Invisible, Part 2

Debbie and Jim continued therapy. While some sessions were focused on Annie’s disordered eating, a large portion of the rest of the sessions were dedicated to Debbie and Jim’s relationship, specifically, Jim’s narcissism and Debbie’s response to such. The following is nearly a complete session, followed by analysis and recommendations for Debbie.

One evening, in between sessions, I unexpectedly met Jim and Debbie at a local pizza restaurant. In this particular restaurant, a small room was set aside for parties and a long table ran the length of the room. On the wall behind the head of the table was the phrase “El Presidente” in large Mexican script.

On the occasion at hand, Jim was seated at the head of the table. Debbie, the girls and extended family sat around the table. I was following a waitress past the room to another table when Jim spotted me.  Debbie was standing by Jim and in the process of handing him a gift-wrapped box (it appeared to be Jim’s birthday). Suddenly, Jim yelled, loudly, “Edward, I’m the president…and this (gesturing to Debbie) is my staff!” I quickly looked at Debbie. She looked embarrassed and then quickly smiled, to her family and then to the rest of the restaurant, as Jim’s loud comment brought the restaurant to a quiet standstill. I briefly smiled, waved and moved on to my table.

About a week later, Debbie and Jim came in for a session. As is my habit, I asked them, “What have you two created between yourselves since our last appointment?”

Debbie quickly looked at Jim and then down to the floor. After a minute, Jim broke the silence.

“Well, I guess I will start…since no one else will. Debbie has been angry with me since we saw you at the restaurant.” Jim rolled his eyes. “She’s been ranting non-stop, wanting me to apologize for saying hello to you! Can you believe that?  I have no idea what she is so mad about but Lord, doc, anything you could do to get her over her fit would be much appreciated.”

“What do you think Debbie is mad about, Jim?” I asked.

“I have no idea.” Said Jim.

“No idea at all?” I pushed.

“No! She gets like this every so often.” Jim shrugged.

“Does Annie ever act like this?” I inquired.

“Yeah, now that you mention it….maybe it’s a period thing (Jim chuckled.). Annie is old enough to be having periods now.” Jim seemed pleased with his ‘insight’.

“Did you ask Debbie what she is mad about?” I inquired.

“Yeah, a number of times actually.” Jim defended.

“And what did she say?”

“I don’t know….she keep going on and on about me ‘always doing that’ or some such baloney. I don’t know what she is talking about. She gets like this!” Jim rolled his eyes again. “How do you think Annie is doing?” he asked, moving the topic.

“Let’s stay with you and Debbie for now Jim. I want you to ask her, right now.” I directed Jim.

“Here….in here? Look, like I said, I have done that a number of times at home and I’ve told you, she makes no sense. She just gets angrier and angrier at me.” Jim refused.

“No Jim, this is important. I want you to ask her again. I know, she could get angry again at you but I’ll be here for you. You ask and I’ll watch. Maybe I can understand her and explain it to you.” I pushed. I looked at Debbie as I spoke. She had no expression on her face but met my gaze.

Jim rolled his eyes again. “Ok”, looking at the floor, “what are you so mad about?” Jim asked.

“Stop” I interjected. “Jim, you were looking at the floor.”

“So….I was talking to her.” Jim said.

“No, you were talking to the floor.” I insisted.

“Oh, for crying out loud! Ok, (Jim now looking at Debbie). What are you so mad about?”

“About you, about how you treated me at the restaurant!” Debbie said with a fairly loud voice. I was impressed with her firmness.

Jim shook his head from side to side and looked at me. “You see doc, she doesn’t make any sense. I don’t understand her. Are all women like this?”

“She made sense to me. I heard why she is angry with you.” I countered.

“What…..what is she mad about because I didn’t hear anything.” Jim refused.

“Ask her again Jim.” I pushed.

“You said you were going to explain it to me.” He resisted.

“I did but I think you can do this yourself Jim” I pushed again. “Ask her again and listen real hard this time.”

“I am not a child! … What are you angry about (Jim said to Debbie, looking at her with considerable frustration in his face)?”

“You Jim, I am angry with YOU! In the restaurant, you called me your ‘staff”!” Debbie said, now almost yelling. Again, I was impressed.

“What are you talking about?” Jim bit back, now engaged with Debbie.

“You. I am talking about you, in the restaurant, you called me your staff…in the restaurant….in front of about, and I don’t know, 50 people. Everyone was looking at me! I felt like a fool. I felt like a…servant.” Debbie, again, almost yelling.

“I don’t know what you are talking about. I remember saying hello to him (motioning to me) but that was all. You are just too sensitive. You are crazy.” Jim answered, now also loud.

“No Jim, she is not…not crazy and yes, you did call her your staff. You said, in front of the all the people in the restaurant, “Edward, I am the president and here is my staff” pointing to Debbie.” I affirmed.

“I did not.” Jim refused.

“You did.” I stood firm, looking at Jim in the eye. Neither of us looked away for a minute.

“I did not. Jesus, what is this. Can’t I say hello to someone without it being a big deal?” Jim said continuing to claim ignorance.

“Yes you can but in this case, you didn’t do that. You didn’t say ‘Hi Edward”, you said, “Edward, I am the president and here is my staff!”

“So what!  What…was I supposed to ignore you? Jim looked at me with an expression of ignorance and indignation on his face.

“Does that mean you remember saying this Jim? I pushed.

“Ok, fine, next time I will ignore you in public!” Jim pouted.

“Does that mean you remember saying this Jim?” I pushed again.

“This is crazy. No! (Turning to Debbie) You are crazy! You have blown this whole thing out of proportion. I work my ass off for you and this is how you repay me!” Jim now fully in defense mode.

Debbie, looking pale and worried, looked at me.

“Jim, Debbie is not crazy. What she said you said, you said. I was there, I heard you.” I affirmed.

“What, now you are on her side? I thought this was to be about Annie and how she is going crazy.” Jim continued to defend himself almost wildly now.

“Jim, Annie is not crazy, Debbie is not crazy and I am not on her side. I am on both your sides. But you did say that. I heard it. Not only did I hear it, I felt embarrassed for Debbie. What you said was embarrassing… belittling.” I continued.

Debbie began to cry.

“Jim, ask Debbie why she is crying.” I urged.

Jim gave a great sigh. “…What is the matter? Jim said with contempt.

“No, Jim…Ask her why she is crying, nicely. I pushed.

“I did” Jim demanded.

“No, you didn’t. You insinuated she was crazy by your sigh and then you spoke down to her. Ask her why she is crying, nicely.” I insisted.

“Why are you crying!” he demanded.

“Again Jim, no! As……” Debbie cut me off.

“I am crying because he is right and that is the first time I feel supported.” Debbie was clear, despite her tears.

“WHAT! I support you every day. Who gets to say home all day….going to your book club, having lunch with your girlfriends? Who is that? It is not me but it is because of me that you can do that!” Jim was yelling now.

Debbie shrank in her chair.

“Jim, I want you to stop yelling. I understand you are mad but you don’t need to yell. What Debbie is saying is important. You need to hear her. Now, did you say, “Edward, I am the president and this is my staff?” I pushed.

“Yes…..godammit, I said that! What is your point?” Jim said loud but not yelling.

“So, when you said you didn’t say that, that was not true. You knew you said it but were…not admitting to it…. right?” I continued to push, knowing he was at his breaking point.

“What is the point of all this? So what if I said it? She was the one that took it wrong. Like I have been telling you, if you would listen to me for once, she is always too sensitive about things. She gets a stick up her ass and then goes crazy….and I then have to apologize! This is crap.” Jim sat back; very angry.

“No Jim, this is not crap. This is your marriage and in this case, this is a problem that is your fault.” Jim looked at me with an expression of surprise. He snorted and rolled his eyes.

“Jim (I continued), what you said to Debbie in the restaurant was insulting, belittling. You may not see that but you need to see it….because you are insulting and belittling at times. Not all the time…but some times. And…. you love your wife and girls and work hard to provide for them. But….you are belittling at times. I know, because I felt embarrassed at what you said. I was there. You were talking to me.”

“What, I can’t even talk now?” Jim continued to fight.

“No, that is not my point and this is part of your problem; you can’t admit when you are wrong.” I pressed.

“This is crazy (Jim shot back). Did she get to you? She has, hasn’t she? She’s convinced you that I am the problem; that I am the cause of Annie’s problems. The truth is that it is her that is the cause of Annie’s problems. She (gesturing to Debbie) is always getting obsessive about shit around the house. Annie sees this and is now starting to act just like her.”

“You are a jackass!” Debbie said. I was shocked but certainly could appreciate her observation.

“Debbie, I think it would help Jim if you could expound on your comment.” I suggested, wanted to laugh.

“I’m obsessive because you want things around the house to be perfect. Do you remember telling me how you thought there was a ring around the collar of your dress shirt a couple weeks ago? Do you know how embarrassed I felt about that? Not so much because there was a ring but because I see how you work your ass off for us and I don’t feel I measure up in return as your wife. DO YOU KNOW THAT!? Do you know that!? Yes, I am obsessive about things being clean and perfect….but that is to please you! And then you say crap like that, “here is my staff”. Fuck you Jim!! FUCK YOU! Debbie yelled.

I was shocked beyond words not only because Debbie had never talked like this before, but, more importantly, she was really confronting Jim and I didn’t think she knew how he would respond.  What if he decided to leave her? This was her biggest fear, based on her comments in our prior session.

“No name calling.” I quipped, wanting to do something to stop this run-away train.

Debbie looked at me, embarrassed.

“Jim, I think what Debbie is saying is the truth; not the fuck you part but from watching you two, I see and hear what she is saying. You want everything to be just so and Debbie has been running around trying to do that. Before kids, you two were able to do that with no apparent problems. But now, with kids, this can’t be done. The girls, or at least Annie is picking it up and exhibiting it. I’m surprised the girls haven’t been exhibiting problems before now.  You two both have created this problem. It is not all Debbie’s fault. It is not all your fault.  Between now and our next appointment, I want both of you to watch yourselves. Jim, I want you to look at all the things you expect from Debbie. Debbie, I want you to look at all the different things you try to do or make perfect for Jim. Ok?” I concluded.

“Ok (said Jim) but before we stop, I have a question. What is the big deal now about my coffee?” Jim retrenched.

“What do you mean?” I asked, looking quickly at Debbie and back to Jim.

“It used to be I always had a cup of coffee waiting for me when I went into the bathroom in the mornings. Now, she doesn’t bring it. What is the deal?” Jim pressed.

“Jim, I want you to ask Debbie this”, I directed Jim.

Jim looked at Debbie with an expectant look. “What is the problem?” Jim asked with sarcasm.

“No Jim.” I said. “That was sarcastic….and you know it. Ask her with respect. After all, she has been bringing you a cup of coffee for quite some time now.”

“…and I am working my ass off for her for quite some time!” Jim forced.

“There are two ways to look at this Jim. You are working your ass off to allow her to stay home and take care of the girls and your home or she is staying home taking care of the kids and your house so you can work. Which is it?” I pressed.

“What is your point?” Jim was still stuck.

“I don’t want to get you your coffee any more in the mornings….or at least for a while.” Debbie interrupted. Again, with admiration and surprise, I thought, ‘Who is this woman?’

