So what’s a parent to do with all the free time kids get in the summer?  Here are some tips for more than just getting the kids out of your hair…

Tip #1: Remember that it is not your job to keep your child from ever experiencing boredom.

Boredom is an inevitable part of life, especially for children. It is also an important teacher. If you allow your kids to feel bored and you don’t immediately jump to “fix it” then your kids will learn how to find something to do for themselves. This is a skill that will benefit them for the rest of their lives. If your kids don’t know how to amuse themselves when alone, they will become more and more dependent on others to entertain them. Most of the greatest inventions and works of art were only completed by individuals who could spend countless hours alone.

Tip #2: Kids are hard-wired to learn.

Just watch a baby or young child. Children, in their healthiest states, are active, inquisitive, curious and playful. No one needs to beg them to play or to explore. Even if parents never applauded when their baby took a first step, you can be sure that toddler would keep walking nonetheless. This inborn motivation is critical to our survival, and underlies human beings’ desire to grow and to learn in all ways- cognitively, socially and physically. If adults stop giving them constant stimulation, kids will begin exploring on their own. Sometimes it’s best to do nothing.

Tip#3: Some of the best summer activities and learning opportunities are either free or cost very little.

Reading books and magazines is one great example–and a routine that is ideally built into every child’s summer on a regular basis. Libraries are important places to start because kids can try a dozen books for free and then discover what they enjoy. Many libraries have summer reading programs that keep track of how many books your child reads and encourages them to share what they have read. When kids are asked why they don’t read, they say it’s because they can’t find books they like. The best way to get them reading is to find books that they gobble up. Never mind that the books are about sports heroes, or bugs or ghosts and vampires. Freedom of choice is the ticket to getting them motivated and excited. Reading a comic book still counts as reading–especially in the summer.

Tip #4: Add all things creative to your summer.

During the school year, most kids complain that they don’t have enough time just to play. Summer is the perfect time to bring out the arts and crafts, the crayons and paints, the scissors and glue. There are countless ideas for arts and crafts projects for kids of every age (grown-ups too) that can be found on line or in books from the library. Dedicate a room, or part of a room if you can, that can stay “messy” so that creative ideas can be worked on whenever the mood is right (or the weather is bad).

Put on music in the house and dance, sing and play along. Music CD’s and educational DVD’s can be taken out of the library for free when you go to get books. Have the kids write and put on a play or a concert. There are educational sites on the web that offer music for kids along with free activities that can promote new learning in fun ways.

Make sure that you and your kids spend as much time outside as your climate allows. Since kids spend the majority of the school year sitting in classrooms, summer is the time to get outside and make exercise a daily habit. Play outdoor games, run in the sprinklers, build forts, plant gardens, set up lemonade stands, catch bugs, and make collages out of leaves and flowers. The sky is literally the limit.

TIp #5: Connect with family, friends, neighbors and find what your local community offers and what you can give back.

Every family in your neighborhood is probably hearing the same complaints that you are–(“I’m sooooo bored.”) so work out trades with other parents. Give each other a free evening off by trading babysitting. One evening each week, arrange a potluck picnic with several families at a park or the beach so that the kids can play together and the parents can commiserate.

Summer is the perfect time for service projects that give back to the community. Encourage your teen or older child to volunteer at a summer camp, local library, trash clean-up day, community garden, or animal shelter. Just having your kid do the research about what the community needs is an excellent learning. Let your kids pack up outgrown clothes, toys and books and plan a garage sale where they donate the proceeds to a cause they believe in.

#Tip #6: A good summer for kids can include both work and play.

Far too often, I see parents who feel guilty that they are not spending enough time with their kids. As a result, they overindulge them with too many material things, video games and TV time, and far too late bedtimes. In many parts of the world, children work side by side with parents and relatives, and have great fun doing so. Unless you teach a child that work is bad and play is good, they will be curious about exploring any activity. Summer is a great time to let your kids help more so you can ALL do something fun together.

