Marital First Aid Kit
By Bryce Kaye
Emotional Starvation Syndrome
Explanation
Emotional starvation is probably the most common malady to afflict couples today. It seems to be a scourge of the new millenium. There are a number of economic and sociological factors contributing to this but we'll save that discussion for another time. "Emotional starvation" is really a metaphor for not getting your dependency needs met. In this context, we are not referring to relying on others to make your decisions. Instead, we are referring to the basic need that we have to perceive that we are important to others. We all need emotional support (except perhaps a few psychopaths). Emotional support from others helps us to feel that our life has meaning beyond our jobs and tangible accomplishments. On a subtle but profound psychological level, we are hungry for love and are emotionally dependent in that way.
When we form a couple with another partner, we want to feel loved by them. Unfortunately, this is not as simple as it sounds. For example, if you would like to believe that you are loved by your partner, about what part of you are you talking? What defines "you"? Are you talking about your appearance? How about your achievements? Do you mean the favors you do for the other person? Maybe it's the fact that you're their spouse and reflect on their good taste. The point is that there are many ways to be considered important by another person and some of them are not emotionally satisfying.
The part of you that is most satisfying to have loved is your experience. Your experiential self involves your hopes, dreams, feelings, and desires. When you feel that these qualities are loved, you will feel loved at your core. The way that you can tell that your partner loves your experiential self is that they are curious and fascinated to know more about how you feel. What are your dreams? How do you view the world? What do you want? Your partner wants to know more, listens intently, and obviously enjoys it. Does this sound familiar or is this all too rare because of the ongoing chaos management of your everyday life? Do other "important" responsibilities eclipse intimate communication: responsibilities such as child-care or work brought home via laptop and other electronic tethers. Many couples spend time together but are are in managerial roles. Therefore, they are not emotionally receptive. Intimate receptive communication takes place at a slower pace than than other forms of communication. It is also not outcome driven. There is no final goal to achieve . The sole purpose derives from the process itself. For both people, it's enough to feel symbolically connected via the sharing of their experience. This is also the attitude of adult mutual play (and of good sex as well).
Emotional starvation occurs when a couple has allowed circumstances to bind them so tightly into responsibility roles that no time is available for intimate communication. There may be play time as in family vacations but the couple are always in parent mode. In these circumstances, intimate communication is still not taking place. An excellent diagnostic tool is to ask yourselves whether or not your relationship averages at least 2 hours per week of focused intimate conversation. By focused, we mean really mean without distraction and where the primary objective is to talk and listen with 100 % attention. This eliminates situations involving children, theater, or other stimulating entertainment. Focused intimate conversation would look more like taking a walk together while the two of you privately talk. It may be a special time together after the children have gone to sleep. It might be getting out for a cup of coffee and exploring each other's worlds in a quiet setting.
When there is almost no time spent in intimate communication, a bonded relationship will start to dysfunction because their dependency needs are not being met. It may come as a surprise to learn that most couples are unaware of when this is taking place. The reason for this is that most people like to view themselves as more autonomous than they really are. As a consequence, they underestimate or even completely eclipse their own dependency needs from their awareness. It's as if a person is starving but has no hunger! When this is happening, most couples will usually show their distress indirectly. Instead of allowing themselves to feel hurt, many people will turn the hurt into feelings of resentment and anger. For a couple with this kind of hidden suffering, the displaced feelings of resentment will condense onto convenient conflicts over control and respect. The couple becomes hypersensitive and anger is provoked by even small issues. The couple are often not even aware that hurt feelings of rejection underlie their conflicts. It's as if their resentment is seeking convenient vehicles for its expression.
Marriage counselors often see the aforementioned dynamic in reverse. As a couple devotes more time to focused intimate communication, their conflicts often "magically" become less numerous and less toxic. This author's interpretation is that when dependency needs are starting to be met, the covert suffering is subsides and less anger is displaced. It has been our experience that 2 hours of focused intimate conversation per week is usually enough to emotionally sustain the dependency needs of most couples. When there has been a lot of previous deprivation, then 4 hours per week is often needed. While there are certainly other causes for suffering and conflict among couples, it still makes sense to try simple interventions first especially when they hold a good possibility for improving the situation. You might want to try the following interventions for a period of about 6 weeks. Other couples who have done so have experienced greatly improved relations as a result.
INTERVENTION #1: Set up a routine for intimate communication
The keyword here is "routine". Set up a time and place on a weekly basis when you and your partner will have 2 hours for really focussing on each other's experiences. If this has not been going on and the relationship has been deprived of intimacy, then set up 2 periods of 2 hours each for a total of 4 hours each week. Make sure that children are not around since dependency needs are not usually met when a person is in "parent mode". Both of you will need to feel unencumbered. The reason for setting up a routine is that it greatly reduces the chances of unconscious sabotage. Make sure that the location is well planned. Usually, outside of the home works better because there are fewer cues and distractions for other responsibilities. Mark off the dates, locations, and times on your schedule book or calendar. Do not underestimate the power of externally representing your commitment this way. It can have a subtle but powerful emotional effect on your felt priorities.
INTERVENTION #2: A "Talking/Listening" exercise
Assuming that you can create a setting that encourages you to focus on each other, you may or may not need help to communicate intimately. If you do, you could start off with an exercise that many couples have found helpful.It's an exercise that actually structures you into intimate communication by slowing down your pace and promoting emotional sharing.
First, flip a coin with your partner. Whoever "wins" is the one who talks first. The partner who talks will talk (or think about what to say) for a full half hour. There are two important rules for the person who is talking. The first rule is that they talk only about themselves and not about the other. They can talk about memories, hopes, wants, dreams, etc. but they need to stay away from analyzing the other person. The second rule is that they use the full half hour even if they run out of things about which to talk. Actually, that last statement is an inaccuracy. There is always an infinite amount of experience that could be shared but a person's anxiety or shame may limit them. When the talking partner stops talking for awhile, they can use the time to think or just meditate. In other words, hang loose. Eventually, given enough time, other thoughts will come to mind to be shared. It is an important principle that time spent in silence is not wasted. It is actually time spent trying to communicate with yourself. With a passive attitude and enough time, your creativity (technically called "primary process") can source up important material for sharing. The irony is that you may be completely unaware that what you eventually have to say is important. But it is with these small sharings that, when received by our partners, we develop a sense of being loved. So, when the awkward silences do inevitably come during this exercise, tell yourself that you're practicing something important.
The person who listens during the first half hour needs to follow one absolute rule. No matter what is said, they don't say anything. There are no refutations, disagreements, agreements, clarifications, etc. Say absolutely nothing. Even if the person talking gets off track and starts talking about you, don't correct them. Let them discover that fact for themselves. Let them bring themselves back to the topic of themselves. Eye contact is important so spend a reasonable effort to look at your partner while you listen.
When the first half hour is through, then reverse roles. The person who originally talked now does the listing. The original listener now does the talking. It is important to note that there should be no comments about what the first person said. Remember that the new person talking should only be referencing themselves.
When the full exercise is through and both people have talked, do not say anything about what has been disclosed. In fact, make a point of not talking about the disclosures for at least three days following the exercise.
The previously described exercise is simple but powerful. It actually structures your interactions to meet subtle dependency needs. You may want to use this exercise for half a dozen times before moving on to less structure. If you still think you need more helpful structure, consider the following intervention.
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University of Cambridge
Counselling Service
CONFLICT WITH OTHERS
Conflict is normal
All of us have interactions with other people which do not go as well as we would like. At one level we may simply feel misunderstood and are often able to shrug this off without much difficulty. But sometimes we can feel personally attacked and our first thought may be to lash out in anger or fear. In these circumstances the strong feelings we experience may make it difficult to hear what someone is trying to say to us. In extreme situations, such confrontation can feel threatening to our overall wellbeing and functioning.
Some common situations where students find themselves at risk of conflict with others are:
* differences with room mates over house rules
* disagreements with parents' wishes or advice
* miscommunications with boyfriends / girlfriends / partners
* challenges from tutors, directors of studies, supervisors or department heads
* clashes of opinion in discussions with peers or academics which get 'personal'.
We can often prevent minor conflicts becoming serious by changing the way we communicate.
Conflict can be an opportunity, not just a threat
It is possible to look at our personal interactions in a different way so that we can turn conflict into an opportunity to achieve clearer communication and bring about change. There are two common reasons why people get into conflict:
* they do not communicate clearly or listen respectfully
* they have different needs or interests which, without some negotiating, do not easily coexist.
Here are some guidelines which may help you deal with situations which are causing trouble.
Guidelines for Good Communication
In the heat of the moment it is easy to forget some common 'rules of thumb' which aid successful communication.
Good communication is a 3-step process
1. Send clear messages - verbal communication and body language both count. Think about what you want to say and how it may be understood.
2. Receive - what is heard is part fact and part feeling so be clear on both levels. When you are listening, pay attention to both facts and feelings.
3. Acknowledge - you can only be sure you have communicated what you intended when your listener gives you feedback confirming their understanding. As a listener, summarise what you have heard and ask questions to seek clarification if parts of the mess age seem unclear.
Respect the other person's needs as well as your own
You have valid concerns which need addressing; and so does the person with whom you are in conflict (even if these are not immediately apparent).
Tackle the problem directly with the other person
It is much better to work directly with the other person in the conflict; going via others makes an escalation of the conflict or further misunderstandings much more likely.
Avoid involving peers, friends or family in 'taking sides' and, as far as possible, keep the conflict out of the public eye. Whilst it can be useful to check others' perceptions of the situation or seek others' views of your actions or desires, if you are mer ely seeking confirmation for your own views this is only likely to lead to a more entrenched position.