“Jim (Debbie continued), I love you and have done almost anything for you in the past but at times I have felt like a slave and I don’t want that anymore. And more importantly, I think Annie is starting to feel that same way….like she has to please you…with good grades, with everything.”

“Here we go again….It is my entire fault” Jim dug in.

“No, Jim that is not what I am saying. You get your own coffee at work. I want you to get your own coffee at home.” Debbie concluded.

“Fine!” Jim sulked.

……

This is narcissism! Or, at least, one face of it.

I did not get far with Jim in this (one) session…and that is the nature of working with narcissists and what spouses experience when they begin trying to make changes at home. Persistence (when confronting inappropriate behavior, making a request, clarifying a point you are making, etc.) is critical and is a good reason to consider engaging the aid of therapist; to support you over time in this process.

Note the different ways Jim avoids, denies and outright lies about what he said. First, he says he has no idea what Debbie says she is mad about. Next, he balks at the idea of engaging her in a conversation in the session. Then he tries to talk to her when looking at the floor. Later, he changes the topic to focus on what he is supposed to do when we meet in public. Then he claims to not understand what Debbie is saying. Ultimately, he denies what he said when confronted directly. This is classic narcissism! To be successful in confronting a narcissist, you must be able to see such tactics and be able to respond to them calmly but firmly.

Note the comment, “I am not a child.” This is important in understanding what is going on inside the narcissist (but not a piece of information to use when confronting him, at least in the beginning). Internally, the narcissist feels powerless, insecure and afraid. He defends himself by projecting the exact opposite in public. This is why his defenses are so strong.

Also be aware, typically, an outside person’s opinion may have more weight or authority when confronting the narcissist on their inappropriate behavior. Many times during the session, I confronted Jim and he denied…and I re-confronted…and eventually, he admitted what he’d done. If you try this at home, he probably won’t confess his wrong-doing; because you are his spouse (Haven’t you ever doubted your spouse’s opinion because you didn’t think they knew what they were talking about?). Because of this, it is critical that you remain calm when addressing him, persist in your point and not get emotional or “give-up” the struggle to make your point.

He may never confess…to you; and later, confess to a therapist. Still, don’t give-up in the fight. Why? By showing him you are not going to back down and remain calm and not be derailed or confused, you are showing him strength and determination. Most spouses, by the time they end up in my office, have a history of starting to confront him for inappropriate behavior but when encountering denials, avoidance, etc., they give up the fight. By then, he knows you are someone who will give up and in most cases, when in a fight, he is just waiting for you to do that (give up).

Further, showing this determination and strength is important because you will need this to face your future. Narcissists are hard to live with! Most who live with one assume a subservient role.

This is another important point to notice in this dialogue. If you get the “feel” of Debbie’s position in the relationship during the session, she bounces between being quiet (but aware of what Jim was doing), to being assertive, then aggressive (“You jackass!” I don’t approve of name calling but that was well placed!), then tearful, then assertive and clever. The jury is still out on this couple – I don’t know if they will stay married. Whether they stay together or not, Debbie is going to need strength and determination.

Jim gives a wonderful example of “gas-lighting” in the session. When confronted about the comment, he denies, changes the subject, tells Debbie she is crazy, etc. It is only when I address him directly and oppose his views of his behavior does he admit to being rude and then in a fit of anger.

Which brings me to my last point, are you strong enough to resist Jim’s emotional sabotage? At the end of the session, Debbie says she is not going to bring him coffee, citing that he gets his own coffee at work and thus, he can get his own coffee at home. Jim agrees but pouts, “Fine!” Can you resist the impulse, so prevalent in women, to take care of the other person? In many spots in the session, Jim gets emotional. Can you resist being bullied by this?

 

 

 

 

 

 

 

 

 

 

Tell Kids the Truth: Hard Work Doesn’t Always Pay Off

This article below if from the July 1, 2019 edition of Time Magazine.  As a quasi-perfectionist, this article really spoke to me and I have seen so many children and adults in my office dealing with the same struggles.

In short, the article says “the humbling, brutal, and messy reality” is that we can try our best and yet still fail and accepting this/teaching our children this can actually help yourself/them become more resilient.

Worth a read!!

 

Tell Kids the Truth:  Hard Work Doesn’t Always Pay Off

By:  Rachel Simmons

A star athlete at the college where I work recently stopped by my office.  After committing a few unforced errors during a weekend match, she was riven by self-criticism.  “I can’t stop beating myself up,” she told me.  “I’m at peak fitness, and I practice hard.  How is this happening?”

This student, like many I teach, believes she should be able to control the outcomes of her life by virtue of her hard work.  It’s a mentality verting on invincibility:  a sense that all-nighters in the library and hours on the field should get her exactly where she needs to go.

I study and write about resilience, and I’m noticing a troubling spike in students like this athlete.  Their faith in their own sweat equity confers a kind of contingent confidence:  When they win, they feel powerful and smart.  When they fall short of what they imagine they should accomplish, however, they are crushed by self-blame.

We talk often about young adults struggling with failure because their parents have protected them from discomfort.  But there is something else at play among the most privileged in particular: a false promise that they can achieve anything if they are willing to work for it.

Psychologists have sources this phenomenon to a misapplication of “mind-set” research, which has found that praising children for effort will increase academic performance.  Developed by Stanford psychologist Carol Dweck, mind-set education has infiltrated classrooms around the world. But a 2018 analysis found that while praising effort (“You worked hard!”) over ability (You’re really smart!) may benefit high-risk or economically disadvantaged students, it does not necessarily help everyone.

One possible explanation comes from Suniya Luthar and Nina Kumar, who argued in a research paper last year that for teens in wealthy, pressure-cooker communities, “it is not a lack of motivation and perseverance that is the big problem.  Instead, it is unhealthy perfectionism, and difficulty with backing off when they should, when the high-octane drive for achievements is over the top.”  This can lead to physical and emotional stress.  In a 2007 study, psychologists Gregory Miller and Carsten Wrosch determined that adolescent girls who refused to give up impossible goals showed elevated levels of CRP, a protein that serves as a marker of systematic inflammation linked to diabetes, heart disease and other medical conditions.  A 2014 study my Luthar and Emily Lyman showed a correlation between the perfectionist tendencies of affluent youth and their vulnerability to substance abuse and feelings of inferiority.

The humbling, brutal, messy reality is that you can do everything in your power and still fail.  This knowledge comes early to underrepresented minorities whose experience of discrimination and inequality teaches them to brace for what is, for no, largely beyond their control to change.  Yet for others, the belief that success is always within their grasp is a setup.  University of Chicago professor Lauren Berlant calls this “cruel optimism,” when the pursuit of a goal harms you because it is largely unachievable.  The college-admission game promises a meritocracy that rewards hard work with entrance to the ivory tower, yet admissions scandals and ultra-thin acceptance rates make such a promises impossible to keep.

Instead of allowing our kids to beat themselves up when things don’t go their way, we should all question a culture that has taught them that feeling anything less than overwhelmed means they’re lazy, that how they perform for others is more important than what actually inspires them, and that where they go to college matters more than the kind of person they are.

Then point is not to give our kids a pass on working hard.  But fantasizing that they can control everything is not really resilience.  We would be wise to remind our kids that life has a way of sucker-punching us when we least expect it.  It’s often the people who learn to say “stuff happens” who get up the fastest.

Invisible

This is the first of many articles I’ll be presenting over the next few months on narcissism.  In this article I present, in a fictitious session, a narcissist and his wife coming in for assistance for their daughter.  I present a brief background of the husband/father (narcissist) and the wife/mother.  Most of the dialog is from an initial session with the couple and of a later session with the wife alone.  Included are the suggestions I made to the wife regarding her husband and insights into the wife’s view of that relationship.  I see these dynamics portrayed often in my office.

 

Invisible

Jim is the president of the trust department of a bank in a large city. His wife, Debbie, works at home, raising their three children, Annie 17, “Mac” (Mackenzie) 15 and Lynn, 11. The couple came in due to Annie’s eating disorder; she was anorexic, 5’5” and weighs 100 lbs. Shortly after I began working with them, I realized Jim was narcissistic.  Debbie, seemingly, had no idea. I am writing about this couple/family because I want to show how narcissism can be invisible at times.

Jim came from a southern family. He was the oldest of three boys and his father spent a lot of time with his sons growing up. Fishing, hunting and sports were the main focus at home or rather, outside the home.  Jim’s father, I was told, was rather crude about women when they, he and the boys, where off together. When around his wife (and other women or in public), he was respectful and polite.  He expected his sons to be the same; respectful when with women but rough when with the guys.

Jim’s mother, on the other hand, ran their home like a general. She understood “Boys will be boys” but at home, she insisted on respect, manners and religion.  Jim’s father backed her on such.

As Jim grew, his self esteem and confidence also grew. Graduating high school, majoring in finance and graduating college, getting his first job at a prestigious banking institution, he was proud and made his parents proud.

He met Debbie in college. She was beautiful, smart and feminine; all the things Jim wanted. They started dating in freshmen year. Quickly, it was clear who was in charge. But that was ok with Debbie. If Jim wanted to do something, that was fine with her; no matter what it was, it would be fun with Jim. Jim was fun, in love and loyal. Debbie couldn’t ask for more and as such, she gave Jim all she had and never looked back.

Jim slowly began to recognize the power or influence he had with Debbie. He’d seen it in his parent’s relationship. He’d seen his father make decisions and his mother follow along; never questioning him, always supporting him. And it was not that his father just made decisions carelessly or selfishly. His father could always explain why he was deciding as he was deciding; could always point out how what he decided was best for he or his wife or the boys. Jim liked that. The correctness of his father’s decisions were right there in front of you…..the success of a close, loving family. What was to be questioned?

Economic growth and opportunity brought Jim and Debbie to this area. Jim’s salary allowed Debbie to not work and soon she was pregnant with Annie. Soon after, Mac came along. Jim climbed the corporate ladder and worked hard. Lynn eventually, came along. Debbie stayed home and took care of the house and girls. They were all happy.

Years passed….

I greeted Jim and Debbie in the waiting room. Because Jim was closer to me, I introduced myself and shook his hand first. As I reached to Debbie, repeating my name and shaking her hand, she told me her name. At the same time however, Jim interrupted and began telling me about their daughter. Debbie laughed nervously and then looked at Jim with a concerned expression. I asked them to follow me to my office. Jim followed me and kept talking. Debbie followed Jim.

Jim walked into my office first. Jim handed his coat to Debbie, who quickly took it. Jim sat down and started to talk before Debbie was settled.

“I just don’t know what is wrong with her. She seemed happy and is such a good girl but now she’s losing weight and apparently cries at night.”

“What do you mean ‘apparently’?” I asked.

“Well, uh, that is what Debbie tells me” Jim said, continuing to look only at me.

“Can you tell me about this?” I ask turning to Debbie.

“Well, like I said, my wife tells me most nights she will hear Annie crying in her room. Debbie says she’s asked Annie what is wrong but just brushes Debbie off.” Jim continues.

“Debbie, is that what you experience with Annie?” I again ask Debbie.

“This has been going on for months now. We are worried sick!” Jim laments.