“The principle aim of psychotherapy is not to transport one to an impossible state of happiness, but to help (the client) acquire steadfastness and patience in the face of suffering. ” -C.G. Jung

Just yesterday, a friend told me how her family doctor prescribed her mother antidepressants for twenty years. She was outraged that he never encouraged her to get counseling as well. She believes her mom could be happier if encouraged to grieve the untimely death of her husband and directed to build a bigger support system.

Last week, a new client came in for help with anxiety, and her doctor told her she must see a psychiatrist—not a psychologist or family therapist. This was the GP’s advice in spite of the fact that the woman complained about the controlling behavior of her husband. Unfortunately, far too many psychiatrists now prescribe medication (usually anti-depressants but sometimes addictive drugs like Xanax) rather than doing psychotherapy or even suggesting it.

Psychotherapy or Drug Therapy?

This is no small question since one in six people will experience depression at some time during their life. Study after study has shown that psychotherapy helps people–and not just for depression. Given that therapy is available in many forms—and that low-cost or sliding fee scale options are available in most communities across America—why are doctors still not prescribing it as the first line of attack for depression and anxiety?

One answer can be found by following the money. Intense marketing strategies on the part of drug companies sell every new drug therapy as the quick and easy fix–while only mentioning in fine print the negative side effects that typically coincide with any drug. In the blog I wrote about anxiety, I received numerous heartfelt comments from readers who became addicted to prescription meds being taken just as their doctor prescribed.

Perhaps there are so many different forms of therapy out there these days that doctors are unfamiliar with and therefore hesitant to make referrals. While it is broadly accepted that psychotherapy can help people with depression, the question of which type of psychotherapy works best for most patients has remained controversial.

That’s why a research team, led by Jurgen Barth at the University of Bern in Switzerland, decided to shed new light on this question. Barth and his team analyzed results from 198 published studies involving over 15,000 patients, one of the largest examinations on the effectiveness of seven different types of therapy. The authors compared each of the therapies described below with each other and with a control group.

The Seven Models:

Interpersonal Psychotherapy: This short-term model (6-20 sessions) focuses on the client’s interpersonal issues, patterns of interaction with family and friends, and has the goal of reducing specific symptoms, improving interpersonal skills, and helping increase social support for the client.

Behavioral Activation: This approach focuses on helping the client increase positive interactions between themselves and the environment, bringing increased awareness of positive activities and interactions.

Cognitive Behavioral Therapy: This kind of treatment uncovers the patient’s negative beliefs about self and others, then teaches how these beliefs impact on behavior in order to facilitate symptom resolution.

Problem Solving Therapy: This model explores the nature of the client’s problems that contribute to the depression. The client examines multiple solutions for each problem, and then selects, implements, and evaluates the best solution.

Psychodynamic Therapy: This paradigm focuses on how unresolved conflicts and issues from the past have a negative impact on the patient’s current situation. Through insight and exploration of old patterns, the client develops new healthier ways of relating.

Social Skills Therapy: This highly educational process teaches people the skills needed to build and maintain healthy relationships.

Supportive Counseling: This less directive model encourages the client to talk about their life experiences and emotions. The therapist then offers active listening and empathy without suggesting solutions or teaching new skills.

The Surprise Ending (or is it?)

These seven treatments for depression in the study were not exhaustive of all the possible treatments now available–such as spiritual counseling, acupuncture, exercise, yoga and meditation (the list goes on)–but are each commonly practiced forms of talking therapy. The study found evidence that all seven interventions achieved moderate to large effects on alleviating depression when compared to no treatment at all.

They also found that the therapies worked equally well for different patient groups, from young to old, from post-partum mothers to single men. The only significant difference was that interpersonal therapy was somewhat more beneficial than supportive counseling. They also found that in larger studies, the cognitive-behavioral, interpersonal, and problem-solving models were more effective than the other three but by a very small margin. Other research on the effectiveness of therapy indicates that experienced clinicians include interventions at all the levels mentioned above (thoughts, feelings, behaviors; providing insight, encouragement and support) no matter what theoretical model they say they follow.