Separate the problem from the person
Pointing out the distinction between the problem and the person, and confirming you wish to treat the other person respectfully may help them do the same. Your issues are more likely to be resolved if you avoid making personal attacks which embarrass or ridicule the other person.
Speak without interrupting each other
You may set up further misunderstanding if you do not give the other person the opportunity to finish what they have to say. You also need to ensure that there is agreement about everything said so far, before going on to the next point at issue.
Negotiate in good faith - dirty deals do not last!
Look for mutually satisfying agreements - one-sided offers tend not to work. Though it is common to think there must be a winner and a loser in a conflict, this is not necessarily true. Participating in negotiations where the goal is a 'win-win' solu tion (i.e. both parties attaining satisfaction on their needs and interests) is both possible and helpful.
'Interests' v 'Positions'
Often in our negotiations with others, we think taking a 'hard position' or exaggerating our 'bottom line' will get us a better result. Actually, such positional bargaining frequently backfires because the other person is likely to get upset, feel unf airly treated or just decide to dig their heels in on their position.
A better approach is to think about the interests underlying our initial position on an issue. An underlying interest is usually related to a principle we hold, a moral value, a hope or expectation, or some less tangible need. If the position is what the conflict is about, the interest is the reason why we want a certain response.
For example, you might get into a conflict with your partner because they didn't call you until much later than they said they would. The conflict could become an argument concerning how late is 'acceptable' (your position might be that 'calling late is not acceptable'). Whereas the underlying interest might be that you want to be reassured of their feelings for you. In this scenario, it will be much easier to sort out what to do about phone calls once you are both reassured about your care for each other.
Four Steps to Resolving Conflict
These suggested steps incorporate the guidelines above and can help resolve conflicts:
1. If you are in public and find yourself in a conflict, stop and ask to meet the other person in a neutral, private and safe setting at a mutually convenient time so you can speak confidentially without creating a scene and without being interrupted.
2. Look at and listen to each other, so each person feels heard and understood, and has their views acknowledged. In this way you begin to undo the damage to your relationship which the conflict has been causing. It is worth taking time hearing the ot her person's viewpoint - it is likely to save you time in the long run. Take turns to list the issues you want resolved (positions) as practical matters to be addressed; and list your interests as principles you would hope any agreement could be based up on, or needs you would like to be met. Go back and forth listening to each other until each person has fully stated their views and you both agree that you have been heard and understood.
3. Offer options with an open mind, using your creativity to brainstorm possible ways of meeting the expressed concerns, needs and interests of both people. Remember the difference between positions and interests, and strive to satisfy both party's int erests. Combine and refine the options brainstormed together, remembering that it may very well be possible to work out a win-win solution together which neither of you could have thought of on your own.
4. Conclude negotiations with agreements in good faith which are specific and satisfy everyone. This minimises the risk of future conflict. Keep your discussions confidential unless you jointly agree to tell any others who may need to know wh at your resolution involves.
Finally, if you don’t reach agreement, don’t be afraid to try again another time. It can sometimes be better to try to resolve a conflict bit by bit, giving everyone concerned time to think - and rest.
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How to Communicate
Anything to Anyone
From Essential Communications Skills Lab training course
"A child repeats his communication to you several times. A man, obviously distracted and worried, refuses to share his uncertainties with his wife. A manager, clearly unhappy with an employee's performance, hesitates to broach the subject. Your teenager remains silent about her insecurities at school, until she brings home a D in algebra."
In these and countless other events every day, our failures to relate boil down to our failure to communicate. Well-publicized studies tell us that certain communication situations elicit our most paralyzing fears, while our common sense tells us that this suffering is unnecessary. While "good communication" becomes a buzz phrase as accepted as "good motherhood," the wherewithal often remains a mystery.
Why? Is it that we as a species are simply new at it? Are we saddled with insurmountable personality conflict in our individualistic society? Is some of the problem inherent in the differences between the sexes? Or could it be that because human communication contains emotion, which we sometimes feel as complex, that we make the challenge of successful communication unnecessarily difficult?
Your Negative Emotions
Every single human communication contains some emotion or some mixture of emotions. There are three simple keys to understanding emotions:
1. To understand that your emotions exist in
a spectrum;
2. To understand that your emotions are vital to your happiness, and;
3. To understand that labeling some emotions "negative" will greatly limit your ability to communicate.
Energy characterizes the emotion spectrum, not good or bad. Much of our personal power rests in understanding this fact. At one end of this spectrum are emotions that consume energy, leaving very little for our use to communicate and achieve. Some of these emotions are hopelessness, sadness, and fear. At the other end are emotions that generate energy. These are emotions like hostility, interest, and enthusiasm. The person who has achieved full use of his or her emotions will tell you that none are bad, though some are more productive and more fun. Nevertheless, most of us have drawn negative conclusions, often in unremembered moments from our past, about certain emotions. The experience of these emotions is uncomfortable and makes communication seem difficult.
Tom, for instance, learned early in life that a man shouldn't cry or show weakness. Somewhere along the line Tom concluded that sadness is unseemly and negative. Today Tom is an important executive. But Tom is also a human being, and as such he has sadness as much as anyone, man or woman. But Tom unconsciously prevents himself from experiencing this emotion. So when he gets sad, Tom blusters about, feeling frustrated and accusatory, making his communications hard to receive. His blustering goes on and on, for he achieves no release or change of experience in this mis-identified emotion. His emotional experience feels complex to Tom, and communications involving these emotions seem difficult. Moreover, Tom, subliminally uncomfortable with his own emotion, has an automatic intolerance of certain emotional expressions in others: "She gets too emotional."
Our habitual sensitivities, then, extend beyond our own communications and affect our ability to receive communications from others. Unrecognized, these sensitivities lead to two kinds of mistakes in receiving communications:
1. We automatically identify with others' emotions (you get sad, I get sad), or,
2. We automatically contrast our emotion to others' (you get mad, I get afraid).
Heated Conversation
Most of us have difficulty remaining truly present during heated conversation, even without real threat. We may feel "yelled at," or "dressed down," when "direct emotionally expressed disagreement" would be more accurate. During these communications, we are often busy making judgments and planning rebuttal. This is understandable, given our emotional discomfort, but it nevertheless compromises our ability to receive. When we mix together the processes of receiving information and judging it, the message changes and the communication fails.
Most young children are excellent receivers: of information, of material support, and of emotions. Busy learning, the very young are able to remain curious and interested through most non-violent communication. In those years, we are able to remain detached from but interested in others' emotions, and the result is usually an excellent communication on all sides.
As an adult you can regain your natural ability to maintain active interested presence, even through the heat of an emotional communication. Notice your private judgments, notice your tendencies to react, but do not act on these temptations. This will help you remove yourself from automatic emotional reaction and replace that with the emotion of genuine interest as the audience. As a receiver during the heated phases of communication, remember that you are there only to gather information and to appreciate the emotions of your partner.
The Courageous Communicator
Fear is one of the emotions that most of us have negative judgments about. These judgments aside, we all do have fears and they are often present in difficult communication situations. Tom, for instance, may have fear about expressing vulnerability to his wife Judy. Judy may shy away from certain direct communications to Tom because his blustering reaction "makes" her uncomfortable.
But having fear is vastly different from not communicating because of fear.
Initiating difficult communications takes courage. Courage does not mean the absence of fear, it means that despite forebodings, and with consideration, you go ahead. As opposed to indefinitely hesitating and worrying, actually jumping off your high dive of anticipation can be a confidence-building and extremely productive experience. To tilt the odds further toward success, you will want to be very good with tact.
Tact and Politeness
Tact does not mean politeness to the point of indirectness ("if he really loved me, he would know to cook spaghetti for me...") The two essential ingredients to tact are:
1. Communicating exactly what you mean, and,
2. Framing the content with effective transitions.
"Excuse me, George, may I interrupt for a moment" will often get you much further than "Hold it, George." Transitions achieve a smoother change by:
1. Giving your receiver(s) some idea of what is
coming, and,
2. Eliciting willingness.
You are, for example, planning to approach your boss on a sensitive subject. Until now you have been hesitating because your boss is busy and often responds poorly to controversy. To help span the gap between your former silent disagreement and your goal of a full communication, you put in a transition: "Bob, I'd like to go over some details of the Smith project. I know we've been through it before, but I've got some new ideas. They may be controversial, but I think they might be valuable, too. Would you be willing to take a few moments to hear me out?" When the meeting starts, add appropriate transitions, including mentioning that your purpose is positive even if your ideas aren't ultimately accepted. Then proceed with an accurate communication, stating exactly what you mean. Emotions, such as a built-up frustration, can be expressed as well: "And actually, I've been a
little frustrated...."
Communication Cycles
Each sentence that I write here is a separate little communication cycle, for each has a beginning, content, and an end. As you read each sentence, and hopefully understand it the way I mean it, then that little cycle starts and completes for us.
A communication cycle cannot exist until everybody involved invests their attention or presence. As you read along here, for instance, you may "drift away" at a certain point. From then on, nothing is being communicated from me to you, for you have dis-invested your presence. Most people observing you, however, would have no clue about this: for all they know, the communication is still happening.
We are all experts at faking presence. Everybody has the ability, not always acknowledged, to sit facing our associates pretending to be present, but actually "be" somewhere else. This little trick is harmless enough, but if you forget about it you may be "doing business" with people who aren't there, counting on that interaction. Small wonder, then, that meetings are seldom as productive as they could be. Next time notice how many participants are really there.
Are You Here?
The most effective quality of presence is active, genuine interest.
Okay, you say to your partner, I'm interested, so the cycle has started. Or has it? Now you know that presence is important, but what about those people with whom you communicate who haven't thought about it? How do you determine their presence, and how do you bring them back?
