person's point of view.
9. Be sympathetic with the other person's ideas and desires.
10. Appeal to the nobler motives.
11. Dramatize your ideas.
12. Throw down a challenge.

A leader's job often includes changing your people's attitudes and behavior. Some suggestions to accomplish this:
1. Begin with praise and honest appreciation.
2. Call attention to people's mistakes indirectly.
3. Talk about your own mistakes before criticizing the other person.
4. Ask questions instead of giving direct orders.
5. Let the other person save face.
6. Praise the slightest improvement and praise every improvement. Be "hearty in your approbation and lavish in your praise."
7. Give the other person a fine reputation to live up to.
8. Use encouragement. Make the fault seem easy to correct.
9. Make the other person happy about doing the thing you suggest.

A Poem Rewrite: This Old Tree

I originally started this poem in 2004, a time when I struggling to get on my feet. Last night I finished it. Here it is. I attached a photo taken 20 years ago that must have unconsciously inspired me.

This Old Tree

The old oak tree
stands tall
and crooked.
Its cracked,
coarse and
weathered surface
reflects the assault of the seasons.

Rain,
heat and snow
of seasons past
grated at its surface
with diamond sharp teeth,
digging in,
leaving permanent marks.

In defiance,
the tree stretches,
grows
and moves skyward.
Its roots
reach around rocky obstacles,
firmly anchoring itself to the earth,
exerting strength and desire,
forcing its viability
to grow into yet another season.

With roots
dug deeply
into uninviting
rocky
and inhospitable soil,
the tree forcefully establishes its home.

And the tree proclaims:

"I am a tree
I am from the earth.
Neither floods,
storms,
nor drought
will tear me away
from where my roots cling.

I remain where I belong
The earth is my home."

Ross Rosenberg
4/11/04

Organic Therapy?

Now a days, everything that is good is supposed to be organic...right? Maybe? Well then...I want to jump on the bandwagon. I offer organic therapy. I work with people from the inside out, providing clients an opportunity to grow into healthy and complete individuals.

How about a definition of "organic"
--Developing in a manner analogous to the natural growth and evolution characteristic of living
organisms; arising as a natural outgrowth.

People who seek my services, often experience unpleasant or negative feelings, behaviors, and/or are involved in unhealthy relationship patterns. Therapy that only relies on self-analysis, talking, and/or venting, may reduce the severity of some symptoms; however, it doesn't always permanently solve or remediate deeper problems, feelings, or behavior patterns.

An "organic" therapy is a holistic and healing approach to helping my clients.. It enables a them to reach a more complete understanding of the origins of the problem(s). Once a person's presenting problem is understood as a symptom created from deeper origins (core), then, lasting and life-altering solutions are possible. Therefore, symptom relief is achieved at the level where the clients were originally hurt, traumatized, and/or psychologically stunted--usually when they were a child. My "organic" approach brings my clients to place of peace, resolution, and/or or serenity.

Solving problems organically is analogous to giving an under-watered and withered plant the right amount of sunshine, water, air, and quality dirt necessary for it become vibrant, healthy and complete. Spraying chemicals on the outside, may make the plant look bigger and better, but as we all know, it is only artificial--and may cause cancer ;)

The Science of Romance/Love Is A Drug

According to the article: "The science of romance: Brains have a love circuit" there is a neuro-chemical aspect to love. Apparently, the feeling of love when analyzed in various medical tests, is chemically related to the same feeling of euphoria elicited by narcotics. It seems that the same dopamine receptors in similar parts of the brain are triggered when you "fall in love" as when you get high off of a drug. Didn't we all know this already? Bryan Ferry of Roxy Music's fame was onto something in his song, "Love is a Drug."

"Jump up bubble up - whats in store
Love is the drug and I need to score
Showing out, showing out, hit and run
Boy meets girl where the beat goes on
Stitched up tight, cant shake free
Love is the drug, got a hook on me
Oh oh catch that buzz
Love is the drug Im thinking of
Oh oh cant you see
Love is the drug for me
Oohhhh Oooooohh

1988 is the same as 2009

The process of creating my website has been very interesting. Little by little, the website has taken form. What has emerged is a picture of Ross the professional and Ross the person. This has been a very interesting process for me, indeed. Right in front of my eyes, I am getting an opportunity who I was and how I got to be who I am now. In my very own website, I have words and symbols depicting my aspirations, dreams, and accomplishments.

While constructing the "experience" part of the website, I decided to post a newspaper article written about me and printed by the Boone (Iowa) News Repulbican in 1988. It highlighted me as a new counselor working with with chemically dependent teens and their families (still do!). I was blown away when I reread it. I am still the same guy! Wow! Who would have thought that my thoughts and idealism would have survived 21 years. And they have... I am greatful and blessed.

Pics and Words

I just added a new element to my website. I converted the "poetry" tab to "pics and words" tab. Now I am showcasing some of my favorite photos. There was a time, long before I knew how to reflect a feeling, paraphrase, or understand why everything starts with our mother, I just took photos.

Check out the link to my pics. is:


Enjoy!

A Conspiring Universe

I am constantly amazed at the seemingly unexplainable events that occur with my clients during our work. The old me, would have discounted the unexplainable events as mere coincidence. The blossoming metaphysical side of Ross is starting to understands how the universe works. Now I know that seemingly random events are often messages from the "universe." I live by the words of Paul Coelho, as written his book the Alchemist: "And, when you want something, all the universe conspires in helping you to achieve it. (p23)"

My last two clients on Friday spoke specifically in incredible detail about a personal issue I am having with my life. For purposes of confidentiality on both sides (clients and family) I have to leave it as a generalization. But the messages were perfect. My goal as a therapist continues to be: develop my intuition, and to continue to interpret certain "coincidental" events as messages.

Now that I put that out there, I have to draw back to my research and scientific roots of psychology. I swing in all ways: a scientific, a mystical, and an intuitive person.

Ross Rosenberg, M.Ed L.C.P.C.

Parent In Training

Who would have guessed that my son would educate me so well in the art of understanding the disaffected, misunderstood, and disgruntled adolescents. No graduate class could have prepared me for this! Once I get past the mumbling, the looks like my IQ borders around 50, and the rolling of his eyes, I am still seemingly an alien in his world. The complicated thought process of a 15 year old is before my eyes...every day. I actually have looked forward to this time. As many who know me professionally, I truly enjoy working with teens. I like the way they talk, I like their drama, and I like their egocentric sense of urgency, and the constant sense that people are looking at them. The good thing about my son, he really is not much work--yet. He actually is a good kid. Lets hope he keeps that way! If not, I may have to use a few techniques on him :)