What does this mean if you suffer from depression?

If you are one of the many for whom medication is a life-saver, stay on your meds AND make sure that some form of counseling is part of your program. When looking for the right therapist, think about what strategy might be best for you. Just because a certain type of therapy has a track record of success doesn’t mean it fits your particular needs or cultural beliefs.Discuss different forms of non-drug therapy with your doctor or friends or check out on-line resources such as those offered here at PsychCentral.

Some people prefer practical hands-on approaches; others merely want a good sounding board. The bottom line: the new standard of care should always include therapy if the depression or anxiety is serious enough to merit taking medication. Find whatever approach feels right for you. Then make a beeline for it.

1. Do you spend time alone on a regular basis? When you are alone, are you comfortable or do you get anxious?

2. When your partner wants to spend time alone, do you feel rejected, scared or unloved?

3. Do you get jealous or upset when your partner spends time with other friends or family members?

4. Are you afraid that when your partner is out of sight, you are no longer in his or her thoughts?

Autonomy is the Foundation of Intimacy

If you are puzzled about what autonomy has to do with the capacity to be alone then keep reading. Autonomy gives us the ability to make choices according to our own free will. Without it, we feel like victims. If you cannot tolerate being alone, then you will choose to spend time with anyone but yourself. You will sacrifice your autonomy, your very sense of personal freedom, in order to feel connected.

If you feel that you cannot survive being alone, then fear will be in the driver’s seat. When run by fear, people choose partners who aren’t good for them (or are even dangerous) just to avoid being alone or rejected. On the other hand, if you know that you can be alone—and take care of your own needs—then you can risk being the unique individual that you are. You are able to let your partner come and go, both physically and emotionally instead of desperately clinging on for dear life.

The Balance Between Closeness and Distance

Most people value their relationships above everything else. Half of my clients come to therapy longing to find a healthy relationship, and the other half seeking to improve an already existing one. We are, by nature, social animals. But living in close quarters with family members is anything but easy. Part of what makes the dance of relationship so difficult is the ongoing tension between closeness and distance, connection and autonomy.

Unfortunately, too many people fall prey to the myth that intimacy is only about connection. Authentic connection is a big part of it, of course, since intimacy is usually defined as the feeling of closeness, trust and transparency among partners. An intimate connection, whether sexual or not, is comprised of mutual loving feelings, shared and expressed in thoughts, feelings and behavior.

Too few of us have been taught that real intimacy starts with the capacity to be alone, to know yourself with all your likes and dislikes, and then to remain true to yourself while relating to another. If you accept yourself, warts and all, you will be able to relate in a genuine way to your partner rather than trying to be what he or she wants you to be. This is the first step of authentic connection.

Why Is It So Difficult To Be Alone?

You are not to blame if you have a difficult time being alone. Part of this capacity stems from your biological wiring, part from how you were nurtured as a baby and small child, and part from your family history which might have included sickness, loss or trauma. If, as a child, you were able to form a healthy attachment to your primary caretaker, you learned how to comfort yourself even when your parent was away from you.This internalized sense of a comforting parent develops into the psychological capacity to regulate anxiety, self-soothe, and experience a true authentic self. This is the capacity to be alone and know that you are still OK.

Learning To Be Alone

If you answered yes to some of the questions above, the first step is to accept, for reasons known or unknown to you, that you have some fear about being alone. The good news is that you can learn to work with your fear rather than surrendering to it. Write down some statements that are true in the present moment, and read them to yourself each day. Examples of this would be: “I can take care of myself as an adult in ways that I couldn’t as a child.”  ”My husband loves me even when he is not here with me.” “I am always surrounded by the love of God (or my children or my friends).”