Eye contact is a pretty good indicator of presence, but it is not infallible. Eye contact is highly dependent on medium and culture. But if a person is following along with you, for instance by telephone, and responding sensibly, chances are good that he is still around. With memos and electronic communications, you have to be more deliberate and ask for closure. When in doubt about your partner's presence, ask a non-assumptive question: "Do I have your attention?", or, "Is this a good time?", or, "Still with me on this?"
"Why are you drifting away?" is an assumptive question; the results are predictable.
Uncompleted Communications
Closure provides clear indication that communications have been received the way they were meant. The absence of closure, though common enough,
is unnerving.
Let us say that I'm sitting next to you. After establishing presence, I ask you to please go get me a ham sandwich. You don't say a word, but get up and walk out of the room.
I'm likely to be left wondering. Are you going to get it? Are you offended? What about the Swiss cheese?
Wonder is the absence of an answer or closure. If the communication is important, or of consequence - say I haven't eaten in two days, or we are involved in an important business cycle that requires action - then I would experience the wonder as worry. Worry, then, is the absence of closure to an important cycle. If you don't remember the cycle, as in one from your childhood, then you might experience the worry as "free-floating anxiety." Ah, but we drift from our subject. Sorry. Do we still have your attention?
Exercise: Awareness Practice
Learn to Notice What's Happening!
By Peter K. Gerlach, M
*
This is one of over 150 articles focused on building high-nurturance family relationships and preventing divorce. This introduction describes the Web site's purpose and the best ways to use its resources. Each article is part of a mosaic of ideas, so the more you read, the more sense they'll all make.
These articles augment, vs. replace, other qualified professional help. The "/" in re/marriage and re/divorce notes that it may be a stepparent's first union. "Co-parents" means both bioparents, or any of the three or more related stepparents and bioparents co-managing a multi-home nuclear stepfamily. Clicking links below will open an informational pop-up or a full window, so please turn off your browser's popup blocker, or allow popups from this site.
Before continuing, reflect: why are you reading this - what do you need?
+ + +
learn seven relationship skills to get more daily needs met Our warp-speed, hyper-stimulating culture discourages developing personal awareness of the vital worlds within and around us. Once aware of this unawareness and motivated to reduce it, people (like you) can intentionally grow more aware. Part of this is growth is intentionally becoming more aware of the communication dynamics and outcomes within and around you. This foundation ability underlies all six other related communication skills.
Learning the seven skills and modeling and teaching them to kids and kin is the second of 12 Projects typical adults need progress on to grow a high-nurturance relationships and families. The alternative is unawareness - one of five relationship hazards.
reminder.gif (128 bytes) My unique, practical guidebook for Project 2 is Satisfactions - 7 relationship skills you need to know (Xlibris.com 2002). It integrates the key Project-2 Web articles and worksheets in this nonprofit Web site.
Communication Awareness Practice
Tailor and use this exercise periodically to expand your communication awarenesses. Pick a partner who shares your interest in growing communication effectiveness. Minimize distractions, and set aside 20” - 30” or so. Adopt the open, questioning "mind of a student," and let go of any need to criticize or blame anyone – starting with you. Reading about communication awareness will do little for you. Trying it can do a lot!
To get the most from this exercise, both of you read these:
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Communication overview - definitions, basics, and skills;
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Overview of communication awareness;
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Ideas on giving effective feedback,
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Overviews of personality subselves, and true and false selves, and...
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This general awareness exercise.
Then…
2) Find a quiet space together with "enough" privacy. Sit facing each other comfortably. Bring a copy of this exercise and some paper and a pen.
3) Each of you recall a recent important conversation with someone else - at home, work, or other - that you're willing to share with your exercise partner. Pick a conversation between you and one other where you feel that the energy and/or outcome was "notable."
4) Decide who will talk first. The speaker's job is to be themselves, and describe their communication incident naturally, in about 5". The listener's job is to attend the speaker non-judgmentally, like a reporter, using a copy of this worksheet to record impressions about their partner's communication process. Minimize or avoid questions and comments. Notice nonjudgmentally how you feel, as the practice unfolds.
5) After ~ 5", wrap up. Listener, go back over the incident with the speaker, and help them clearly answer the seven awareness questions below. Aim to be a researcher and facilitator, not a healer. You don't need to be right here. The goal here is to help each other notice the processes in and between you – i.e. to grow your communication awarenesses.
6) When you both feel done enough, reverse roles and repeat these steps. Take about 15 minutes or more for each half.
7) If you've extra time, assess these seven focus areas in the debriefing process you've just shared together. Again: this is not about right-wrong (blaming) or competition. It's about getting main communication needs met in a way that feels good enough to both of you. Note and discuss special learnings you want to remember from this experience.
Seven Basic Awarenesses
Awareness 1) - Who was probably in charge of each person's personality – their true Self, or a false self? When your Self is steadily trusted to guide your other subselves, you'll usually feel some mix of clear, sure, calm, alive, awake, aware, focused, resilient, grounded, light, up, strong, purposeful, balanced, alert, centered, and compassionate:
If a false-self group of subselves is in charge, you feel a mix of the reverse of those – anxious, unclear, upset, unsure, “heavy,” cloudy, hesitant, defensive, hostile, wary, numb, confused, sarcastic, "down," apathetic, distracted, and so on.
Notice what it feels like to mull who was in charge of your respective inner families. This is primary awareness to build in all important situations. Have you ever heard of it before? Do your kids and key others know about it? When false selves dominate, communication effectiveness plummets.
Awareness 2) - Communication needs: Why was each of you communicating in that situation? Which of these did you each need?
_ To keep or build respect (usually always present), plus…
_ To give or get information (vs. emotions); and/or…
_ To cause action (what?________________), and/or to feel potent or powerful;
_ To vent (be heard, understood, and accepted); and/or…
_ To cause excitement (end boredom), or distract from something; and/or…
_ To avoid discomfort. like awkward silence or a conflict.
* Did your communication needs match well enough? By whose standards?
Option: if you practice-partners are both aware of the difference between surface and primary needs, note and discuss whether the people in the speaker’s situation (a) could have benefited from "digging down" to identify their primary needs; and if so, whether they (b) identified them, and (c) acted to fill them or not.
Awareness 3) - R(espect)-Messages: What main R-message/s do you sense that each partner got from the other person during this exchange: “I’m 1-up (superior)," “I’m 1-down (inferior)," or “I see our needs and dignity as co-equal here (=/=)?” Were the R-messages received the same ones that were sent?
Awareness 4) - E(motion)-Levels, and the communication skills used: How would you judge the E-levels of each partner over the span of your exchange:
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“Above the ears” (distracted, and can't hear the other person well),
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“Below the ears” (probably can hear them), or…
*
Variable?
With their combination of E-levels, which of the seven communication skills do you think each partner should have used to get their main communication needs met? What skills did they use?
Did anyone's E-level rise or fall during the exchange? If so, How did the other person react – i.e. did they shift to empathic listening, or do something else?
Awareness 5) - Channels and double messages: Did either of the people in the situation seem to send or receive double messages - e.g. did their words say "Yes," while tone, face, hands, body, or other non-verbals said "Maybe" or "No"? If so, who said what?
Awareness 6) - Distractions and focusing: From what you know, is it possible or probable that either communication partner in this situation was significantly distracted
_ Internally (physical discomfort, worry) or...
_ externally (noise, lights, motion... )?
If so, how did the partners seem to handle these distractions? (e.g. ignored them, reduced them, talked about them, argued about them…)
If either person had an agenda (topic / focus), do you feel both partners focused on it or them, or did they get off track and lose their focuses? If so – did either of them notice that?
Awareness 7) - Communication outcomes: Was this effective (vs. "open and honest") communication?
* Did both people get their respective communication needs met enough (in their opinion)? If not, why?
* Did they both feel OK enough about (a) themselves, (b) their partner, and (c) the communication process they co-created? If not, why?
Options
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When you both feel done with changing roles, discuss how this exercise process felt to you two, and what you’re aware of.
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Apply these same seven questions to the exercise you’re sharing. Notice your “self-talk” (inner thought-streams and feelings) about this.
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User this exercise by yourself to assess an important or troublesome communication experience you had recently – inside you or with another person.
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use these summaries of common communication process-factors, blocks and useful tips to expand the scope of this awareness practice.
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review these empathic listening, assertion, and problem-solving skill practices.
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The Truth About Child Molestation
Sexual Abuse
The Child Protection Program
In 2005, there were 189 confirmed cases of child sexual abuse in Rhode Island. Carole Jenny, MD, a specialist in pediatrics and child abuse at Hasbro Children’s Hospital, says this number is only “the tip of the iceberg” as most cases of sexual abuse go unreported and undocumented.
Jenny offers tips on how to help protect your children from possible victimization. She also gives advice on how to support victims of abuse and start the healing process.
Choose Caretakers Carefully.
Jenny says the most important consideration when working to protect your children is to “be very careful about who watches your kids.” Make sure that your children’s caretakers are people you completely trust. Jenny says she is “amazed when families leave their children with neighbors, casual friends and people they barely know.”
Jenny also suggests that parents be wary of “a male friend who insists on babysitting your kids or a person who takes surprising, unusual or excessive interest in your children.”
A question that parents don’t often consider is, "Who is watching your children in church groups or youth organizations?" Jenny says that parents should always “inquire about the policies regarding whether or not children are left alone with adults. Some groups insist that all children be accompanied by at least two adults at a time.” If your child is being left alone with one adult, without any other supervision, you need to be aware.
Keep Communication Open.
In order to protect your children, there needs to be open lines of communication between yourself and your kids, as well as within the extended family.
Most molesters are known to the child and the family. They are often family members or family friends. Jenny says, “Family secrets put children at risk. Talk openly in your extended family about others’ experiences as children. If someone in your family has been molested in the past, keep your children away from the person who did the molesting.”