“I understand and I’d be worried too if my daughter were struggling like this but… Debbie, tell me what you see and hear from Annie.” I ask again.

“I…told you doc…our baby is sick. Can you help her?” Jim said, now almost begging.

During this conversation, Debbie is continually looking at Jim every time I ask her a question; but not saying a word.

“Have either of you noticed I have asked Debbie a question now about three times and each time, Jim, you respond. I know you two are worried but…have either of you noticed this?” I ask.

“What….uh….well, I was just answering your question.” Jim responded. “What’s your point?”

“I don’t know if it is related to Anne’s struggles but I noticed you, Jim, answer for both, you and Debbie.” I said.

“What do you see going on with your daughter?” I ask Debbie.

Jim sat back a little with a worried and slightly disgruntled look on his face. He looked at that moment, I thought, like a parent trying to be patient while teaching his son or daughter to drive a car and the child turned right when he told them to turn left.

“Well, she is very worried,” Debbie began, almost hesitantly but with a firm voice. “She talks a lot about being worried, worried about all kinds of things and that she just can’t get herself to stop…worrying.”

“Just like I told you doc…” Jim jumps in.

“Well…not really. You said Annie was crying at night. Debbie said Annie is worried and can’t stop worrying.” Jim nodded his head sideways and gave a tight grin.

“Okay…but what do you think is wrong. What do you think we should do?” Jim pressed.

“I don’t know yet…” I responded. Jim looked back, rather shocked.

“Debbie, what has Annie been worrying about?” I continued with Debbie.

Debbie looked at Jim, who began to talk. I stopped him with my hand (holding it up like a ‘stop sign’). “Go on Debbie…what has Annie told you she is worried about?”

Again, Debbie looked at Jim, almost wanting him to talk for her but after a minute, she continued. “She is worried about making mistakes…” Debbie said as if she were revealing a forbidden truth.

“About making mistakes…?” I asking, encouraging her to continue.

“Yeah…” Debbie continued now without hesitating. Jim also didn’t jump in but he was looking at me directly, almost searching or demanding a statement or conclusion from me. “She says she is afraid of saying the wrong thing in class, not getting A’s, Jim getting upset with her because she didn’t do something around the house right….things like that.”

“What…” Jim was shocked at the last comment. “She’s afraid of me getting upset at her for not doing something right? Why didn’t you say something to me before this?

“Oh Jim, you didn’t do anything wrong. I don’t think it is you. This is her issue, all in her head. So I didn’t say anything to you. My God, you love all three of your daughters. Anyone can see that. This is her problem…but I don’t know what it’s all about.” Debbie looked back at me. “Have you ever seen this before?”

As the session continued, I noticed Debbie would easily fall back into the habit of deferring to Jim and Jim answering for both of them. It was not that Jim was arrogant in this conversation or interaction with his wife. He was just more…. dominant, in charge.

At the end of the session, I asked about rescheduling. Jim was quick to pull his schedule up and suggested, “I am free next Tuesday morning…” without asking Debbie.

“…and what is your schedule like honey…?” I said as if I were Jim, engaging her to schedule together.

“Huh…” Jim responded, looking up at me.

“You answered my question without asking Debbie when she wanted to reschedule or what day. This is part of that ‘talking over/for her’ stuff that I have pointed out to you a couple times over the last hour. Do you see that?”

“Uh…yeah.” Jim asked, genuinely confused.

“…and I’ll bet it has something to do with Annie, her behavior. It is something to think about. Anyway…” now looking directly at Debbie, “when do you want to reschedule?”

“I said Tuesday would be good.” Jim continued.

“You did it again Jim. I looked directly at Debbie and you answered for her. Debbie, when do you think you should come back?” I asked Debbie directly.

“I think Annie should come next.” Debbie said looking at Jim, almost pleadingly.

“Oh, yeah, that would be good idea.” Jim said. “Schedule Annie for next Tuesday doc.” Jim said to me.

“Once again Jim, look at what you just did. You went from scheduling with me on Tuesday, not asking your partner, to telling me to schedule Annie for next Tuesday, not asking me if I thought I should see Annie. What do you think that means….about you?” I asked Jim.

“I….don’t know. What you are getting at? Jim said with indignation.

“Jim, I know you love your kids and your wife but you think of situations, this situation, only from your perspective. You don’t ask Debbie her perspective or Annie hers. It is as if you expect yourself to know the answer and fix the problem. The fact is, you really don’t know what the problem is and this scares you. But, you act like you are in charge of the situation. You take over conversations, answer for others, say what others say is what you said, don’t ask others for their opinions, consider only your schedule, etc. Because of this, you miss a lot of information that could help you and others find solutions.” I said.

“….I don’t know…about this.” Jim said hesitantly.

“I understand. Ask Debbie what she thinks about what I am saying.” I directed.

Jim hesitated a minute and then looked at Debbie.

“I think he is right Jim. Sometimes, you just jump into things, start doing something without really looking at the situation first….and it messes things up. Look, this is not just about you. I am part of this too. I just stand back and let you take the lead.” Debbie said, watching Jim’s facial expression as she spoke, as if trying to read how he would respond to what she was saying.

“I am only just trying to help my daughter.” Jim said defensively.

“I know…but what has worked for you in the past may not work this time. You are being challenged, in this situation, to learn to ask others what they think is going on and what they think should be done, instead of telling others what the problem is and how to fix it.” I said.

I’d like to see you two again, together. When could you two come in” I asked again.

“Next Tuesday is go….” Jim stopped himself and looked at me. He then looked at Debbie.

“How is Tuesday for you honey?” I prompted.

Jim snorted, “Yeah, how is Tuesday for you?” he said to Debbie.

“Okay but I want to schedule an appointment for Annie also.” Debbie said.

Jim quickly looked from Debbie to me, with a surprised look on his face. “Jim,” Debbie spoke, “Is that ok with you?”

“Uh….yeah.”

……

Debbie came by herself the following Tuesday. Jim had an unexpected meeting and couldn’t attend.

“Tell me about your relationship with Jim.” I asked.

“Shouldn’t we be talking about Annie? Debbie questioned.

“We will but I want to start with you and Jim.” I redirected.

“Well, he’s a good man….We met in college and I quickly fell in love. He was tall, good-looking and funny. He always had a plan. He was kind, respectful hard-working…and faithful. So, I…I never questioned him, his opinion. It was easy, comfortable” Debbie said with a small smile.

“How the relationship been over the years?” I pushed.

“Jim has always been a hard-worker and again, has always been faithful.” She said.

“You already said that…I wonder why?” I said.

“I love Jim and I would never leave him. Most women would die for a chance to have a good man like him. He’s faithful, he provides well for us….but, over the years, I have begun to notice things, things I don’t….don’t want to acknowledge, much less talk about.” Debbie stopped.

“Such as….” I pushed.

“It is always about Jim! What we do, where we go….what we eat, who we talk to, hell, even how we make love!” She was silent. I was silent.

“It’s always been this way. In the beginning, it was fun to have someone who always had an idea of something to do, someplace to go, people to be with. I know, I am repeating myself.  I loved it. It was certainly better than being with my dad. He left us when I was 7. I remember mom and dad always fighting. He was always mad about something. Mom tried to do everything. I tried to be good and do everything right, so he’d be happy, so they wouldn’t fight. But he left us. Men leave.” Debbie cried.

“Do you think about leaving Jim?” I asked.

“No” she said (I wasn’t so sure), “…it’s just….my whole life is wrapped around him. I don’t think I would know who I am anymore….apart from Jim.” She was silent for a minute. “It’s so easy though. He does everything for me….think, decide, and talk…everything.”

“In the beginning, you said the relationship was fun. Then, it sounds as though something changed in the relationship.” I asked. “Am I right?”

“Yes. Over the years, I think we both got locked into certain roles. Jim had all the answers and I went along with him. I think part of this happened for me when I got pregnant with Lynn. Before that, I was busy with raising Annie and Mac. I didn’t want to have any more children but Jim did. I think he was hoping for a boy. It was when he was pushing me to get pregnant I realized how vulnerable I am to him. If I were to say “No”, would he leave me like my dad left mom? I don’t have any employable skills. Would I end up living on child support? And who would want me with three kids? It was easier to just go along with what he said, what he wanted. I wouldn’t have to think about being on my own. So, we had Lynn. I love her and am glad we had her but…more and more, I know this is going to sound crazy, more and more I feel myself shrinking and Jim getting, somehow, ‘bigger’.”

Debbie continued, “What’s worse, Annie is now doing the same things I used to do when I was a young woman. When I was her age, I starved myself, worried about everything, cried every night.”

“Relate this to Jim”, I asked.

“I think that, as Jim gets bigger and bigger, he believes, more and more, that he is always right….and it is harder and harder for me to stand up to him. And if it is hard for me, I can’t imagine what it is like for Annie. ” Debbie sighed.

“What about Mac and Lynn?” I asked.

“Mac, I think, knows what is going on with Jim and me. She is always complaining how we never get to do anything that is not Jim’s idea….and complaining I don’t speak up to him about this. Lynn is disappearing. More and more, she seems to be getting quieter and quieter. I think this is her way of…surviving. It is not that Jim is a bad guy, husband or father. He just always thinks he is always right. A lot of time he is right, which only makes this worse. Just because he is right doesn’t mean we still couldn’t do something different or do something the way the girls or I would suggest.” Debbie looked off in the distance, worried.

“You ever thought about being a therapist?” I said. We both laughed.

“I think you are right Debbie”, I said. “I see what you say in our sessions and can appreciate this happening with your girls because I have seen it unfold in other families just as you predict.” I said.

Debbie shared other examples of Jim’s narcissism in their relationship/home:

Debbie gets up, before Jim, to shower and have things ready for him when he gets up; a cup of coffee for him in the bathroom, preparing his breakfast, ironing his clothes for the day, etc.

The girls are asked to shower the night before so there is enough hot water for Jim in the mornings. They have never ran out of hot water but Debbie just doesn’t want to take a chance.

After he showers, Debbie helps Jim dress. Jim is color-blind and doesn’t match colors well. “Here I go…” Debbie said Jim will say rather loudly when he walks from the bath to their bedroom, alerting Debbie to join him.

Jim manages the finances; Debbie knows she could handle the checkbook and bills but thinks it is prudent to let Jim do it, since he works for a bank.

Debbie fixes dinner every night, always keeping in mind what Jim likes. She feels it is only fair given “he works all day”.  The same applies to TV after dinner; Debbie defers to his choice of shows or lets him watch TV on the big screen (while she’ll watch in the bedroom).

“When Jim is not there in the evenings, the girls get excited about what they will have for dinner and watching TV on the big screen. Not that they want something extravagant. Usually, they just want mac and cheese and/or mashed potatoes and gravy but it is just having a say that I think excites them the most.” Debbie explained.

“Once Mac suggested we all have an equal say or vote in where we eat dinner on Friday nights. Jim initially went along with it but then the girls realized if they all agree together, they could out-vote Jim and I. One Friday, they all voted for Taco-Bell. I could see immediately, Jim was not happy. I didn’t vote. When we got there, the girls ran in and I begged Jim to just go along with it. He did but didn’t talk during dinner. The next week, he had a business after-hours thing and the following week Jim just decided where we ate. We never voted again. Mac was pissed and I tried to calm her down. She yelled at me for not standing up to him. She was right but….Jeez, I felt just like my mother before dad left. I thought I’d throw up.”