Practice being alone for short periods of time each day, gradually building your capacity. Often a great way to start is to begin with time spent alone in prayer or meditation. Some people spend time writing in a journal, drawing or painting, listening to music, or being out in nature. Notice if you are tempted to fill your alone time with hectic “doing” rather than peaceful “being”.

As you are nurturing your ability to quiet your fearful mind and to soothe and calm yourself, practice deep breathing and relaxing your body at the same time. Classes in yoga or meditation can be very helpful, and initially practicing centering yourself while in a room with others is a great way to start.

The Benefits of Being Comfortable with Solitude

“Alone time is when I distance myself from the voices of the world so I can hear my own.”  -Oprah

1. You can be yourself. As you learn to be more comfortable living in your own skin, you will be able to be more honest and open with loved ones. You can only say “YES” if you know that you can say “NO” and still be OK. This means that you can deal with conflict in healthier ways, asserting what you think and believe, and what you want or don’t want from your mate. You can tolerate having a difference of opinion and the temporary disconnect that often comes with arguing, or conversely, you can agree to follow your partner’s opinion without fear of being controlled.

2. You can be less dependent. Your partner will be relieved of the burden of entertaining you because you will each be able to pursue different activities and friendships without threatening your bond. You will realize that you don’t need to do everything together. With a bit of separation, time spent together will be more interesting and special.

3. You can feel empowered rather than victimized. And the very best gift of all–you can hear your own voice and stand up for what you want in the relationship. You don’t need to take everything personally that your partner does or doesn’t do. As you come to treasure your individuality and that of your mate, you will realize that your differences bring strength and creativity into the relationship. Your ability to be authentically close will grow and grow as your fear shrinks into the background.

While certainly both of those claims are true for many, when men in self-described unhappy relationships are asked what they want most from their partners that they’re not getting, the first answer was communication and the second answer was affection. Exactly the same answers that the unhappy women answered!

When it came to the third answer, men said more sex and women more financial security. More sex was #4 on women’s list. So the surprisingly good news is that all of us want more of the same thing…more talking and listening. Although improving our communication can take hard work and commitment, at least we can be assured that this goal is both mutual and a deal-breaker for healthy relationships.

New Study on What is “Normal” in Relationships

This information and a lot more is now available thanks to Chrisanna Northrup and social science researchers, Pepper Schwartz and James Witte, who conducted an on-line survey of  more than 70,000 participants from around the world. The results, published in the new book, The Normal Bar, provide us with hard empirical evidence about what really goes on behind closed doors, not only in America but in Europe, Australia, Latin America and Asia. As Northrup discovered, ”Cultural stereotypes and the media’s fantasies of romance and lust have little to do with what really goes on in relationships, especially since conduct varies over time and across geographic boundaries.”

Although their study does indeed reveal some differences between men and women and across cultures which I will discuss in future blogs, the broad similarities are striking. Men and women in almost every country described communication as the biggest relationship issue. The only exception were the French respondents who ranked affection first and communication second. Go figure.

“Ultimately the bond of all companionship, whether in marriage or in friendship, is conversation.”  -Oscar Wilde

What do couple and families need to build a strong sense of loving connection? The answer is simple, even if difficult. We must spend quality time together talking, or if separated by geography, still stay in communication with one another. Only by making the time to share the details of our daily lives as well as our successes, hardships, dreams and disappointments can we reap the rewards of our intimate bonds.

Unfortunately, twenty-first century families are more isolated than ever before. With both parents working more hours than ever and with the demands of work infiltrating family time via computers and cell phones, most everyone we talk to complains about the same thing. There’s just not enough time!

So remind yourself in the following week to take some time each day–even if only minutes– to connect with your family members. Remember to use the precious times you already have to talk and listen rather than remain plugged into cell phones or ipods. Catch the moments in between–like driving in the car, eating a snack, walking the dog–to share thoughts and feelings with your loved ones. Use your cell phone to send your love or to check in on how your partner’s day is going.