Jenny expresses her disbelief at how many children are molested by the same people who molested their aunt, uncle, cousin or other relations because the abuse is never revealed. This is often because the victim feels that the family will not believe them or will reject them. If a family member tells you they have been molested, take it seriously. Let your family and your children know that you will always support them.
Most importantly, you need to talk to your children about abuse as soon as they are able to understand language. Make them aware that though most people are trustworthy, there are people out there who may want to harm them. Teach them about the proper names of their body parts and which are private. Jenny says to tell your kids to “trust their instincts. If someone is making them uncomfortable, tell them they should talk to a trusted adult immediately. Let them know they should not be embarrassed to ask for help.”
Though it is essential to teach your children about sexual abuse, Jenny says, “it is unfair to make children responsible for their own safety.” This is why parents need to be aware and make every effort to see that children are safe and well supervised.
Recognize the Signs.
Unfortunately, despite our best efforts, sometimes children are abused. They may hide the abuse. They may be afraid to tell someone for fear of being judged or may be intimidated into silence by their abuser. This is why it is so important for parents to keep an eye out for warning signs.
“The most reliable indicator that a child is being abused is when the child acts out sexually. Sometimes, a child will show non-specific signs, such as depression or unusual anger," says Jenny. "Having said that, many times children will show no outward signs of abuse.”
Since there are cases where there will be no signs, it is essential that your children know that they can talk to you about absolutely anything. Remind them of this often.
Healing in the Aftermath of Abuse
If your child tells you that they have been sexually abused in any way, listen and be supportive. Jenny says, “The most important thing a parent can do when a child reports abuse is to believe and support the child. One of the conditions that is known to cause severe psychological problems in abuse survivors is when parents ignore the child’s report of abuse. The worst thing a parent can do is say, ‘You're lying’ or ‘I know he would never do such a thing’. "
Also, parents should stay calm and reassure their children. Jenny says that if parents react emotionally in front of the child, he or she will feel frightened and insecure. Let your child know that everything will be okay and you are going to keep him or her safe.
Once it has been established that a child has been abused, counseling should occur immediately. Jenny says that a child who does not deal with his or her abuse becomes an adult at risk for long-term problems such as posttraumatic stress disorder, depression, sexual dysfunction, problems with relationships and substance abuse.
“The good news is that psychotherapy can help. Abuse survivors can look forward to a happy, healthy life if they are willing to get into therapy and work hard at getting better,” says Jenny. “Psychotherapy with a counselor who has been specifically trained to deal with childhood trauma has been shown to be very effective at helping people overcome the effects of abuse.”
If you are a parent who was abused as a child, Jenny strongly urges you seek out psychotherapy. It will help you to heal as well as decrease the chances that your own children will be victimized.
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INDEPTH: MARRIAGE
Marriage by the numbers
CBC News Online | March 9, 2005
CBC/ENVIRONICS POLL RESULTS:
April 10, 2005: What do Canadians think of same-sex marriage?
April 8, 2005: Should Prince Charles become king after his marriage to Camilla Parker Bowles?
» more
Despite recent increases in common-law unions, marriage continues to form the foundation for most Canadian families. Statistics Canada researchers say that in 2002, about 84 per cent of Canadian families were headed by married couples.
Average age for first marriage:
The average age for first marriages is rising steadily for both brides and grooms. In 2000, first-time brides were 31.7 years old, while grooms proclaimed their first marriage vows at an average age of 34.3.
Only two decades earlier, women and men were 25.9 and 28.5 years old, respectively, when they got married. Statistics Canada attributes the change to greater economic opportunities for women and the growing popularity of common-law unions.
Common-law relationships:
The number of couples forgoing marriage has more than doubled since 1981, the first time the statistic was tallied. At the time, there were 357,000 common-law relationships – about six per cent of all couples. By the 2001 Census, roughly 14 per cent of all couples were common law. Common-law unions are most prevalent among young people and couples living in Quebec, where more than 30 per cent of all families are common law.
Common-law unions tend to be temporary and transitory, though they often transform into marriage. However, those marriages break up far more frequently than marriages not born out of common-law relationships.
Divorce:
With the passing of the Divorce Act in 1968, grounds for divorce were extended to include "no-fault" divorce based on separation for at least three years; in 1986, the separation period was revised to one year.
Within a decade of the introduction of the Divorce Act, the total divorce rate (the percentage of marriages that dissolved in the previous 30-year period) rose from 14 per cent of all marriages in 1969 to 30 per cent in 1975.
The total crude divorce rate peaked at 362 divorces per 100,000 inhabitants in 1987. The divorce rate in 2000 was 231 per 100,000 inhabitants.
Multiple divorces:
Statistics Canada figures from 2003 show the number of Canadians getting divorced more than once is on the rise. Researchers found the number of marriage breakups involving husbands who have been divorced at least once tripled in three decades.
In 2003, 16.2 per cent of husbands getting divorced had at least one previous divorce, while in 1973, the rate was 5.2 per cent.
Similarly, divorces involving wives who had previously been divorced rose from 5.4 per cent in 1973 to 15.7 per cent in 2003.
Overall, more couples are getting divorced in Canada. The Statistics Canada report didn't factor in whether the number of marriages had also increased.
After three years of marriage, the divorce rate was at its highest, at 26.2 per 1,000 couples. The risk of divorce declined slightly with each passing year after that.
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The Top 10 Compulsive Behavior Symptoms
Category: Personal Development: Basic (BA3)
Originally Submitted on 5/11/97.
The following ten behaviors are probably the most common of what could be categorized with "Obsessive-Compulsive" disorders. Many of them are "curable," but the person who has any of these compulsions should seek *professional* help in dealing with their particular problem area.
1. "Checking" Behaviors.
Worrying if you turned off lights or stove, locked the door, etc. Excessive daily checking and re-checking of these types of things is a compulsive behavior.
2. Needing to Buy Something Each Time You Go Shopping.
Lack of ANY willpower when it comes to buying when out shows compulsive behavior. This often leads to severe financial and business problems unless the person is financially very well off.
3. Gambling For Recreation, But Continually Losing & Going Into Debt.
Many people gamble for fun, and when they lose all their money they go home or quit. Compulsive gamblers keep going and borrow money, sell items to get money to gamble etc. They are "addicted" to gambling.
4. Substance Abuse/Addiction.
When alcohol, recreational drugs, or tobacco are so much a part of your life that without them you are agitated, afraid, anxious, or do not feel "yourself," then you have a compulsion to use those substances,even though they are harmful to your physical and emotional wellness.
5. All Work & No Play.
If you are a person who ALWAYS feels they have to be working or doing something "productive," such as your business work or other projects that are not considered "recreation," then chances are good you are compulsive about work. These people often are called "Type A" people, but a true compulsive workaholic will literally work until they fall asleep or are no longer able to function.
6. Compulsive Relationship Behavior.
Examples of this are the man or woman who *must* be in a relationship, sometimes with only one special person, or they feel lost. If the relationship is terminated by the other party, the compulsive "lover" will stalk, call incessently, and do all kinds of legal and illegal things to get close to or "get back" the person they feel they must have in their life to be "whole." It is similar to the "Fatal Attraction" movie character Glen Close played.
7. Compulsive Lying.
This person, not unlike the gambler, or the alcoholic, has little or no control over the lies he or she tells. To the compulsive liar, lies come out of the mouth as easily as truths, usually with little or no forethought to why or what the consequences will be.
8. Compulsive Eating.
Eating disorders are well known by now, and the subject of numerous books and talk shows. The compulsive eater is a person who simply CANNOT say no to food! They may have just eaten a dinner, but they go back for more until they are either sick and must "purge" the food, or until they get so sick they cannot eat any more. Most people with severe overweight problems are compulsive when it comes to eating.
9. Sexual Compulsions.
Men and women who bounce from one bed to the next and MUST have an ongoing sexual relationship or very frequent sex no matter with whom or what the situation, are addicted to sex, and would be classified as having a sexual compulsion. These people unfortunately put themselves at high risk for getting sexually transmitted diseases, unwanted pregnancies, and very unhealthy personal and professional lives.
10. Compulsive Exercising.
Sometimes tied into competitiveness, sometimes to a weight or *perceived* weight problem, and sometimes simply another example of compulsive behavior, some people exercise to the extreme, often endangering their health. Some runners and "marathon" zealots may live to exercise. They do it for much longer than suggested by health experts, they do it harder than suggested, and they do it more frequently as well. It often interferes with their social and business life, and in women and men can cause unhealthy changes in the body's normal "rhythms," the person's body fat percentage, and can cause many "sports related" injuries to the knees, legs, hips, and other major joint and muscle areas.
Family Roles
It is widely acknowledged that the effect that our family and chosen role model's has upon us is fundamental to our individual development.
In a dysfunctional or psychologically unhealthy family we inherit or develop negative roles or defence mechanisms that we can become trapped in. These are often manifested most when under stress or in a crisis situation where our learnt defence mechanisms become effective.
In contrast to functional or healthy families that foster positive development where trust, love and honest, open relationships thrive, dysfunctional families may produce insecurities and stop ‘normal’ development.
Commonly one or more members of the family, either parents or child will have some problem that affects the rest of the unit. They may be alcoholic, abusive, absent, neglectful, or possess some other disorder.
As in any family there is likely to be at least one ‘healthy’ individual who tries to compensate for the failings of those around them.
*
The hero role is taken up to try and solve the problems in the short-term, by deflating the situation feeling that the issue has been dealt with. In reality the problem will probably still exist and the heroes will constantly find themselves fighting against it, taking on needless responsibility and feelings of inadequacy.
*
The scapegoat believes that they are the cause of the problem(s) and develop complex defence mechanisms to combat these feelings, they may shun personal relationships, rebel against perceived threats including family and adopt feelings of guilt and shame.