….

Debbie and Jim continued in therapy. Annie joined, attending with her parents and individually (I also referred her to a physician.) but for the purposes of this article, this is a good example of what I call invisible narcissism. Experts would call this “Covert Narcissism”.  Let’s look now at the suggestions I made to Debbie (in regards to Jim’s narcissism):

  1. I asked Debbie to begin noticing and list all the things she does for Jim. For example, in the mornings, make sure the girls shower the night before so he has enough hot water, shower before him, have a cup of coffee for him waiting in the bathroom, lay his clothes out, help him dress.

Now, look at the list and decide what things are necessary and what things are nice. For example, laying his clothes out sounds necessary, in light of his color-blindness. Bringing him coffee or helping him dress sounds to me nice.

Comprising this list may take a week or so to do. I encouraged Debbie to look at every aspect of her day with Jim; morning, afternoon, evening, weekends, bedtime, intimacy, etc.

Then, I suggested she look at the invisible aspects of her day with Jim; how she let’s Jim’s preferences influence her choices, actions, etc.: what she doesn’t do or allow in the home, the morning routine, why she stopped voting where she wanted to go on Fridays for dinner, what to fix for dinner, how they make love, where she watches TV in the evenings, etc.

Finally, I had her make a list of how she’d like life to be at home: how she would like to make love, what she (or the girls) would like to have for dinner, if she would like to revive the tradition of voting where the family eats on Friday evenings and where she would like to eat, how she would like the morning routine to be for she and the girls, etc.

We reviewed her list in an individual session.

  1. I asked Debbie to look at how she sees herself in relation to Jim, in the relationship:

Debbie says she does a lot of things for Jim because “….he works hard for us all day”. I asked Debbie if she works hard all day.

I questioned if her hard work allows Jim to be gone and work at his job or if his working allows her to be home (working).

  1. I asked Debbie to look at how she sees Jim in relation to her in the relationship:

Could Jim get along without Debbie doing some of the things she does for him?

Could he dress himself?

Could he get his own coffee in the morning?

Could he live for one evening if she fixed macaroni and cheese and mashed potatoes for dinner for the family one night?

  1. I asked her where she learned to see herself the way she does in relation to Jim; where had see seen this positioning in a couple before and how did that relationship work.

Our discussions of these lists and questions lead Debbie back to her family and what she saw in her parent’s relationship: her mother had waited on her father, her parents fought because her father thought her mother’s efforts were not good enough….and eventually, her father left her mother and she sank into a bitter depression.

Our discussion also revealed:

Debbie really did think Jim’s efforts/work was more important than hers and consequently, he was more important than she.

Debbie honestly thought she did too much for Jim and that some of Jim’s preferences were unfair to the girls.

Debbie sort-of liked waiting on Jim; it gave her a sense of purpose, position and even control. Her purpose in life (besides being a mother to her daughters) was to take care of her husband and subsequently there was an order in her life; the order was: Jim was first, she was second and the girls were third (In truth, I think the order really was: Jim, the girls and then Debbie).

Debbie also didn’t like this. She resented being a house wife like her mother. She feared she would become just like her mother someday; bitter and depressed. And she was tired and angry at always being second and Jim always being first.

Finally, Debbie was very confused about both liking and not liking her role as Jim’s care-taker. First, it was not like Jim was selfish or stingy. He was very generous with gifts and money….but it was always his decision! Second, Debbie was a very intelligent woman. She did well in college. She had gifts, talents, skills. She had job offers out of college that could have lead to a number of different careers. What happened? Where did that woman and that life go? Third and most importantly, Could changes be made? Jim was very stubborn when crossed. What if he left her…what would her life be then? What would happen to the girls in such a case?

…..

It was ultimately Annie’s struggles with food (and not Debbie’s disappointment and dissatisfaction with her life and relationship with Jim) that prompted Debbie to act. Debbie knew Annie needed to start to talk about what she was worrying about if her self esteem and eating were ever to improve. Debbie also knew Annie couldn’t do this on her own; she needed a model to work from and someone “in her corner” to support her. Debbie knew she (Debbie) had to be the one to model for and support Annie. Debbie knew she needed to start standing up to Jim, initiating changes in their relationship and the family. And most importantly, Debbie knew she didn’t know where such changes would lead….

……

In Invisible 2, I discuss how Debbie initiated changes and the consequences.

 

 

 

Invisible

This is an article I recently wrote about a narcissist and his wife.  It is in conjunction with an e-book I am currently writing.

There are more articles about narcissism on my website.  Go to my blogs and select “Relationships” then scroll down to “Signs That You’ve Been Abused by a Narcissist”.

 

Invisible

Jim is the president of the trust department of a bank in a large city. His wife, Debbie, works at home, raising their three children, Annie 17, “Mac” (Mackenzie) 15 and Lynn, 11. The couple came in due to Annie’s eating disorder; she was anorexic, 5’5” and weighs 100 lbs. Shortly after I began working with them, I realized Jim was narcissistic.  Debbie, seemingly, had no idea. I am writing about this couple/family because I want to show how narcissism can be invisible at times.

Jim came from a southern family. He was the oldest of three boys and his father spent a lot of time with his sons growing up. Fishing, hunting and sports were the main focus at home or rather, outside the home.  Jim’s father, I was told, was rather crude about women when they, he and the boys, where off together. When around his wife (and other women or in public), he was respectful and polite.  He expected his sons to be the same; respectful when with women but rough when with the guys.

Jim’s mother, on the other hand, ran their home like a general. She understood “Boys will be boys” but at home, she insisted on respect, manners and religion.  Jim’s father backed her on such.

As Jim grew, his self esteem and confidence also grew. Graduating high school, majoring in finance and graduating college, getting his first job at a prestigious banking institution, he was proud and made his parents proud.

He met Debbie in college. She was beautiful, smart and feminine; all the things Jim wanted. They started dating in freshmen year. Quickly, it was clear who was in charge. But that was ok with Debbie. If Jim wanted to do something, that was fine with her; no matter what it was, it would be fun with Jim. Jim was fun, in love and loyal. Debbie couldn’t ask for more and as such, she gave Jim all she had and never looked back.

Jim slowly began to recognize the power or influence he had with Debbie. He’d seen it in his parent’s relationship. He’d seen his father make decisions and his mother follow along; never questioning him, always supporting him. And it was not that his father just made decisions carelessly or selfishly. His father could always explain why he was deciding as he was deciding; could always point out how what he decided was best for he or his wife or the boys. Jim liked that. The correctness of his father’s decisions were right there in front of you…..the success of a close, loving family. What was to be questioned?

Economic growth and opportunity brought Jim and Debbie to this area. Jim’s salary allowed Debbie to not work and soon she was pregnant with Annie. Soon after, Mac came along. Jim climbed the corporate ladder and worked hard. Lynn eventually, came along. Debbie stayed home and took care of the house and girls. They were all happy.

Years passed….

I greeted Jim and Debbie in the waiting room. Because Jim was closer to me, I introduced myself and shook his hand first. As I reached to Debbie, repeating my name and shaking her hand, she told me her name. At the same time however, Jim interrupted and began telling me about their daughter. Debbie laughed nervously and then looked at Jim with a concerned expression. I asked them to follow me to my office. Jim followed me and kept talking. Debbie followed Jim.

Jim walked into my office first. Jim handed his coat to Debbie, who quickly took it. Jim sat down and started to talk before Debbie was settled.

“I just don’t know what is wrong with her. She seemed happy and is such a good girl but now she’s losing weight and apparently cries at night.”

“What do you mean ‘apparently’?” I asked.

“Well, uh, that is what Debbie tells me” Jim said, continuing to look only at me.

“Can you tell me about this?” I ask turning to Debbie.

“Well, like I said, my wife tells me most nights she will hear Annie crying in her room. Debbie says she’s asked Annie what is wrong but just brushes Debbie off.” Jim continues.

“Debbie, is that what you experience with Annie?” I again ask Debbie.

“This has been going on for months now. We are worried sick!” Jim laments.

“I understand and I’d be worried too if my daughter were struggling like this but… Debbie, tell me what you see and hear from Annie.” I ask again.

“I…told you doc…our baby is sick. Can you help her?” Jim said, now almost begging.

During this conversation, Debbie is continually looking at Jim every time I ask her a question; but not saying a word.

“Have either of you noticed I have asked Debbie a question now about three times and each time, Jim, you respond. I know you two are worried but…have either of you noticed this?” I ask.

“What….uh….well, I was just answering your question.” Jim responded. “What’s your point?”

“I don’t know if it is related to Anne’s struggles but I noticed you, Jim, answer for both, you and Debbie.” I said.

“What do you see going on with your daughter?” I ask Debbie.

Jim sat back a little with a worried and slightly disgruntled look on his face. He looked at that moment, I thought, like a parent trying to be patient while teaching his son or daughter to drive a car and the child turned right when he told them to turn left.

“Well, she is very worried,” Debbie began, almost hesitantly but with a firm voice. “She talks a lot about being worried, worried about all kinds of things and that she just can’t get herself to stop…worrying.”

“Just like I told you doc…” Jim jumps in.

“Well…not really. You said Annie was crying at night. Debbie said Annie is worried and can’t stop worrying.” Jim nodded his head sideways and gave a tight grin.

“Ok…but what do you think is wrong. What do you think we should do?” Jim pressed.

“I don’t know yet…” I responded. Jim looked back, rather shocked.

“Debbie, what has Annie been worrying about?” I continued with Debbie.

Debbie looked at Jim, who began to talk. I stopped him with my hand (holding it up like a ‘stop sign’). “Go on Debbie…what has Annie told you she is worried about?”

Again, Debbie looked at Jim, almost wanting him to talk for her but after a minute, she continued. “She is worried about making mistakes…” Debbie said as if she were revealing a forbidden truth.

“About making mistakes…?” I asking, encouraging her to continue.

“Yeah…” Debbie continued now without hesitating. Jim also didn’t jump in but he was looking at me directly, almost searching or demanding a statement or conclusion from me. “She says she is afraid of saying the wrong thing in class, not getting A’s, Jim getting upset with her because she didn’t do something around the house right….things like that.”

“What…” Jim was shocked at the last comment. “She’s afraid of me getting upset at her for not doing something right? Why didn’t you say something to me before this?

“Oh Jim, you didn’t do anything wrong. I don’t think it is you. This is her issue, all in her head. So I didn’t say anything to you. My God, you love all three of your daughters. Anyone can see that. This is her problem…but I don’t know what it’s all about.” Debbie looked back at me. “Have you ever seen this before?”

As the session continued, I noticed Debbie would easily fall back into the habit of deferring to Jim and Jim answering for both of them. It was not that Jim was arrogant in this conversation or interaction with his wife. He was just more…. dominant, in charge.

At the end of the session, I asked about rescheduling. Jim was quick to pull his schedule up and suggested, “I am free next Tuesday morning…” without asking Debbie.