One of my favorite times to talk to my mother is when I am chopping vegetables for dinner with my headset on. We take those minutes to share details of our day, and my mom always asks me what’s for dinner. My adult kids know this is a good time to reach me as well. My husband has long weekly talks with his mom (who lives out of town) when he goes on hikes. It often helps to schedule talking and listening time in whatever schedule “book” you use, committing yourself to family time instead of slipping into the habit of watching TV, computer surfing, video gaming or answering one more email.

If you think that you need more help to become a better communicator, there are books and blogs, podcasts and videos. There are seminars that couples can attend together and therapists who specialize in working with couples and families. If you set only one goal for self-improvement, this would be the place to start.

“Affection is responsible for nine-tenths of whatever solid and durable happiness there is in our lives.”  -C.S.Lewis

As for the second most important ingredient to build more close and loving bonds, make a conscious decision to be more affectionate with your partner. The need for physical touch is a basic human desire for both men and women. Remember the early days of courtship when you held hands, kissed and hugged hello and goodbye (and then some), shared back rubs or cuddled up on the couch? Do that again.

Our words and gestures can also be affectionate. Both men and women feel more loved when they are complimented rather than criticized, when their partner smiles at them when they walk in the door, when they blow kisses or wink from across the room. Use pet names like sweetheart or honey, and don’t forget to say the precious words “I love you” like you really mean it.

None of these things will repair a deeply distressed relationship but they won’t hurt it either. When people are asked what is most important to their happiness, the universal answer given is “my family” or “my relationships”. If you want to be happier, start by giving what you most want to receive.

I attended a powerpoint presentation recently, given by a nationally renowned psychiatrist, who provided an excellent overview of modern day psychiatry in America. It was quite disturbing to learn that the most widely prescribed psychiatric drug is Xanax. More bad news is the Center for Disease Control and Prevention (CDC) reporting a sharp increase in fatal overdoses of prescription drugs. In fact, if you look at the top fifteen most prescribed psychotropic drugs, you will find Ativan (at #3), Valium (#8) and Klonopin on the list as well. If your regular doctor is prescribing them, they can’t be all that bad, right?

The History of Benzodiazepines

Many of you reading this article may not know that all four medications are classified as “minor tranquilizers” and are from the same family of drugs, called benzodiazepines. The first “benzo” sold in America was Librium in 1960, followed quickly by Valium, which was the number one prescribed psych med for most of the 1970′s and is still high on the list. When Xanax became available in 1981, it was marketed as the best drug for panic attacks. Certainly Pfizer did a great job of marketing, making Xanax the big winner–the most popular psychiatric drug in America–but is this really the best treatment for anxiety?

Some of you who are reading this article may currently be taking one of these drugs as prescribed by your doctor. I am a psychotherapist, not a doctor, and I am not offering medical advice here. Rather, I am offering information so that you, as a consumer or interested family member, can have more facts at your disposal. Unfortunately, hugely expensive, clever commercials flash onto our screens daily, touting one promising drug or another for various psychiatric conditions. Given how debilitating anxiety can be, it is no wonder that we reach for something, anything, to fix it.

Without going deeply into the chemical composition of benzodiazepines (such information is readily available on line), they offer short-term sedation, muscle relaxation, seizure prevention, and anxiety reduction. Xanax (also known as alprazolam) and Ativan (lorazepam) are short-acting, usually providing temporary relief in 15-30 minutes. Klonopin (clonazepan) and Valium (diazepam) are longer-acting. In general, benzodiazepines are safe and effective in the short term when used as prescribed. What is highly controversial is their long-term use for anxiety disorders, and whether or not they should be the first line of attack for the anxiety that often accompanies depression.

For people who can’t get on an airplane without breaking into a cold sweat, the use of this form of medication is a life-saver. One of my clients (who had not taken any drugs) recently told me that one of the flight attendants told her she should take Valium next time because she was making everyone on the airplane nervous. Medications like this are used routinely for surgical procedures where the doctor wants the patient awake but not anxious. After a traumatic event or loss, the use of short-term anti-anxiety agents can be the only way some people can get any sleep. These are just a few of the appropriate uses of these medications.