*
The lost child prefers to ignore the immediate situation and withdraw into a safe personal world in which no one can disturb them, isolating themselves from meaningful relationships.
*
The mascot becomes a distraction, often apt at social situations and entertaining they prevent people from focusing upon the problem believing that it will solve itself rather than deal with painful tasks.
Adverse Consequences of Alcohol Abuse and Dependence
Adverse Consequences of Alcohol Abuse and Dependence
W. Alexander Morton, Pharm.D., BCPP
Professor of Pharmacy Practice
Associate Professor of
Psychiatry and Behavioral Sciences
Medical University of South Carolina;
Institute of Psychiatry, Charleston, SC
Sophie Robert, Pharm.D.
Psychiatric Pharmacy Practice Resident
Medical University of South Carolina,
Charleston, SC
Alcohol, also known as ethanol and ethyl alcohol, is an interesting drug for a numberof reasons. Although most consumers do not consider alcohol to be a drug, alcohol in fact may be the most thoroughly studied of all drugs. The scientific literature contains numerous documented effects of alcohol.1 However, many healthcare practitioners fail to appreciate the clinical picture produced by alcohol in patients with undiagnosed conditions who use or abuse alcohol. When presented with a case involving early physical symptoms of alcohol abuse, primary care physicians in one study failed to diagnose the problem 94% of the time.2 In addition to its other adverse events, alcohol is thought to be responsible for up to 105,000 deaths per year, not including deaths attributed to drunken driving.1
This article is intended to help health practitioners recognize some of the physical and mental complications of alcohol abuse and dependence in patients with undiagnosed illnesses. The information provided can help practitioners formulate treatment plans for patients who use alcohol and who have concomitant medical and psychiatric illnesses. In addition, it may be used to educate patients, helping them view alcohol differently when they have difficulty recognizing their alcohol use as a problem.
Popular Myths About Alcohol Use
People consuming excessive amounts of alcohol will use several popular myths to justify their continued drinking. These myths are discussed below:
Alcohol is good for your heart. Overall, excess alcohol is bad for the heart because the heart has to work harder and it may function irregularly.
Alcohol protects against heart attacks. This is only partly true. Alcohol decreases the "bad" cholesterol (LDL) and increases the "good" cholesterol (HDL). When used in small amounts, alcohol has been associated with less coronary heart disease. This fact is often cited by alcoholics in an attempt to justify their continued use. The main problem with this rationalization is that alcoholics do not drink small amounts.
Alcohol relaxes you. Alcohol does act to relax a person as the blood alcohol level rises. However, alcohol levels above modest limits can actually make one more anxious as alcohol is eliminated from the body.
Alcohol helps you sleep. Alcohol does help people fall asleep; however, middle-of-the-night awakening is common, as well as inability to fall back asleep. Adverse effects on sleep have been documented to last for months after alcohol has been stopped.
Suggested Reading:
* Rosenqvist M. Alcohol and cardiac arrhythmias. Alcohol Clin Exp Res 1998;22(7,suppl.):318S-322S.
* Koskinen P, Kupari M, et al. Alcohol and new onset atrial fibrillation: a case-control study of a current series. Br Heart J 1987;57(5):468-473.
* Thun MJ, Peto R, et al. Alcohol consumption and mortality among middle-aged and elderly U.S. adults. N Engl J Med 1997;337(24): 1705-1714.
* Camargo CA, Hennekens CH, et al. Prospective study of moderate alcohol consumption and mortality in US male physicians. Arch Intern Med 1997;157(1):79-85.
* Roth T, Roehrs T, et al. Pharmacological effects of sedative-hypnotics, narcotic analgesics, and alcohol during sleep. Med Clin N Am 1985; 69(6):1281-1288.
Effects of Alcohol
The unique properties of alcohol have been linked to its effects on the cell membrane.3 In general, the cell membrane regulates the activity and stability of the cell. Alcohol nonspecifically increases cell membrane permeability. In addition, it affects various neurotransmitters and their receptors, such as gamma-aminobutyric acid (GABA), N-methyl-D-aspartate (NMDA), and serotonin.3 Thus, for any cell within the body, alcohol can exert an effect--including possible adverse events. This ability alone is enough to consider alcohol a universal cellular toxin. However, the toxic effects of alcohol frequently are not seen until after many years of use.
Absorption and Distribution: Alcohol is quickly and almost completely absorbed in the stomach.4 Food and juice slow the absorption, thus, the effects.5 Most people like alcohol because it works quickly (within 5 to 15 minutes). There is a connection between choice of abused substances and the rate at which the drug produces desirable effects: the faster the onset of action, the higher the abuse potential.6
Alcohol is distributed throughout all fluids and tissues of the body, in proportion to their water content;7 this is one reason why it causes so many problems and systemic complications. Women usually have more fat tissue than men, and will generally achieve higher blood alcohol concentration when given the same dose of alcohol per kg of total body weight.7
Pharmacology: Alcohol is a central nervous system depressant.8 While some excitatory transmitter systems are enhanced by acute alcohol ingestion, most of them are inhibited. The inhibitory transmitter systems are augmented, resulting in disinhibition. Because of this decrease in inhibition, people's behavior may change dramatically. As a result of its interaction with various neurotransmitters and receptors, alcohol produces changes in the channels of the cell membrane to allow influx and efflux of ions, such as chloride, calcium, sodium, and potassium.8 This change in ion flux leads to changes in cellular polarization which, for the most part, results in inhibition of neurotransmission.
Metabolism: Alcohol is eliminated predominantly by breakdown in the liver. It is primarily metabolized by alcohol dehydrogenase to acetaldehyde, which is then rapidly destroyed by aldehyde dehydrogenase.9 On average, the body metabolizes 1 oz (30 mL) of alcohol in about 3 hours, although this metabolism rate is weight-dependent.10 Genetically controlled variants of these enzymes in ethnic groups such as the Asian population are associated with a lower risk of alcoholism.11 This fact has led to the hypothesis that higher acetaldehyde levels produce an uncomfortable sensation that can deter excessive use. A small amount of alcohol--usually less than 1%--is eliminated unchanged through the lungs. This contributes to the odor of alcohol on one's breath.4
Approved Uses
There are numerous industrial uses for alcohol, including as a germicide and a solvent; however, medical indications and approved uses are limited.10 The only FDA-approved indication is in combination with dextrose as an intravenous solution for increasing caloric intake and replenishing fluids.12 Alcohol has an unapproved use in the treatment and slowing of premature labor.12 It has also been used to treat methanol poisoning10 and as a pain reliever when injected into a nerve to cause neural toxicity.10
Adverse Effects
Alcohol can produce a variety of adverse effects at different stages of use (FIGURE 1)10,13,14 Stages of use include acute ingestion of moderate amounts, severe intoxication, chronic ingestion, withdrawal, and effects as a result of malnutrition. Mental and psychiatric adverse events include anxiety, panic, sedation, euphoria, irritability, restlessness, aggressiveness, violence, depression, sleep disturbances, memory and cognitive deficits, confabulation, hallucinations, and delusions. A lifetime comorbidity of alcohol and psychiatric disorders of 86% has been reported, and often there is a worsening of psychiatric diagnoses.15,16
CNS effects can include headaches, cerebral atrophy, ataxia, and seizures. Skull fractures and subdural hematoma can occur. The eyes may undergo blurred vision, loss of vision, or color vision abnormalities. Cardiovascular effects can include cardiomyopathy, congestive heart failure, arrhythmias, coronary artery disease (with heavy consumption), hypertension, edema, increased risk of stroke with heavy drinking (especially hemorrhagic), but possible reduced risk of ischemic stroke with moderate doses. Respiratory effects can range from increased risk of pneumonia to asthma or acute respiratory distress.
GI effects include gastritis, ulcers, bleeding, malabsorption of food and nutrients such as vitamins, diarrhea or constipation, and esophageal varices. Liver problems include fatty liver, hepatitis, jaundice, fibrosis, cirrhosis, blood coagulopathies, hypoprotenemia, and ascites. Pancreatitis can develop. Genitourinary disorders such as electrolyte imbalances, urinary tract infections, and sexual dysfunction may occur. Neurological complications include paresthesias, peripheral neuropathies, extrapyramidal symptoms and pain as well as fetal alcohol syndrome. Musculoskeletal problems such as myalgias, cramps, atrophy, weakness, joint inflammation, worsening of rheumatoid arthritis, gout, bone ischemia, necrosis, and hypofunctioning marrow can arise.
Hematological disorders are common and include iron deficiency anemia, macrocytic anemia, leukopenia, and thrombocytopenia. Dermatological adverse effects can include dermatitis, flushing, angiomas, urticaria, bruising, and sweating. Endocrine complications include altered glucose tolerance, unstable diabetes, menstrual cycle irregularities, and gynecomastia. In addition, the immune system has an impaired response. Finally, alcohol use has been associated with neoplasms in the upper digestive and respiratory tracts, liver, and with possible increases in breast and large bowel cancers.