“…and what is your schedule like honey…?” I said as if I were Jim, engaging her to schedule together.

“Huh…” Jim responded, looking up at me.

“You answered my question without asking Debbie when she wanted to reschedule or what day. This is part of that ‘talking over/for her’ stuff that I have pointed out to you a couple times over the last hour. Do you see that?”

“Uh…yeah.” Jim asked, genuinely confused.

“…and I’ll bet it has something to do with Annie, her behavior. It is something to think about. Anyway…” now looking directly at Debbie, “when do you want to reschedule?”

“I said Tuesday would be good.” Jim continued.

“You did it again Jim. I looked directly at Debbie and you answered for her. Debbie, when do you think you should come back?” I asked Debbie directly.

“I think Annie should come next.” Debbie said looking at Jim, almost pleadingly.

“Oh, yeah, that would be good idea.” Jim said. “Schedule Annie for next Tuesday doc.” Jim said to me.

“Once again Jim, look at what you just did. You went from scheduling with me on Tuesday, not asking your partner, to telling me to schedule Annie for next Tuesday, not asking me if I thought I should see Annie. What do you think that means….about you?” I asked Jim.

“I….don’t know. What you are getting at? Jim said with indignation.

“Jim, I know you love your kids and your wife but you think of situations, this situation, only from your perspective. You don’t ask Debbie her perspective or Annie hers. It is as if you expect yourself to know the answer and fix the problem. The fact is, you really don’t know what the problem is and this scares you. But, you act like you are in charge of the situation. You take over conversations, answer for others, say what others say is what you said, don’t ask others for their opinions, consider only your schedule, etc. Because of this, you miss a lot of information that could help you and others find solutions.” I said.

“….I don’t know…about this.” Jim said hesitantly.

“I understand. Ask Debbie what she thinks about what I am saying.” I directed.

Jim hesitated a minute and then looked at Debbie.

“I think he is right Jim. Sometimes, you just jump into things, start doing something without really looking at the situation first….and it messes things up. Look, this is not just about you. I am part of this too. I just stand back and let you take the lead.” Debbie said, watching Jim’s facial expression as she spoke, as if trying to read how he would respond to what she was saying.

“I am only just trying to help my daughter.” Jim said defensively.

“I know…but what has worked for you in the past may not work this time. You are being challenged, in this situation, to learn to ask others what they think is going on and what they think should be done, instead of telling others what the problem is and how to fix it.” I said.

I’d like to see you two again, together. When could you two come in” I asked again.

“Next Tuesday is go….” Jim stopped himself and looked at me. He then looked at Debbie.

“How is Tuesday for you honey?” I prompted.

Jim snorted, “Yeah, how is Tuesday for you?” he said to Debbie.

“Ok but I want to schedule an appointment for Annie also.” Debbie said.

Jim quickly looked from Debbie to me, with a surprised look on his face. “Jim,” Debbie spoke, “Is that ok with you?”

“Un….yeah.”

……

Debbie came by herself the following Tuesday. Jim had an unexpected meeting and couldn’t attend.

“Tell me about your relationship with Jim.” I asked.

“Shouldn’t we be talking about Annie? Debbie questioned.

“We will but I want to start with you and Jim.” I redirected.

“Well, he’s a good man….We met in college and I quickly fell in love. He was tall, good-looking and funny. He always had a plan. He was kind, respectful hard-working…and faithful. So, I…I never questioned him, his opinion. It was easy, comfortable” Debbie said with a small smile.

“How the relationship been over the years?” I pushed.

“Jim has always been a hard-worker and again, has always been faithful.” She said.

“You already said that…I wonder why?” I said.

“I love Jim and I would never leave him. Most women would die for a chance to have a good man like him. He’s faithful, he provides well for us….but, over the years, I have begun to notice things, things I don’t….don’t want to acknowledge, much less talk about.” Debbie stopped.

“Such as….” I pushed.

“It is always about Jim! What we do, where we go….what we eat, who we talk to, hell, even how we make love!” She was silent. I was silent.

“It’s always been this way. In the beginning, it was fun to have someone who always had an idea of something to do, someplace to go, people to be with. I know, I am repeating myself.  I loved it. It was certainly better than being with my dad. He left us when I was 7. I remember mom and dad always fighting. He was always mad about something. Mom tried to do everything. I tried to be good and do everything right, so he’d be happy, so they wouldn’t fight. But he left us. Men leave.” Debbie cried.

“Do you think about leaving Jim?” I asked.

“No” she said (I wasn’t so sure), “…it’s just….my whole life is wrapped around him. I don’t think I would know who I am anymore….apart from Jim.” She was silent for a minute. “It’s so easy though. He does everything for me….think, decide, and talk…everything.”

“In the beginning, you said the relationship was fun. Then, it sounds as though something changed in the relationship.” I asked. “Am I right?”

“Yes. Over the years, I think we both got locked into certain roles. Jim had all the answers and I went along with him. I think part of this happened for me when I got pregnant with Lynn. Before that, I was busy with raising Annie and Mac. I didn’t want to have any more children but Jim did. I think he was hoping for a boy. It was when he was pushing me to get pregnant I realized how vulnerable I am to him. If I were to say “No”, would he leave me like my dad left mom? I don’t have any employable skills. Would I end up living on child support? And who would want me with three kids? It was easier to just go along with what he said, what he wanted. I wouldn’t have to think about being on my own. So, we had Lynn. I love her and am glad we had her but…more and more, I know this is going to sound crazy, more and more I feel myself shrinking and Jim getting, somehow, ‘bigger’.”

Debbie continued, “What’s worse, Annie is now doing the same things I used to do when I was a young woman. When I was her age, I starved myself, worried about everything, cried every night.”

“Relate this to Jim”, I asked.

“I think that, as Jim gets bigger and bigger, he believes, more and more, that he is always right….and it is harder and harder for me to stand up to him. And if it is hard for me, I can’t imagine what it is like for Annie. ” Debbie sighed.

“What about Mac and Lynn?” I asked.

“Mac, I think, knows what is going on with Jim and me. She is always complaining how we never get to do anything that is not Jim’s idea….and complaining I don’t speak up to him about this. Lynn is disappearing. More and more, she seems to be getting quieter and quieter. I think this is her way of…surviving. It is not that Jim is a bad guy, husband or father. He just always thinks he is always right. A lot of time he is right, which only makes this worse. Just because he is right doesn’t mean we still couldn’t do something different or do something the way the girls or I would suggest.” Debbie looked off in the distance, worried.

“You ever thought about being a therapist?” I said. We both laughed.

“I think you are right Debbie”, I said. “I see what you say in our sessions and can appreciate this happening with your girls because I have seen it unfold in other families just as you predict.” I said.

Debbie shared other examples of Jim’s narcissism in their relationship/home:

Debbie gets up, before Jim, to shower and have things ready for him when he gets up; a cup of coffee for him in the bathroom, preparing his breakfast, ironing his clothes for the day, etc.

The girls are asked to shower the night before so there is enough hot water for Jim in the mornings. They have never ran out of hot water but Debbie just doesn’t want to take a chance.

After he showers, Debbie helps Jim dress. Jim is color-blind and doesn’t match colors well. “Here I go…” Debbie said Jim will say rather loudly when he walks from the bath to their bedroom, alerting Debbie to join him.

Jim manages the finances; Debbie knows she could handle the checkbook and bills but thinks it is prudent to let Jim do it, since he works for a bank.

Debbie fixes dinner every night, always keeping in mind what Jim likes. She feels it is only fair given “he works all day”.  The same applies to TV after dinner; Debbie defers to his choice of shows or lets him watch TV on the big screen (while she’ll watch in the bedroom).

“When Jim is not there in the evenings, the girls get excited about what they will have for dinner and watching TV on the big screen. Not that they want something extravagant. Usually, they just want mac and cheese and/or mashed potatoes and gravy but it is just having a say that I think excites them the most.” Debbie explained.

“Once Mac suggested we all have an equal say or vote in where we eat dinner on Friday nights. Jim initially went along with it but then the girls realized if they all agree together, they could out-vote Jim and I. One Friday, they all voted for Taco-Bell. I could see immediately, Jim was not happy. I didn’t vote. When we got there, the girls ran in and I begged Jim to just go along with it. He did but didn’t talk during dinner. The next week, he had a business after-hours thing and the following week Jim just decided where we ate. We never voted again. Mac was pissed and I tried to calm her down. She yelled at me for not standing up to him. She was right but….Jeez, I felt just like my mother before dad left. I thought I’d throw up.”

….

Debbie and Jim continued in therapy. Annie joined, attending with her parents and individually (I also referred her to a physician.) but for the purposes of this article, this is a good example of what I call invisible narcissism. Experts would call this “Covert Narcissism”.  Let’s look now at the suggestions I made to Debbie (in regards to Jim’s narcissism):

  1. I asked Debbie to begin noticing and list all the things she does for Jim. For example, in the mornings, make sure the girls shower the night before so he has enough hot water, shower before him, have a cup of coffee for him waiting in the bathroom, lay his clothes out, help him dress.

Now, look at the list and decide what things are necessary and what things are nice. For example, laying his clothes out sounds necessary, in light of his color-blindness. Bringing him coffee or helping him dress sounds to me nice.

Comprising this list may take a week or so to do. I encouraged Debbie to look at every aspect of her day with Jim; morning, afternoon, evening, weekends, bedtime, intimacy, etc.

Then, I suggested she look at the invisible aspects of her day with Jim; how she let’s Jim’s preferences influence her choices, actions, etc.: what she doesn’t do or allow in the home, the morning routine, why she stopped voting where she wanted to go on Fridays for dinner, what to fix for dinner, how they make love, where she watches TV in the evenings, etc.

Finally, I had her make a list of how she’d like life to be at home: how she would like to make love, what she (or the girls) would like to have for dinner, if she would like to revive the tradition of voting where the family eats on Friday evenings and where she would like to eat, how she would like the morning routine to be for she and the girls, etc.

We reviewed her list in an individual session.

  1. I asked Debbie to look at how she sees herself in relation to Jim, in the relationship:

Debbie says she does a lot of things for Jim because “….he works hard for us all day”. I asked Debbie if she works hard all day.

I questioned if her hard work allows Jim to be gone and work at his job or if his working allows her to be home (working).

  1. I asked Debbie to look at how she sees Jim in relation to her in the relationship:

Could Jim get along without Debbie doing some of the things she does for him?

Could he dress himself?

Could he get his own coffee in the morning?

Could he live for one evening if she fixed macaroni and cheese and mashed potatoes for dinner for the family one night?

  1. I asked her where she learned to see herself the way she does in relation to Jim; where had see seen this positioning in a couple before and how did that relationship work.

Our discussions of these lists and questions lead Debbie back to her family and what she saw in her parent’s relationship: her mother had waited on her father, her parents fought because her father thought her mother’s efforts were not good enough….and eventually, her father left her mother and she sank into a bitter depression.

Our discussion also revealed:

Debbie really did think Jim’s efforts/work was more important than hers and consequently, he was more important than she.

Debbie honestly thought she did too much for Jim and that some of Jim’s preferences were unfair to the girls.