The Dark Side of Xanax (and Other Benzodiazepines)

There is a dark side to this story. First, all benzodiazepines are addictive and have the potential to be abused. They are known by street names like zannie bars, school buses, white ladders, totem poles, tonka toys, and zanners. They can lead to a physical and/or psychological dependence. If dependence develops, it can be extremely difficult for a person to stop using the medication because withdrawal symptoms may occur. Typical withdrawal symptoms include sleep disturbances, irritability, increased nervousness, and muscle cramps. If someone has been abusing them at high doses, the withdrawal effects could include psychosis, epileptic-type seizures, coma, or even death.

From the reports of doctors working in rehab facilities and from the self-report of dozens of clients I have seen, they say it can be more difficult to get off of benzo’s than to detox from heroin. They wished someone had warned them before they began long-term use of these meds. There are some excellent resources if think you might be addicted and you want to know more about this topic. That being said, never stop taking any psychiatric medication suddenly or without the supervision of your doctor.

Another important fact is that when Xanax is combined with alcohol or many other drugs, its effects are magnified. We all know the dangers that come with drinking and driving, or other ways that drugs can impair judgment. Given that the benzo’s can affect physical coordination, they can be particularly dangerous for the elderly. They can also interfere with memory–I have worked with college kids who have suffered blackouts from the mixing of alcohol and benzo’s.

Third–and perhaps most importantly–there are other effective treatments out there for panic attacks, and these treatments are not dangerous or addictive. Panic attacks and other anxiety disorders are usually treated successfully with psychotherapy and when medication is needed, with safer, non-addictive antidepressants. Another important component of good treatment is the education of both the patient and significant others. The cure of panic disorder involves the sufferer understanding that the panic attack itself, although horribly uncomfortable and frightening, is not fatal and will ultimately end.

In order to recover completely, the panicking person must remain in the phobic situation long enough for the panic attack to lessen on its own. Learning that you can face a feared event–and conquer your fear–is a turning point. If instead, you simply pop a pill, you might think that only the pill will bring relief rather than learning effective strategies for self-soothing and breathing through the discomfort.

Studies have shown that Americans report higher levels of anxiety than most anywhere in the world. Can that really be true? We are certainly not the only nation that is overwhelmed with problems. In fact, we have more wealth and resources than most. So why have we become a nation with millions of Americans being tranquilized artificially? Is it possible that we have begun to confuse real cases of anxiety–a painful diagnosable disorder–with the normal, inevitable pain of being human?

How, in this day and age, with so much information available, is it possible that depression can still go undiagnosed and therefore untreated? Perhaps this is part of the reason why the blog “Depression Part Two” on Hyperbole and a Half  just went viral (besides how extraordinarily creative it is). Here are some reasons why smart people can miss the signs of depression:

1. Depression can creep up on you.

Not all depression is so severe that you can’t stop crying or get out of bed. For many people, the feelings of sadness manifest as a growing disinterest in life’s activities. What used to be fun or interesting seems unimportant or shallow. You don’t feel like going to your friend’s birthday party so you make up an excuse. You feel bored by the books or TV shows that used to appeal to you. You don’t notice how, little by little, you are pulling back from others, spending more time alone, locked in your room.

2. Depression seems to be a logical response to life’s challenges.

Since depression often worsens or can be triggered by loss or stress, you figure that you are responding appropriately to what is indeed a painful time in your life. You may have broken up with a boyfriend, had difficulties at work, done poorly on a school assignment, or moved away from a supportive environment. When you don’t snap out of it, even when your life circumstances appear to get better, you don’t realize that your negative mood state has persisted for months or even years. 