Drug Interactions
Alcohol can alter the elimination of certain drugs by affecting gastric emptying, hence their absorption, or liver metabolism.17 Binge drinking is associated with inhibition of cytochrome P4502E1 (CYP2E1), whereas chronic heavy alcohol intake induces the activity of that enzyme group. Induction of CYP2E1 can lead to production of metabolites more toxic than the parent compound, such as is seen with concomitant use of acetaminophen.17 Alcohol can also enhance the adverse effects of various drugs, especially the sedative effects of benzodiazepines and older antihistamines.17
Use of alcohol in combination with cocaine can produce cocaethylene. This metabolite has a higher toxicity than either agent alone and has been found to produce marked toxicity.18 Recently, the combination of alcohol and methylphenidate has been found to undergo the same transformation, and may be the cause of serious adverse events.19
Long-Term Use
People who use alcohol regularly over several months can become physically dependent on it. Upon abruptly stopping, withdrawal will start within 4 to 12 hours. The symptoms will vary considerably from person to person. Sometimes the person will be asymptomatic. Withdrawal can last from 3 to 10 days. If severe withdrawal occurs and goes untreated, death can result.20
Many alcohol-dependent people never go into withdrawal because they are always drinking small amounts. Morning drinking may be an attempt to treat withdrawal. Very few people drink in the morning to get intoxicated or drunk; instead they drink to maintain performance at work. Tolerance to alcohol occurs quickly, so that more is needed to produce the same effect.21 People who can "hold their liquor" have most likely developed tolerance.8,22
Alcohol Dependence
Chemical dependence on alcohol affects almost every aspect of a person's life. In addition to the physical and mental effects cited, a person with alcohol problems will usually have major problems at work or school, with his or her family, or with friends. Financial and legal problems are also usually present. For a diagnosis of alcohol dependence, a person need only have three of the following:23
-Tolerance to the effects of alcohol so that a person needs more to produce the wanted effect--or gets less effect with the same amount.
-Withdrawal such that characteristic symptoms occur when the person stops drinking--or the person drinks to relieve withdrawal symptoms.
-Alcohol is consumed in larger amounts--or for a longer time than was intended.
-A person makes repeated attempts to cut down or control the amount of alcohol consumed.
-A lot of time is spent in obtaining alcohol or recovering from its effects (hangover).
-Important social or recreational activities are given up because of alcohol use.
-A person continues to drink even though he or she knows his or her medical or psychiatric problem is made worse by drinking.
Acute Toxicity
Acute ingestion of large amounts of alcohol can result in death due to cardiovascular collapse and respiratory arrest. Blood levels associated with coma and death average 400 mg/dL;10 however, this varies considerably; some individuals have tolerated levels as high as 1,510 mg/dL.24 (Hangover is the aftereffects of consuming alcohol and is usually related to amount consumed. It may be a combination of mild withdrawal and side effects, both mental and physical.)25
Despite the common belief that beer, wine, and liquor have different pharmacological effects, these effects depend only on the percentage of alcohol contained in the beverage. Certain substances in various beverages have been reported to produce more hangover effects. Some beverages also can be consumed faster than others, but the active ingredient is still ethyl alcohol.
Treatment
Alcohol dependence is straightforward, but difficult to treat. Withdrawal is usually treated with a safer, cross-tolerant drug; benzodiazepines are the agents of choice.26 Treatment is given for only 3-7 days to reduce the associated 10% death rate closer to 0%-1%.20 Concomitant medical and psychiatric problems, which are frequent, need to be addressed and treated effectively.20 Education about the disease of alcoholism is essential. Supportive treatment in the form of psychotherapy and group therapy is often initiated.20 Family therapy is almost always indicated, as there is often serious dysfunction in an alcoholic's family. Most people are encouraged to attend Alcoholics Anonymous (AA), as this is one consistent modality that helps people recover.20
Comorbid psychiatric disorders need aggressive treatment, usually with pharmacologic and nonpharmacologic treatment. Referral to practitioners with experience in addiction treatment may be useful in developing a successful treatment plan to prevent or minimize relapse. Recovering addicts may require initial and/or long-term treatment with nonaddictive medications. Pharmacological treatment of ethanol dependence with agents, e.g., naltrexone, can reduce drinking frequency and relapse rate.27 All substances with potential for abuse should be stopped and avoided.28 Learning and practicing alternative, safe activities that produce pleasure and decrease stress is essential in treatment and recovery.20
Conclusion
Alcohol is a drug. Practitioners need to be reminded that excessive use and/or high doses of alcohol can have profound effects on almost every system in the human body. Many medical and psychiatric conditions are often exacerbated, making these conditions difficult to control. FIGURES 1 and 2 help to demonstrate potential adverse effects of alcohol and may help practitioners rethink a patient's treatment plan if alcohol is involved and the patient is not responding optimally.
Nuclear Family Emotional System
The concept of the nuclear family emotional system describes four basic relationship patterns that govern where problems develop in a family. People's attitudes and beliefs about relationships play a role in the patterns, but the forces primarily driving them are part of the emotional system. The patterns operate in intact, single-parent, step-parent, and other nuclear family configurations.
Clinical problems or symptoms usually develop during periods of heightened and prolonged family tension. The level of tension depends on the stress a family encounters, how a family adapts to the stress, and on a family's connection with extended family and social networks. Tension increases the activity of one or more of the four relationship patterns. Where symptoms develop depends on which patterns are most active. The higher the tension, the more chance that symptoms will be severe and that several people will be symptomatic.
The four basic relationship patterns are:
Marital conflict- As family tension increases and the spouses get more anxious, each spouse externalizes his or her anxiety into the marital relationship. Each focuses on what is wrong with the other, each tries to control the other, and each resists the other's efforts at control.
Dysfunction in one spouse- One spouse pressures the other to think and act in certain ways and the other yields to the pressure. Both spouses accommodate to preserve harmony, but one does more of it. The interaction is comfortable for both people up to a point, but if family tension rises further, the subordinate spouse may yield so much self-control that his or her anxiety increases significantly. The anxiety fuels, if other necessary factors are present, the development of a psychiatric, medical, or social dysfunction.
Impairment of one or more children- The spouses focus their anxieties on one or more of their children. They worry excessively and usually have an idealized or negative view of the child. The more the parents focus on the child the more the child focuses on them. He is more reactive than his siblings to the attitudes, needs, and expectations of the parents. The process undercuts the child's differentiation from the family and makes him vulnerable to act out or internalize family tensions. The child's anxiety can impair his school performance, social relationships, and even his health.
Emotional distance- This pattern is consistently associated with the others. People distance from each other to reduce the intensity of the relationship, but risk becoming too isolated.
The basic relationship patterns result in family tensions coming to rest in certain parts of the family. The more anxiety one person or one relationship absorbs, the less other people must absorb. This means that some family members maintain their functioning at the expense of others. People do not want to hurt each other, but when anxiety chronically dictates behavior, someone usually suffers for it.
Example:
The tensions generated by Michael and Martha's interactions lead to emotional distance between them and to an anxious focus on Amy. Amy reacts to her parents' emotional over involvement with her by making immature demands on them, particularly on her mother.
[Analysis: A parent's emotional over involvement with a child programs the child to be as emotionally focused on the parent as the parent is on the child and to react intensely to real or imagined signs of withdrawal by the parent.]
When Amy was four years old, Martha got pregnant again. She wanted another child, but soon began to worry about whether she could meet the emotional needs of two children. Would Amy be harmed by feeling left out? Martha worried about telling Amy that she would soon have a little brother or sister, wanting to put off dealing with her anticipated reaction as long as possible. Michael thought it was silly but went along with Martha. He was outwardly supportive about the pregnancy, he too wanted another child, but he worried about Martha's ability to cope.
[Analysis: Martha externalizes her anxiety onto Amy rather than onto her husband or rather than internalizing it. Michael avoids conflict with Martha by supporting the focus on Amy and avoids dealing with his own anxieties by focusing on Martha's coping abilities.]
Apart from her fairly intense anxieties about Amy, Martha's second pregnancy was easier than the first. A daughter, Marie, was born without complications. This time Michael took more time away from work to help at home, feeling and seeing that Martha seemed "on the edge." He took over many household duties and was even more directive of Martha. Martha was obsessed with Amy feeling displaced by Marie and gave in even more to Amy's demands for attention. Martha and Amy began to get into struggles over how available Martha could be to her. When Michael would get home at night, he would take Amy off her mother's hands and entertain her. He also began feeling neglected himself and quite disappointed in Martha's lack of coping ability..
Martha had done some drinking before she married Michael and after Amy was born, but stopped completely during the pregnancy with Marie. When Marie was a few months old, however, Martha began drinking again, mostly wine during the evenings, and much more than in the past. She somewhat tried to cover up the amount of drinking she did, feeling Michael would be critical of it. He was. He accused her of not trying, not caring, and being selfish. Martha felt he was right. She felt less and less able to make decisions and more and more dependent on Michael. She felt he deserved better, but also resented his criticism and patronizing. She drank more, even during the day. Michael began calling her an alcoholic.
[Analysis: The pattern of sickness in a spouse has emerged, with Martha as the one making the most adjustments in her functioning to preserve harmony in the marriage. It is easier for Martha to be the problem than to stand up to Michael's diagnosing her and, besides, she feels she really is the problem. As the pattern unfolds, Michael increasingly over functions and Martha increasingly under functions. Michael is as allergic to conflict as Martha is, opting to function for her rather than risk the disharmony he would trigger by expecting her to function more responsibly.]
By the time Amy and Marie were both in school, Martha reached a serious low point. She felt worthless and out of control. She felt Michael did everything, but that she could not talk to him. Her doctor was concerned about her physical health. Finally, Martha confided in him about the extent of her drinking. Michael had been pushing her to get help, but Martha had reached a point of resisting almost all of Michael's directives. However, her doctor scared her and she decided to go to Alcoholics Anonymous. Martha felt completely accepted by the A.A. group and greatly relieved to tell her story. She stopped drinking almost immediately and developed a very close connection to her sponsor, an older woman. She felt she could be herself with the people at A.A. in a way she could not be with Michael. She began to function much better at home, began a part-time job, but also attended A.A. meetings frequently. Michael had complained bitterly about her drinking, but now he complained about her preoccupation with her new found A.A. friends. Martha gained a certain strength from her new friends and was encouraged by them "to stand up" to Michael. She did. They began fighting frequently. Martha felt more like herself again. Michael was bitter.