Debbie sort-of liked waiting on Jim; it gave her a sense of purpose, position and even control. Her purpose in life (besides being a mother to her daughters) was to take care of her husband and subsequently there was an order in her life; the order was: Jim was first, she was second and the girls were third (In truth, I think the order really was: Jim, the girls and then Debbie).

Debbie also didn’t like this. She resented being a house wife like her mother. She feared she would become just like her mother someday; bitter and depressed. And she was tired and angry at always being second and Jim always being first.

Finally, Debbie was very confused about both liking and not liking her role as Jim’s care-taker. First, it was not like Jim was selfish or stingy. He was very generous with gifts and money….but it was always his decision! Second, Debbie was a very intelligent woman. She did well in college. She had gifts, talents, skills. She had job offers out of college that could have lead to a number of different careers. What happened? Where did that woman and that life go? Third and most importantly, Could changes be made? Jim was very stubborn when crossed. What if he left her…what would her life be then? What would happen to the girls in such a case?

…..

It was ultimately Annie’s struggles with food (and not Debbie’s disappointment and dissatisfaction with her life and relationship with Jim) that prompted Debbie to act. Debbie knew Annie needed to start to talk about what she was worrying about if her self esteem and eating were ever to improve. Debbie also knew Annie couldn’t do this on her own; she needed a model to work from and someone “in her corner” to support her. Debbie knew she (Debbie) had to be the one to model for and support Annie. Debbie knew she needed to start standing up to Jim, initiating changes in their relationship and the family. And most importantly, Debbie knew she didn’t know where such changes would lead….

……

In Invisible 2, I discuss how Debbie initiated changes and the consequences.

 

 

 

After Divorce, Reflections…..

The following 2 articles are from the blog of someone who comes to me for therapy.  These two entries stand out.

The “Never Have I Ever” is a replay of a childhood game (kids, typically girls) get together and make statements starting with “Never have I ever” and the others are challenged to figure out if they are being honest or dishonest.  The author uses the phrase here to highlight the drastic changes she observed since her divorce.

From “We to Me” first laminates the shift after divorce to a solo “me”; and then calibrates it.  Learning to celebrate “me” is an essential skill of divorce.

 

Never Have I Ever

It’s been just about a year since I realized that my marriage was truly over.  It’s been just about a year since I heard the words, “I love her….I guess we get a divorce.”  And during that time there have been many more realizations-revelations-that have come:

Never have I ever thought I would be starting over before I turned 35.

Never have I ever thought my husband would tell me he loved someone else.

Never have I ever thought my husband would be living with his girlfriend in our house (before our divorce is finalized).

Never have I ever thought I would lose people who were like my family.

Never have I ever thought I’d feel heartbreak the way I have.

Never have I ever thought I’d make it through the pain.

Never have I ever realized what a range of emotions I could experience in my lifetime, let alone in just one day.

Never have I ever realized the strength I have within myself until I went through this.

Never have I ever realized how truly amazing my friends and family are – helping me at every turn, lifting me when I needed it….and, boy, have I needed it.

Never have I ever realized how much you need a friend’s couch and that friend who hands you tissue when you can’t do anything more than cry.

Never have I ever realized the power of a good cup of coffee or glass of wine with those same friends.

Never have I ever realized how much my friends are also my family.

Never have I ever realized how dark things can get.

Never have I ever realized how much the light at the end can bring you back.

Never have I ever realized how much my students can be a healing balm when everything else seems to be out of control.

Never have I ever realized how the laugh of a baby can calm the quaking in my heart.

Never have I ever known how a hug could convey so many different messages.

Never have I ever thought I’d be starting over, but also faced with so many opportunities.

Never have I ever realized what it means to persevere.

Never have I ever realized what it means to find my own strength.

Never have I ever realized what is most important to me in life.

Never have I ever realized what it means to take advantage of new chances…but I’m about to.

 

From “We” to “Me”

For almost 15 years you were in my life.  For almost 15 years almost everything was “we”.  For almost 15 years our friends were intertwined, our lives were one.  For 15 years the decisions we made were together.  But you made it so that is no longer so.

For the first time in almost 15 years it is no longer “we” but “me”.  For the first time in almost 15 years, when friends are getting together I no longer say, “WE will be there” and now I say, “It’ll be ME”.  For the first time in almost 15 years I only have one schedule to keep track of.

I’m still getting used to it.  I’m still adjusting to it just being me and not we.  Part of me feels out of place when a dinner is planned and it’s just me.  I’m not sure how the dynamic works when I get together with friends and it’s just me.  I’ve never been a fan of odd numbers, and yet now I’m the odd one out.  I’m always afraid I’m throwing off the seating or the arrangements or the partnering up when I’m saying, “You can count on me”.

But, it’s also just ME.  I can say I’m coming over for coffee this morning, because it’s just me.  I can say I’ll come out to California to run a race, because it’s just me.  I can decide to have only cheese and crackers for dinner, because it’s just me.  I can go out of town for a weekend, because it’s just me.  I can get a paddle board and enjoy it when my schedule allows, because it’s just me.  I can meet friends for dinner, because it’s just me.  I can stay up at night reading, because it’s just me.

While I’m still not used to it being me instead of we, I’m getting there.  I’m finding the joy in it being me.  I’m embracing new opportunities that come up because it’s just me.  If I can’t do something because money is tight, then it’s up to me.  If I want to say yeas to something, then I can because it’s just me.  It’s hard to get used to something that’s no longer there after 15 years.  It’s not easy to change the path I was on to this new one.  It’s up to ME.

A Woman Should Have………

This, I found, on Facebook and it’s something all women should read and consider.

 

A woman should have…..

Enough money within her control to move out…

And rent a place of her own

even if she never wants to

or needs to…

Something perfect to wear if the employer

or date of her dreams wants to See Her in an hour….

 

A woman should have

A youth she’s content to leave behind…

A past juicy enough that she’s looking forward to

retelling it in her Old Age….

 

A woman should have….

A set of screwdrivers,

a cordless drill, and a black lace bra…

One friend who always makes her laugh…

And one Who lets her cry…

 

A woman should have….

A good piece of furniture not previously owned

by anyone else in her family….

Eight matching plates,

wine glasses with stems,

And a recipe for a meal that will make

her guests feel honored…

A feeling of control over her destiny….

 

Every woman should know….

How to fall in love without losing herself…

How to quit a job,

Break up with a lover,

And confront a friend without

Ruining the friendship….

When to try harder…

And when to walk away

 

Every woman should know

That she can’t change the length of her calves,

The width of her hips,

or the nature of her parents…

That her childhood may not have been perfect…

But it’s over…

 

Every woman should know….

What she would and wouldn’t do for love or more….

How to live alone…

Even if she doesn’t like it…

 

Every woman should know

Whom she can trust…

Whom she can’t….

And why she shouldn’t take it personally…

 

Every woman should know….

Where to go….

Be it to her best friend’s kitchen table….

Or a charming inn in the woods….

When her soul needs soothing…..

 

Every woman should know…..

What she can and can’t accomplish in a day…..

A month….

And a year…..

 

 

Written by Pamela Redmond Satran

I (Still) Believe in Love

This is an article one of the people I work with wrote after the ending of a significant relationship.

 

 

“Last week my therapist told me that I see things, life, through rose-tinted glasses.  He meant this as a cautionary statement, but I couldn’t agree with him that this was a bad thing; I couldn’t agree with him that I needed to get angry instead of sad.

I think this is because I choose to see the good in things.  To me, it takes too much work to focus on the negative.  When I do I feel myself being dragged down, falling down the spiral of negative thoughts, negative feelings that swirl around you when that’s what you focus on.  So I choose to step out of that vortex (when I can) and focus on the good, to find the positive in each day, maybe even each moment.

For a year I have had this pit of emptiness, the sting of tears, and the hollowness in my heart that I have had to struggle with.  For a year, I have had to face the fact that we don’t always get the fairy tale ending, or even the ending we had planned for ourselves.  Instead, I’ve had to face a new reality that sometimes the prince doesn’t choose happily ever after with the princess, but instead will run away with the tavern wench.  So what does the princess do in that moment?  Does she wait for the so-called prince to come back?  Well, maybe at first, yes.  But when the reality of it sets in, that princess needs to learn that she doesn’t need the prince any longer even if there are times she still wants him to come riding back on that horse.

But what princess wants the frog (or is it snake) who left her in the first place?

So I choose to face reality with my rose-tinted glasses even as I face this life ahead of me.  But despite those glasses, I know that things are not always going to be easy.  Despite the glasses, I know that there are those I have to build my defenses up against in order to protect myself.  Despite the glasses, I know that I have to do things for myself.

However, despite the reality that I now face, I still believe in the prince who loves the princess – except this time she won’t’ be sitting around waiting for him to come rescue her.  I believe in love as romantic as the story books; I believe in the small simple gestures that speak so much louder than any of the words that could be said.  I believe that despite the pain, there is hope and happiness in my future.  I believe that the sting of the tears waiting to fall in despair will be replaced by the tears that fall from laughter.  I believe that the emptiness in my heart will be filled with a happiness and a joy that is beyond words.

But until that day, this princess will not be locked in some tower waiting for someone to let her out.  Instead, I will embrace the moments as they come, I will choose adventure until I am swept off my feet by the prince who chooses the princess.”

Perfectionism

This is an email I received recently from a young woman asking for help with perfectionism.

 

 

Dear Mr. Esselman,

I’m 13 years old and experiencing signs of being a perfectionist. I got interested in this topic because I always catch myself getting extremely mad and aggressive with myself. At first I thought it was anxiety because I would get extremely frantic and I would worry. I did not know how to control the feelings so I would yell at myself and get myself in a bad mental state. I was looking at all the signs of being a perfectionist and I came to meet every single one of them. I was wondering how I could calm down when I rage at myself and how I can control the feelings.

 

 

Dear XXX,

I found your letter very interesting. When I was about 13, I too began struggling with perfectionism. Unlike you, I did not reach out for help. So, I applaud your courage to ask for assistance and your commitment or investment in yourself.

If getting mad at yourself has not helped, stop doing it! Getting angry can feel like we are really doing something to change but since it has not helped, it is just an illusion.

Try to accept the fact that no one can be perfect. You probably are good at some things and bad at others. I good at am some things and bad at others but NO ONE is perfect at anything or everything!

I think the drive to be perfect comes from: 1. Parents and teachers encouraging us to always “do our best” and that gets taken too far, 2. Our own desires to please either others or ourselves, especially when it comes to grades or projects, and that also gets taken too far, 3. Being overwhelmed by the expectations we feel in our lives and most importantly, 4. Incorrect beliefs about making mistakes.

People fear that if they don’t expect themselves to be perfect, they will stop trying at everything. This is usually why parents and teachers urge us to always “Do your best!” This belief is false. When we stop expecting ourselves to be perfect at everything, we free ourselves up to decide how much we want to try at doing something. This can be hard to do because, as an adolescent, you are just beginning to develop the skills you will use in your adult life and you don’t know what your innate skills/abilities/talents are…..so teachers and parents tell you to do your best at everything. Also, sometimes you have to work really hard in the beginning when learning something new. Later on, once you have learned more about the subject, it then comes more naturally and you excel in the area.