3. Some depression manifests as extraordinary irritability rather than sadness.

One of the most commonly misunderstood or overlooked manifestations of depression is hypersensitivity or irritability. People around you tell you that you are constantly cranky. You seem annoyed (and feel annoyed) at every little thing. People or activities that you didn’t like before become intolerable. One of my clients, Sally, upset her husband and kids because she yelled at the TV announcers and seemed critical and judgmental about everything. Only when I inquired about whether Sally might be depressed, did she realize that she was sleeping an inordinate amount of time and no longer had any appetite. She never felt sad, just incessantly irritable.

4. Some depression manifests as extreme anxiety.

Many people do not realize that anxiety is a frequent companion of depression. Mark, a local college student, came to see me because of paralyzing test anxiety and social phobia. Since he did not feel sad and never cried, Mark attributed all of his problems to his fears. Only after a thorough assessment that revealed his gradual weight gain since high school, his difficulty with sleeping, his growing disinterest in sports (which had been his passion), did Mark realize that his anxiety was one of many symptoms of his depression.

5. If you’ve been depressed your whole life, it just seems normal.

I worked with Randall, a 54-year-old math professor, who never said a word about being depressed. He had even had bouts of suicidal thoughts on and off since he was a teenager. Randall’s mother was chronically unhappy, and his father was an alcoholic. Surrounded by a family of unhappy people, this client thought of his mood state as normal. It never occurred to him that he might learn to treat himself more generously. To be happy was unthinkable in Randall’s world.

6. You have been raised to be stoic in the face of any form of pain.

Justina came into therapy because her child was having problems adjusting to school. She insisted initially that everything was fine in her life. It was only when her son told her that he was afraid to go to school because he thought his mom might hurt herself that Justina began to talk about how difficult it was to get out of bed every morning. As we talked further, she described her upbringing in a highly religious family where she was not allowed to complain. Her parents taught her to be grateful for her privileged life in a world where others suffered from poverty and religious persecution. Justina’s shame about what she saw as her personal weakness had kept her from talking about how badly she felt.

7. You feel hopeless, believing nothing will change how you feel.

Another group of people just soldier on, convinced that there is nothing anyone could do to help. Since depression causes people to withdraw from life, to stop reaching out to others, and to be immobilized by insecurity and anxiety, the idea that their misery is unchangeable becomes a self-fulfilling prophecy. The very things that loved ones do to try to help–telling the depressed person to exercise, go out more, drink less, and look at the bright side–are the very things that the depression makes impossible.

Do any of these sound familiar? If so, you are not alone. There are numerous resources both here at PsychCentral and elsewhere. And thank you to blogger Allie Brosh for her willingness, not only to share her own struggles with depression, but to do so with both humor and hyperbole. Hope comes in many forms.

“Nature, we are starting to realize, is every bit as important as nurture. Genetic influences, brain chemistry, and neurological development contribute strongly to who we are as children and what we become as adults.”

Sue and Alan Richardson are like so many other distressed parents who reach out to our counseling clinic. They have three kids. Two have been launched successfully, and they have warm relationships and good communication. Sue and Alan are devastated because one of their kids, now 19, is such a problem. Samantha struggled with depression beginning in junior high, rages at them on occasion, tried to make it at college but couldn’t stand the pressure, and has bounced back home again. What went wrong? They parented all three kids similarly but Samantha was always more difficult and highly sensitive.

Stopping the Blame Game

Parents often get blamed or blame themselves for any problem that shows up in their children. We now know that every baby is born with certain innate inherited characteristics or temperament. Temperament is, by definition, the part of a child’s personality that is not caused by good or bad parenting. Built-in traits will affect each child’s style of interacting with people, places and things throughout their lifetime. The research validates what many parents knew intuitively all along. Some babies are easy, and some are more challenging. Because it is almost taboo to say something negative about one child or to compare your kids, many parents don’t get the support that they need when struggling with a more difficult child.