[Analysis: Martha's involvement with A.A. helped her stop drinking, but it did not solve the family problem. The level of family tension has not changed and the emotional distance in the marriage has not changed. Because of "borrowing strength" from her A.A. group, Martha is more inclined to fight with Michael than to go along and internalize the anxiety. This means the marital pattern has shifted somewhat from dysfunction in a spouse to marital conflict, but the family has not changed in a basic way. In other words, Martha's level of differentiation of self has not changed through her A.A. involvement, but her functioning has improved.]
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Don't Seethe in Silence
Don't Seethe in Silence
by Heather Long
Family life, married life - none of it is perfect and most couples that are married know this. There is the promise of married life when we're young - an image of the perfect happily ever after. Too often when a young couple, not prepared for the rigors of married life, discover that it's not a happily ever after unless they put in a lot of effort.
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Understanding this and accepting it is called being mindful in your acceptance. Your married life isn't going to be perfect. You and your spouse will argue. Your kids will yell at you. You'll be angry with them. When you can accept this, you won't seethe in silence and you won't walk around with a belly full of resentment and misery.
No One Is Perfect
It can be hard to wake up and realize that no one is perfect - not you and not your spouse. It can be hard maintain the expectation of perfection. It can create a great deal of stress on both of you and your marriage. It can be very unhealthy promote a belief in domestic bliss that is based on perfection.
Does that mean you and your spouse can never achieve a sensation of domestic bliss? Of course, you can. You can accept that from time to time you will disagree. You will argue. You will sort it out. You will make up. You will make love. You will snuggle. You will keep each other at arm's length. Disputes will become discussions, discussions may even become dispute.
If you practice mindful acceptance of these ideas, you will likely have a happier marriage. Sometimes, a good argument clears the air of all the little resentments that we foster. Did he forget to pick up the stuff at the store you asked for? Did she say she'd throw your laundry in and then forgot? We gather up these little resentments every day like Easter eggs.
Accept the fact that neither of you are not perfect and that you're going to make mistakes and you're going to argue. If you can do these things, chances are you and your spouse are going to work on the making up a lot harder than you did on the argument. You may be too angry to hear each other at first, but you're going to come back to that table of discussion again and again to sort it out - and you'll both be far less likely to just throw in the towel on the relationship.
Physical Abuse
Definition
Physical abuse is a form of child maltreatment (a broad category of behavior that also includes sexual abuse, emotional abuse, and neglect). As a general rule, physical abuse refers to the infliction of physical harm on a child by a parent or caregiver. It is not necessary for the harm to be intentionally inflicted, and in the majority of situations physical abuse is the unintentional end result of harsh disciplinary methods or corporal punishment that have escalated to point of physical injury or the risk of physical injury. Physical abuse often occurs simultaneously with other forms of child maltreatment. An unfortunate but common example of this is when a boy is hit with closed fists by his father while also being belittled and verbally insulted. In this case, the boy would be considered to have experienced both physical and emotional abuse.
Establishing a precise definition of physical abuse is difficult due to the different standards that can be applied to this term. For example, at what point do normal child-rearing behaviors cross the line into the realm of abuse? Although exact legal definitions vary in the United States from state to state, there are two commonly accepted types of definitional standards that can be used to specify what is meant by physical abuse. The first is the harm standard, which considers behavior as abusive only if it results in demonstrable harm or injuries. Demonstrable harm could mean bruises, abrasions, cuts, burns, fractures, bites, or any of a number of other injuries. The second definitional standard for physical abuse is that of endangerment. Under this standard, physical assault by a parent or caregiver that presents a substantial risk of physical injury is considered abuse. Behaviors that would be considered abusive under this standard include hitting a child with a hard instrument or with closed fists, burning, scalding, poisoning, suffocating, drowning, kicking, shaking, choking, and stabbing. Although these actions may not result in observable injuries such as bruises or cuts, they are still considered abusive under an endangerment standard. Comparing these two standards, it can be seen that injury to the child is central to harm definitions while perpetrator behavior is the focus of endangerment definitions. Furthermore, harm definitions are more restrictive and more objective than endangerment standards.
Incidence and Prevalence
Physical abuse is a widespread problem in the United States and its incidence appears to be increasing according to figures from the Third National Incidence Study of Child Abuse and Neglect, or NIS-3 (Sedlak & Broadhurst, 1996). The NIS-3 is the most recent of a series of congressionally mandated studies on the current incidence of child abuse and neglect in the United States. It is based on data collected in 1993 and compiles statistics for child maltreatment using both harm and an endangerment standard. The NIS-3 revealed that physical abuse as defined under its endangerment standard nearly doubled between 1986 and 1993, with the number of children being affected increasing from 311,500 to 614,100. Under its harm standard, the number of physically abused children increased during this period by 42%. Even under this more restrictive standard, the number of children who were physically abused during 1993 totaled 381,700. This corresponds to an annual incidence rate of roughly 5 out of every 1,000 children. It has been suggested that the increase in incidence rates is a reflection of an actual increase in the rate of physical abuse as well as a result of increased awareness among professionals of the signs and indications of physical abuse, leading to a greater likelihood that abuse will be identified and reported. In the majority of cases of physical abuse, a birth parent is found to be the perpetrator. Overall, physical abuse constitutes 22% of all child maltreatment in the United States.
The phenomenon of physical abuse is not limited to any specific subset of the population. Families from all racial/ethnic and socioeconomic backgrounds engage in physical abuse, and children can be subjected to physical abuse regardless of their sex or age. However, certain social and demographic factors are correlated with higher levels of reported physical abuse. According to the NIS-3, children of single parents were 77 percent more likely to be harmed by physical abuse. This increased level of risk can be understood as a likely result of the stress and pressure of single parenthood. Single parents often find themselves socially isolated from sources of support that could help decrease the burdens of parenting, and they can also lack adequate models to help them make disciplinary choices that are less likely to lead to physical abuse. Additionally, compared to children from families earning more than $30,000 a year, children from families making less than $15,000 annually were almost sixteen times more likely under the harm standard and nearly twelve times more likely under the endangerment standard to experience physical abuse. Again, this finding is understandable given the association of low income with stressors that may lead parents to engage in discipline methods that are likely to become physically abusive.
In other studies examining risk for physical abuse, it is clear than any conditions that increase distress for the family, parent or disrupt interaction between parent and child will increase risk for physical abuse. Such conditions include: children with complex medical problems or developmental delays, children who are unwanted, “difficult" children who are hyperactive, children whose caregivers are under significant life stressors or have unrealistic developmental expectations of children.
Identification and Reporting
It is important to remember that “child abuse thrives in the shadows of privacy and secrecy; it lives by inattention (Bakan, 1971).” The first step in preventing and treating physical abuse is identification and reporting. Children may disclose physical abuse to teachers, physicians, family friends, or their own friends. Disclosures may be indirect, such as a child saying, “I have a friend whose father hits them and hurts them.” Many children find it difficult to openly discuss the abuse that is occurring. They might also be frightened, since many abusers threaten the child in order to make him or her remain silent and not discuss family matters outside of the home. Any disclosures by children of any age should be taken seriously and reported to law enforcement officials.
Further complicating the identification of physical abuse is the fact that children will often cover up for abusive parents and not discuss the cause of an injury, even when questioned. The child may say, “I can't remember,” or, “It was an accident.” Sadly, many children experience abuse from such a young age, they may think abusive behavior is normal. All children, particularly adolescents, are more likely to disclose physical abuse to an adult with whom they have developed a trusting relationship such as a teacher or counselor. It takes great courage for children to speak about physical abuse, particularly if the abuser is a parent.
Physical Indicators
Physical abuse is the most visible form of child abuse or maltreatment because physical indicators are the first to be noticed. The first step to eliminating child physical abuse is to acknowledge that it occurs. The next step is to learn to recognize the signs and symptoms in order to determine if a child is being abused. There are several factors to be considered in raising the question of possible physical abuse. First, the location, nature, and extent/severity of the injury are important to consider. Does the injury fit with the explanation given? Is the child's age or developmental stage consistent with the type of injury? For example, burns that are in the shape of an iron, grill, or cigarette, or immersion burns that children could not have inflicted upon themselves. Other indicators may include human bite marks, fingernail scratches that leave parallel linear marks, or other lacerations or abrasions that may indicate an instrument used. Some children may have missing, loose, or broken teeth, bald spots on their head, or bruises/welts in various stages of healing all over the body.
Behavioral Indicators
Depending on the child’s age, level of functioning, and developmental stage, behavior can be an indication that something is wrong. The following are some of the behavioral indicators which may suggest possible physical abuse: the child is unusually wary of physical contact with adults, seems frightened of parents or other adults, is afraid to go home, or is overly compliant with authority. These children may wet the bed and exhibit regressed behavior. Abused children may be shy, withdrawn, and uncommunicative or hyperactive, aggressive, and disruptive. Many abused children do not show emotion when they are hurt, and as discussed earlier, offer implausible explanations of injuries. A caution flag should be raised when a child is habitually absent from school or late without an explanation from the parents. Parent may be keeping the child at home until physical evidence of abuse has disappeared. When they come to school, they may wears inappropriate long-sleeved or high collared clothing on hot days to hide injuries. It may appear to others that the child is accident prone or just moves/walks awkwardly. It is important to pay attention to these indicators and not dismiss them as insignificant, especially when several of these occur together. Older children may exhibit different behavioral signs than younger children. For example, they may engaging in acting out behavior such as running away, getting involved in criminal activities, or engaging in self-destructive behaviors such as abuse of drugs and alcohol.