People usually feel making mistakes is bad. But, in truth, MOST LEARNING is based on making mistakes/learning from those mistakes. When we beat ourselves up after making a mistakes, we are so flooded with shame or guilt, we lose the opportunity to figure how why or how we made the mistake and learn from it.

Back to your question about how to you calm down when you are angry at yourself. I’d suggest first you try to decide which things in your life you want to excel at and the things you want to do “just good enough”. Second, change your wording. Eliminate “perfect” from your vocabulary and substitute words that reflect your desire to excel or do “good enough”. Third, talk to someone who will encourage you in this. This will be a big change for you in your life and you will need help. I did.

Did that answer your question? I am happy to email more about this topic but ask that you tell your parents about our conversation and show them our emails.

 

Edward

 

12 Tough Truths about Life No One Wants to Admit

  1. There is a lot about our lives we absolutely cannot control.

We cannot control everything that happens in life, but you can control how you respond.  Your response is your greatest power.

 

  1. Our expectations often make us utterly unhappy.

Happiness is letting go of what you assume your life is supposed to be like right now and sincerely appreciating it for everything that it is.

 

  1. We will always be incredibly imperfect.

If you wait until you’re “perfect” before you share your stories, ideas, talents, and gifts with the world, no one will ever hear from you.

 

  1. A moment spent worrying is a moment wasted.

Worrying will never change the outcome.  Do more, worry less.  Train your mind to see the lesson in every situation and then make the best of it.

 

  1. The best lessons often come from the hardest days.

Stand strong.  Sometimes you have to experience a low point in life to learn a good lesson you couldn’t have learned any other way.

 

  1. Success easily gets to our heads and failure easily gets to our hearts.

Our character is often revealed at our highs and lows.  Be humble at the mountain tops.  Be steadfast in the valleys.  Be faithful in-between.

 

  1. We confuse being busy with being productive.

What you pay attention to grows.  So focus on what truly matters and let go of what does not.

 

  1. More money left unmanaged just creates more problems.

Yes, we need money to live.  Earn it.  Save it.  Invest it.  But avoid spending money you haven’t earned, to buy things you don’t need, to impress folks you don’t even know.  Manage your money so it doesn’t end up managing you.

 

  1. Most of us don’t need more to be happy – we need less.

When things aren’t adding up in your life, begin subtracting.  Life get a lot simpler when you clear the clutter (mental and physical) that makes it complicated.

 

  1. Our fancy gadgets often get in our way and dehumanize us.

We all need to learn to be human again.  Don’t avoid eye contact.  Don’t hid behind gadgets.  Smile often.  Ask about people’s stories.  Listen.

 

  1. We don’t always get what we give.

You will end up sadly disappointed if you expect people will always do for you as you do for them.  Not everyone has the same heart as you.

 

  1. Most of the arguments we have with one another are pointless.

Be selective in your battles.  Oftentimes, peace is better than being right.  You simply don’t need to attend every argument you’re invited to.

 

 

Two more points…… (My own)………

 

  1. People are frequently disappointed with sex and love, yet it is such a central part of our lives.

 

  1. Happiness cannot be obtained directly. It is the result of doing what you are supposed to do, often when people are not looking.

THE DIFFERENT TYPES OF ADD/ADHD

ADD/ADHD

Different Types

Over the years, I have attended many workshops on Attention Deficit Disorder (ADD) and Attention Deficit Hyperactive Disorder (ADHD). The following is a compilation of different questionnaires and handouts on ADD/ADHD I have collected. Much of the following is from Dr. Daniel Amen and his experiences treating ADD/ADHD.

 

 

DIFFERENT TYPES OF ADD/ADHD

Daniel Amen

 

 

Differential Diagnosis                                                        page 2

(What else could it be?)

 

ADD with Hyperactivity                                                    page 3

“Classic”  ADHD

Prefrontal Cortex

 

ADD without Hyperactivity                                              page 4

“Couch Potato”

Prefrontal Cortex

 

ADD Over-focused Type                                                    page 5

“Stuck” Type

Cingulate System

 

ADD Depressive-Type                                                        page 6

“Negative/Dark” Type

Limbic System

 

ADD Explosive Type                                                           page 7

“Angry” Type

Temporal Lobe

 

Typical Problems with Each Type                                   page 8

 

Suggestions to try for each type                                      page 9

 

Right Brain/Left Brain ADD Characteristics                page 10&11

 

Right Brain/Left Brain ADD Questionnaire                  page 12

 

Right Brain/Left Brain ADD Scoring Sheet                   page 13

 

 

ADD/ADHD Differential Diagnosis

What else could it be?

 

 

Psychiatric Conditions:                                               Environmental:

Language and Learning Disability                                Unsafe/Disruptive Learning Environment

Bipolar Disorder                                                                  School Curriculum/Child Mismatched

Tourette’s Syndrome                                                          Family Dysfunction

Oppositional Defiant Disorder                                         Poor Parenting

Conduct Disorder                                                                Child Abuse/Neglect

Major Depression                                                                Food Allergies

Anxiety Disorders                                                               Environmental Allergies

Pervasive Developmental Disorder                                Teacher/Child Personality Clash

Auditory Processing Disorder

Dyslexia

Autism or Asperger’s

Schizophrenia

Post-Traumatic Stress Disorder

Mild Mental Retardation

Head Injuries or Brain Trauma

Drug Abuse

 

Living/Social/Parenting/Personality:

Low Self Esteem

Poor Social Skills

 

Medications:

Anticonvulsant

Antihistamines

Decongestants

 

General Medical Conditions:

Hypothyroidism

Severe Anemia

Lead/Mercury/Heavy Metal Exposure or Poisoning

Chronic Illness

Hearing/Vision Impairment

Fetal Alcohol Syndrome

 

Neurologic Conditions:

Sleep Disorders

Seizure Disorders

 

 

 

2

 

 

 

Attention Deficit Disorder with Hyperactivity

“Classic” ADHD

(Pre-Frontal Cortex Area of the Brain)

 

 

Either (1) or (2)

 

  1. Six (or more) of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

 

Inattention:

 

____ 1.  Often fails to give close attention to details or makes careless mistakes in schoolwork,                  work, or other activities

____ 2.  Often has difficulty sustaining attention in tasks or play activities                                                    ____ 3.  Often does not seem to listen when spoken to directly

____ 4.  Often does not follow through on instructions and fails to finish schoolwork, chores, or                     duties in the workplace (not due to oppositional behavior or failure to understand                             instructions)

____ 5.  Often has difficulty organizing tasks and activities

____ 6.  Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental                         effort (such as schoolwork or homework)

____ 7.  Often loses things necessary for tasks or activities (e.g., toys, school assignments,                                       pencils, books, or tools)

____ 8.  Is often easily distracted by extraneous stimuli

____ 9.  Is often forgetful in daily activities

 

 

  1. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:

 

Hyperactivity:

 

____ 1.  Often fidgets with hands or feet or squirms in seat

____ 2.  Often leaves seat in classroom or in other situations in which remaining seated is                                       expected

____ 3.  Often runs about or climbs excessively in situations in which it is inappropriate                                       (in adolescents or adults, may be limited to subjective feelings of restlessness)

____ 4.  Often has difficulty playing or engaging in leisure activities quietly

____ 5.  Is often “on the go” or often acts as if “driven by a motor”

____ 6.  Often talks excessively

 

Impulsivity:

 

____ 7.  Often blurts out answers before questions have been completed

____ 8.  Often has difficulty awaiting turn

____ 9.  Often interrupts or intrudes on others (e.g., butts into conversations or games)

 

3

Attention Deficit Disorder without Hyperactivity

“Couch Potato”

(Pre-frontal Cortex Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD without hyperactivity.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Excessive daydreaming

____ 4.  Disorganized

____ 5.  Responds impulsively or without thinking

____ 6.  Problems completing things

____ 7.  Doesn’t seem to listen

____ 8.  Shifts from one uncompleted activity to another

____ 9.  Often complains of being bored

____ 10.  Often appears to be apathetic or unmotivated

____ 11.  Frequently sluggish or slow moving

____ 12.  Frequently spacey or internally preoccupied

 

 

The onset of these symptoms often become apparent later in childhood or even adolescence.  The brighter the individual, the later symptoms seem to become a problem.  The symptoms must be present for at least six months and not be related to a depressive episode.  The severity of the disorder is rated as mild, moderate, or severe.

 

Even though these children have many of the same symptoms of the people with ADHD, they are not hyperactive and may, in fact, be hypoactive.  Girls are frequently missed because they are more likely to have this type of ADD.  In addition, they may: daydream excessively, complain of being bored, appear apathetic or unmotivated, appear frequently sluggish or slow moving or appear spacey or internally preoccupied – the classic “couch potato.”  Most people with this form of ADD are never diagnosed.  They do not exhibit enough symptoms that “grate” on the environment to cause people to seek help for them.  Yet, they often experience severe disability from the disorder.  Instead of help, they get labeled as willful, uninterested, or defiant.

 

As with the ADHD subtype, brain studies in patients with ADD, inattentive subtype reveal a decrease in brain activity in the frontal lobes of the brain in response to an intellectual challenge.  Again, it seems that the harder these people try to concentrate, the worse it gets.  ADD, inattentive subtype is often very responsive to stimulant medications listed above, at a percentage somewhat less than the ADHD patients.

 

 

 

 

 

 

 

 

 

4

ADD Over-Focused Type

“Stuck” Type

(Cingulate Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD over-focused (1 and 2 are needed to make the diagnosis.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Excessive or senseless worrying

____ 4.  Disorganized or super-organized

____ 5.  Oppositional, argumentative

____ 6.  Strong tendency to get locked into negative thoughts, having repetitive thoughts

____ 7.  Tendency toward compulsive behavior

____ 8.  Intense dislike for change

____ 9.  Tendency to hold grudges

____ 10.  Trouble shifting attention from subject to subject

____ 11.  Difficulties seeing options in situations

____ 12.  Tendency to hold on to own opinion and not listen to others

____ 13.  Tendency to get locked into a course of action, whether or not it is good for the person

____ 14.  Needing to have things done a certain way or you become very upset

____ 15.  Others complain that you worry too much

 

 

People with ADD, over-focused subtype, tend to get locked into things and they have trouble shifting their attention from thought to thought.

 

This subtype has a very specific brain patter, showing increased blood flow in the top, middle portion of the frontal lobes.  This is the part of the brain that allows you to shift your attention from thing to thing.  When this part of the brain is working too hard, people have trouble shifting their attention and end up “stuck” on thoughts or behaviors.

 

This brain pattern may present itself differently among family members.  For example, a mother or father with ADD over-focused subtype may experience trouble focusing along with obsessive thoughts (repetitive negative thoughts) or have compulsive behaviors (hand washing, checking, counting, etc.), the son or daughter may be oppositional (get stuck on saying no, no way, never, you can’t make me do it), another family member may find change very hard for them.

 

This pattern is often very responsive to new “anti-obsessive antidepressants,” which increase the neurotransmitter serotonin in the brain.  I have nicknamed these medications as my “anti-stuck medications.”  These medications include Prozac, Pail, Zoloft, Anafranil, and Effexor.

 

 

 

 

 

 

 

5

 

ADD Depressive Type

“Depressed” Type

(Limbic Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD depressive subtype (1 and 2 are needed to make the diagnosis).