Mandatory Reporting
All fifty states currently have mandatory child abuse reporting laws in order to qualify for funding under the Child Abuse Prevention and Treatment Act (CAPTA, 1996; U.S. Department of Health and Human Services, 2001). Although all states have some type of reporting law, each state differs in their application of mandatory reporting laws.
Mandatory reporting refers to a legal obligation to report suspected or known child maltreatment. Many people do not know that failure to report carries a legal penalty. Mandatory reporting legislation overrides any professional code of conduct or ethical guidelines. For example, although psychologists must maintain client confidentiality, they may break this confidentiality if a client reports that a child is being abused. Medical practitioners, psychologists, police officers, social workers, welfare workers, teachers, principals, and in many states film developers are all mandatory reporters. Several states have broadened the list of mandatory reporters to any person suspecting abuse.
Although mandatory reporting laws vary from state to state, there are some general guidelines to follow when determining whether to report abuse. The most obvious would be when a child reveals that he or she has been abused. However, often it will be a sibling, relative, friend or acquaintance that reveals the abuse. In some cases, a child may reveal that he or she knows someone who being abused. In such a case, there is a legal responsibility to report the abuse to the proper authorities, either the police or children’s protective services. As noted earlier, there are many indicators of abuse. Based on observations of a child, if abuse is suspected, it must be reported. It is important to note that proof of abuse is not required to make a report. The requirement is whether there is knowledge or suspicion of abuse. If there is suspicion or knowledge, the name of the suspected abuser and child should be reported to children’s protective services or the police. Most states have toll-free abuse reporting hotlines where anonymous reports can be made.
The National Incidence Study of Child Abuse and Neglect reports that there has been a forty-one percent increase in the number of reports made nationwide since 1988 (U.S. Department of Health and Human Services, 2001). However, reporting abuse does not necessarily mean that all abused and neglected children are being identified. Some research has indicated that many professionals fail to report most of the maltreated children they encounter. Hence, underreporting continues to be a major problem in the war against child abuse.
Impact of Physical Abuse on Children
Child physical abuse damages children physically, emotionally and socially. The most obvious and immediate result is physical.
Physical
An abused child may experience one of more of the following: hitting, shaking, choking, biting, kicking, punching, burning, poisoning, suffocating, or being held underwater. Physical abuse may lead to bruises, cuts, welts, burns, fractures, internal injuries, or in the most extreme cases death.
Initial impact on children will be the immediate pain and suffering and medical problems caused by the physical injury. However, the pain will last long after the bruises and wounds have healed. The longer physical abuse of a child occurs, the more serious the impact. Chronic physical abuse can result in long term physical disabilities, including brain damage, hearing loss, or eye damage. The age at which the abuse takes place influences the impact of the damage. For example, infants who are physically abused are more likely to experience long-term physical effects and neurological alterations such as irritability, lethargy, tremors, and vomiting. In more serious cases where the abuse was more forceful or longer in duration, the infant may experience seizures, permanent blindness or deafness, mental and developmental delays or retardation, coma, paralysis, and in many cases death. This has recently been called the “Shaken Baby Syndrome” since it most often occurs as a result of violent shaking or shaking of the head.
Emotional
Beyond the physical trauma experienced by children, there are other consequences of physical abuse. Studies of physically abused children and their families indicate that a significant number of psychological problems are associated with child physical abuse. Abused children compared with non-abused children may have more difficulty with academic performance, self- control, self-image and social relationships. A recent US study comparing physically abused and non-abused children provided considerable evidence of the negative and lasting consequences of physical abuse. The physically abused children in the study experienced far greater problems at home, at school, amongst peers and in the community.
Children who are physically abused have a predisposition to a host of emotional disturbances. They may experience feelings of low self-esteem and depression or may be hyperactive and overly anxious. Many of these children may exhibit behavioral problems such as aggression towards other children or siblings. Other emotional problems include anger, hostility, fear, humiliation, and an inability to express feelings. The long-term emotional consequences can be devastating. For example, children who are abused are at risk of experiencing low self-esteem, depression, drug/alcohol dependence, and increased potential for child abuse as a parent.
Social
The social impact on children who have been physically abused is perhaps less obvious, yet still substantial. Immediate social consequences can include an inability to form friendships with peers, poor social skills, poor cognitive and language skills, distrust of others, over-compliance with authority figures, and a tendency to solve interpersonal problems with aggression. In their adult life, the long-term consequences can impact both their family and their community. There are financial costs to the community and society in general, e.g., funding social welfare programs and services and the foster care system. Studies have shown that physically abused children are at a greater risk for mental illness, homelessness, crime, and unemployment. All of these affect the community and society in general and are the social costs of physical abuse.
Interventions
Every family that experiences physical abuse is different. Therefore, effective interventions must target the problems and deficits specific to each family that increase the risk of physical abuse. An inability to appropriately control and express anger is an example of a risk factor that is frequently associated with parents who engage in physical abuse. For these parents, anger management would be a useful intervention. Goals of anger management include the lessening of heightened arousal levels during challenging parenting situations, the improvement of abusive parents’ coping skills, and the reduction of the probability that parents will have uncontrolled emotional reactions that end in physical abuse. Techniques that can be used to attain these goals including training parents in the use of positive imagery and relaxation methods, helping them identify when they are angry before their emotions get out of control, and teaching them how to come up with thoughts that help them stay calm.
Another risk factor associated with physical abuse is social isolation, a concern that can be addressed through the use of education and support groups. Parents also engage in physically abusive behaviors because they are unaware of effective parenting techniques. Educating these parents about such useful skills as active listening, unambiguous communication, nonviolent means of discipline, and setting meaningful rewards and consequences for specific behaviors can go a long way towards reducing the risk for the recurrence of physical abuse. Interventions focusing on skills training should give parents plenty of opportunities to observe others model parenting techniques and should also provide parents with role-playing and real-life exercises that allow them to practice what they’ve learned in a safe, non-threatening environment. These interventions can also allow parents to receive honest feedback about their parenting behaviors from experienced professionals.
Finally, other conditions that go beyond simple deficits in knowledge or difficulty managing anger can interfere with the ability of parents to appropriately discipline their children. These include external pressures such as financial problems, interpersonal difficulties like marital strife or domestic violence, and serious mental health conditions such as schizophrenia, major depression, and substance abuse problems. When these circumstances are linked to physical abuse, wide-ranging solutions must be sought, whether this means connecting parents with appropriate social services or locating referrals for marital counseling, psychotherapy or psychiatric care.
Intervening when physical abuse is identified not only involves working with the perpetrators of the abuse but also includes treating the wide-ranging emotional and behavioral consequences that physical abuse can have for children. For example, it is common for children to experience symptoms of post-traumatic stress in the aftermath of physical abuse. Providing these children with anxiety management techniques and psychoeducation about family violence can be a useful intervention for these symptoms. Play therapy can also be helpful in providing children with an opportunity to express and work through the painful emotions that may be contributing to anxiety, depression, or behavioral difficulties. Often, those who have been physically abused need help expressing their anger in appropriate ways. For these children, interventions include teaching them relaxation techniques, engaging them in role-playing exercises, providing them with supervised group interactions and feedback, and helping them identify the signs of anger early in order to prevent inappropriate outbursts. Children who exhibit difficulties in their relationships with peers and adults as a result of their abuse can benefit from social skills training that teaches them how to have positive interactions with other children and come up with solutions to problems and ways of handling negative social situations. Another useful intervention with children who have poor peer relationship skills pairs them with children who have been identified as having strong social skills. These children then engage in positive play activities together with the expectation that the less socially-adept children will begin to behave in more appropriate ways towards their peers. While mental health professionals deliver the majority of these interventions, school personnel can also be brought in to help with both the academic deficits and behavioral problems that can result from a history of abuse.
Prevention
A number of prevention and intervention efforts have been designed to help decrease the scope and frequency of child physical abuse. Knowledge is the first step to prevention of child abuse.
Early detection of physical abuse starts with teachers, day care center, hospitals, and other agencies that serve children and families. Professionals that work with children must be educated about identifying abuse. In all states, these professionals are considered mandatory reporters and are required by law to report abuse. Beyond educating those who might detect abuse, prevention efforts have focused on both the population in general as well as population subgroups that have been identified to have a higher risk of engaging in abusive behaviors. They include such indirect means as using media campaigns designed to spread information on child development or parenting skills. Other prevention efforts involve establishing peer helplines to provide support for parents experiencing crises that could increase their likelihood of abusing their children. Another approach is to develop ways to get parents who would otherwise be isolated from their child-rearing peers linked to social support networks.
An example of a more direct prevention program would be one that provides in-home family support for parents who are considered to be at risk: families with lower socioeconomic status, single parents, inexperienced or isolated parents, or those with alcohol or drug problems. Health services professionals often offer such preventative measures to parents at stressful transition points in their lives when the risk of physical abuse is judged to increase. Because abuse is transferred from one generation to the next, it is important to understand that children who are abused are at higher risk for being abusers. It is understandable that children who have not received the needed nurturance and support from their parents may find it difficult to provide this for their children. Prevention efforts must acknowledge the intergenerational patterns of violence and work with children who are abused to prevent them from becoming abusers themselves.
Future Directions
The majority of studies related to physical abuse have been descriptive, focusing primarily on prevalence and possible causes, or retrospective in nature. Little empirical research has been conducted with children who have experienced physical maltreatment despite the fact that it remains one of the foremost reasons for referral to child protective services. Areas for future research include examining longitudinal outcomes for children who have experienced physical maltreatment. Such longitudinal studies could include duration and treatment modalities. Focus on information related to the child’s placement in foster care is also important, especially length of stay in custody, types of placements (e.g., foster home, group home, residential treatment), placement disruptions, and type of permanent placement. Examining the long-term effects of physical abuse would provide important direction for treatment and the potential placement of children who have similar experiences in the future.
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