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Moodiness

____ 4.  Negativity

____ 5.  Low energy

____ 6.  Irritability

____ 7.  Social isolation

____ 8.  Hopelessness, helplessness, excessive guilt

____ 9.  Disorganization

____ 10.  Lowered interest in things that are usually considered fun

____ 11.  Sleep changes (too much or too little)

____ 12.  Forgetfulness

____ 13.  Chronic low self-esteem

 

 

It is very important to differentiate this subtype of ADD from clinical depression.  This is best done by evaluating the symptoms over time.  ADD, depressive subtype, is consistent over time and there must have been evidence from childhood and adolescence.  It does not just show up at the age of 35 when someone is going through serious stress in life.  It must be a pattern of behavior over time.  Major depressive disorders tend to cycle.  There are periods of normalcy which alternate with periods of depression.

 

The medications used for ADD, depressive subtype, include standard antidepressants, such as Tofranil (imipramine), Norpramin (desipramine), and Pamelor (nortryptiline), the newer antidepressants such as Prozac and Wellbutrin (buprion), and the stimulants.  Clinically, I have been very impressed with the ability of stimulants to help this subtype of ADD.  This is why it is very important to differentiate this subtype from primary depressive disorders.

 

 

 

 

 

 

 

 

 

 

 

 

 

6

ADD Explosive Type

“Angry” Type

(Temporal Lobe Area of the Brain)

 

 

Six (or more) of the following symptoms are indicative of ADD violent, explosive (1 and 2 are needed to make the diagnosis.

 

____ 1.  Difficulty with sustained attention or erratic attention span

____ 2.  Easily distracted by extraneous stimuli

____ 3.  Impulse control problems

____ 4.  Short fuse or periods of extreme irritability

____ 5.  Periods of rage with little provocation

____ 6.  Often misinterprets comments as negative when they are not

____ 7.  Irritability builds, then explodes, then recedes, often tired after a rage

____ 8.  Periods of spaciness or confusion

____ 9.  Periods of panic or fear for no specific reason

____ 10.  Visual changes, such as seeing shadows or objects changing shape

____ 11.  Frequent periods of deja vu (feelings of being somewhere before even though you

never have)

____ 12.  Sensitivity or mild paranoia

____ 13.  History of a head injury or family history of violence or explosiveness

____ 14.  Dark thoughts, may involve suicidal or homicidal thoughts

____ 15.  Periods of forgetfulness or memory problems

 

 

In my clinical experience, temporal lobe symptoms are found in approximately 10-15% of patients with ADD.  Temporal lobe symptoms can be among the most painful.  These include periods of panic or fear for no specific reason, periods of spaciness or confusion, dark thoughts (such as suicidal or homicidal thoughts), significant social withdrawal, frequent periods of deja vu, irritability, rages, and visual changes (such as things getting bigger or smaller than they really are).  Temporal lobe dysfunction may be inherited or it may be caused by some sort of brain trauma.

 

Temporal lobe symptoms associated with ADD are often very responsive to anti-seizure medication, such as Tegretol or Depakote.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Typical Problems with Each Type

ADD With and Without Hyperactivity

The Pre-Frontal Area of the Brain

 

Area of the Brain Affected                        Typical Problem

Focus                                                                           Short attention span

Attention span                                                             Distractibility

Judgment                                                                     Impulsivity

Impulse control                                                            Procrastination

Organization                                                                Poor organization and planning

Planning                                                                      Lying

Critical thinking                                                           Misperceptions

Forward thinking                                                         Poor judgment

Internal supervision                                                     Social and/or test anxiety

Unavailability of emotions

 

ADD Over-Focused Type

The Cingulate Area of the Brain

 

Area of the Brain Affected                              Typical Problems

Allows shifting of attention                                           Worrying

Helps the mind move from idea to idea                                    Holds onto hurts from the past

Gives the ability to see options                                     Becoming stuck on thoughts-(obsessions)

Cognitive flexibility                                                      Becoming stuck on behaviors-(compulsions)

Helps you go with the flow                                           Argumentativeness

Oppositional behavior

Addictive behaviors

(alcohol abuse, eating disorders, chronic pain)

 

ADD With Depression

The Limbic Area of the Brain

 

Area of the Brain Affected                             Typical Problems

Sets the emotional tone of the mind                             Moodiness, irritability, clinical depression

Stores highly charged emotional memories                  Increased negative thinking

Modulates motivation                                                   Perceive events in a negative way

Controls appetite and sleep cycles                                Decreased motivation

Promotes bonding                                                        Flood of negative emotions

Directly processes the sense of smell                            Appetite and sleep problems

Modulates libido                                                           Social isolation

Decreased or increased sexual responsiveness

 

ADD Explosive Type

The Temporal Area of the Brain

 

Area of the Brain Affected                              Typical Problems

Abnormal perceptions

Understanding and processing language                      Hallucinations

Short term memory                                                     Amnesia

Long term memory                                                      Feelings of déjà vu

Auditory learning                                                         Ja mais vu

Complex memories                                                      Periods of panic or fear for little reason

Visual and auditory images                                          Periods of spaciness or confusion

Excessive religiosity

Visual distortions

Rage outbursts

 

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Suggestions to Try for Each Type

 

ADD/ADHD Type Suggestions:

Rx #1:  Clear focus on how you want to live

Rx #2:  Focus on the penguins in your life, notice the behavior of others you like (Fat Freddy)

Rx #3:  Have meaning, purpose, stimulation, and excitement in your life to prevent shut down

Rx #4:  Medications include stimulants, such as Ritalin, Cylert, Adderall, Desoxyn, or Dexedrine

 

 

ADD Over-Focused Type Suggestions:

Rx #1:  Notice when you’re stuck, distract yourself and come back to the problem later

Rx #2:  Don’t try to convince someone else who is stuck, take a break and come back to them later

Rx #3:  Write out options and solutions when you feel stuck

Rx #4:  Seek the counsel of others when you feel stuck (often just talking about feeling stuck will

Open new options for you)

Rx #5:  Medications include Prozac, Paxil, Zoloft, Effexor, Anafranil, Luvox, Serzone

 

 

ADD Depressive Type Suggestions:

Rx #1:  Every thought matters!  Kill the ANTs in your mind

Rx #2:  The limbic system is involved with bonding, surround yourself with people who provide

Positive bonding

Rx #3:  Great smells

Rx #4:  Medications include Norpramin, Tofranil, Wellbutrin, and other anti-depressants

 

 

ADD Explosive Type Suggestions:

Rx #1:  Strive for wonderful experiences

Rx #2:  Improve your ability to use words

Rx #3:  Sing whenever/wherever you can

Rx #4:  Listen to a lot of music

Rx #5:  Move in rhythms

Rx #6:  Medications include Depakote, Tegretol, Neurontin, Dilantin, and other anti-convulsants

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Right Brain/Left Brain ADD Questionnaire

 

  1. Are you better at remembering faces than names?

 

  1. When you’re presented with a toy or piece of furniture to assemble, are you likely to discard the printed directions and figure out how to build it yourself?

 

  1. Are you better at thinking of ideas if you’re left alone to concentrate, rather than working with a group?

 

  1. Do you rely mostly on pictures to remember things, as opposed to names and words?

 

  1. Do you have especially acute hearing?

 

  1. Do you cut the labels out of clothes? Do you favor garments that are especially soft and well worn, finding most clothing too rough or scratchy?

 

  1. Do you tend to put yourself down a lot?

 

  1. When you’re asked to spell a word, do you “see” it in your head rather than sound it out phonetically?

 

  1. When you’re studying a subject, do you prefer to get the “big picture” as opposed to learning a lot of facts?

 

  1. Are you good with puzzles and mazes?

 

  1. Can you imagine things well in three dimensions? In other words, can you visualize a cube in your mind, rotate it, and view it from every angle without difficulty?

 

  1. Were you considered a late bloomer?

 

  1. Did you need to like your teacher to do well in his/her class?

 

  1. Are you easily distracted to the point that you find yourself day-dreaming a lot?

 

  1. Are you a perfectionist to the point that it gets in the way of trying new things?

 

  1. Are you ultra-competitive, hating to lose more than most people do?

 

  1. Are you good at figuring people out? Do others tell you that you’re good at “reading” people?

 

  1. Is your handwriting below average or poor?

 

  1. Were you a late walker, or have other delayed motor skills as a child?

 

  1. When you’re in a new place, do you tend to find your way around easily? 12

 

Right Brain/Left Brain ADD Questionnaire

 

Scoring Page

 

 

The more yes responses you have, the more to the right you or your child will be on my left-right brain continuum.

 

In general:

0-4   yes answers indicate you’re very left-brained

5-8   yes answers indicate you’re somewhat left-brained

9-12  yes answers indicate you’re whole brained

13-16  yes answers indicate you’re somewhat right-brained

17-20  yes answers indicate you’re very right-brained

 

Again, while this is not a scientific test, it will give you a general understanding of your brain dominance.

 

 

Note:  If you’re working with a preschooler or kindergartener who doesn’t yet have full letter recognition, you can use the following exercise to give you an early indication of his/her brain dominance.  This is a fun activity and can give you a clue as to how right-brained and visual your little one really is.

 

 

Activity:  On a piece of plain white paper, draw seven circles of approximately the same size in a straight line across the page.  Randomly use three or four different colored markers or crayons so that the sequence might be:  green, blue, red, red, yellow, green, yellow.  Instruct your child to study the circles for at least twenty seconds, until he/she feels confident he can remember them.

 

Remove the paper and ask your child to name the colors from left to right, and then right to left.  The results may surprise you!  Most children with ADD will be able to do this by hyper-focusing and using their visual memory.  Notice whether your child closes his eyes or looks upward, and indication that he/she is getting a picture of those colored circles in his/her mind.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Right Brain ADD/ADHD Characteristics

 

 

Learns better when moving

 

Stress ball, different textures on desk

 

Quiet place for learning

 

Relevant, hands on, interactive, practical learning

 

Show the child the end picture – fill in the pictures

 

Reading – Scan – get ending – fill in the pictures

 

Make a picture in his/her head, then create

 

Color, pictures movies and cartoon to fill in the story

 

“Touch math” – money counting, using beads, abacus

 

Can you see what I am saying?

 

Are you getting the picture?

 

Let me show you what I mean?

 

Problem solving – picture books

 

Paying attention – sequence of pictures on desk

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Left Brain ADD/ADHD Characteristics

 

 

Sequential and logical, analytical and reliable

 

Uncomfortable with change

 

Live in an auditory world – storage in words

 

Routines and rules

 

They have to hear things to learn them – Laugh and Learn

 

Literal interpretation of world

 

Need step by step instructions

 

Must run through everything verbally to make sense

 

Talk to themselves as they take notes

 

Look away during lessons to process

 

Oral tests, report giving, lessons audio taped (for later listening)

 

Jingles, songs, poems

 

Big projects into small steps

 

Tell me about it?  Can you hear that?

 

Problem solving – storybooks to solve a problem

 

Tell me a story

 

Paying attention – words to be said – put on desk

 

 

 

 

 

 

 

 

 

 

 

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