The Nature Vs. Nurture Debate

The debate about just how much of our behavior and personality is genetic vs. environmental, or nature vs. nurture, has raged on for the last hundred years. Twenty or thirty years ago, in an ongoing effort to understand why people behave in certain ways, both good and bad, researchers focused more on the nurture side, examining things like the family environment or types of parenting that were correlated with problems or resiliency in children. In the past ten years, with advances in technology that have helped us unravel more of the mysteries of both genetics and also how the brain works, the pendulum has swung back towards the important impact of a child’s genetic make-up, the nature side of the debate.

Kids Can Be Easy, Difficult, and Slow to Warm Up

The truth, of course, of why we are the way we are, lies somewhere in the middle. Each of us is the product of both our biology (nature) and our social learning (nurture). Beginning in the 1950′s, researchers Thomas, Chess, Birch, Hertzig and Korn, launched the New York Longitudinal Study, which rated young infants on nine characteristics and followed them as they grew up. They discovered that sixty-five percent of babies readily fit into one of three categories: easy, difficult, and slow-to-warm-up.

Of the sixty-five per cent, forty percent fit the easy pattern, readily adapting to new experiences, generally exhibiting positive moods, with normal eating and sleeping patterns. In contrast were the ten percent who fell into the difficult pattern, These babies were very emotional, crying a lot, often irritable and fussy, with irregular eating and sleeping patterns. Another fifteen percent were slow to warm up, typically withdrawing from new situations and people, only adapting to new people or environments after repeated exposure.

The other thirty-five per cent were more subtle combinations of each of nine factors that comprise temperament including activity levels, adaptability, intensity, moodiness, and distractibility. Researchers have found that these broad patterns of temperamental qualities are remarkably stable into adulthood and are also found in children across all cultures. Think about your children, yourself or your mate and what might be the innate differences between you.  (Here is a link to a list of all nine characteristics and further reading).

How Well Does Your Child Fit with You?

Now let’s come back to the story of the Richardson family and the hundreds of thousands like them. Because of temperament, some children adapt quickly and easily to family routines and get along with siblings, but others who are more active, intense, shy, or moody may have a difficult time adjusting. The frustrating, negative interactions between these children and their parents or siblings can cause enormous stress and friction between the parents and within the family.

Once you have learned more about your child’s temperament as well as your own, you can see how some children “fit” better with some adults. If your temperament is vastly different from that of your child, it is easy to think something is terribly wrong with one or both of you. Further exploration of temperament can help parents spot the trouble areas, notice problems of poor fit, and come up with strategies for adapting to their child’s unique strengths and weaknesses.

For example, a slow-paced parent may be irritated by a highly active child or vice versa; or if both parent and child are highly sensitive and intense, lots of conflict could result. What may appear at first glance to be a behavioral problem may actually be a mismatch between a parent’s temperament (and their resultant parenting style) and their child’s. Sometimes one child seems to bring out the worst in both parents. Or conversely, sometimes one parent seems to bring out a difficult child’s strengths.

Not all kids are alike, and some kids take parents with almost superhuman powers of patience and persistence. Taking the first step–from blame to understanding–is crucial. We are each born with a given temperament as well as a myriad of other strengths and challenges. Out of our genetic grab bag, are the building blocks of character, mysteriously designed to blend destiny with free will.

“There exists, for everyone, a sentence – a series of words – that has the power to destroy you. Another sentence exists, another series of words, that could heal you. If you’re lucky you will get the second, but you can be certain of getting the first.”

It will probably come as no surprise that I have been writing since I could put pen to paper–that’s my bias. That being said, I’m not sure what I would have done without it. In my teen years and early adulthood when I would never (and did never) set foot in a therapy office, I created a safe space in my journals to express everything I couldn’t talk about. Years later, when I began my journey of self-exploration and healing in early adulthood, I was able to reflect with new eyes on everything I had written. What had I learned, if anything, and what was I supposed to learn from the lessons life was giving me?

If you are not in therapy because you don’t believe in it, can’t afford it, or it’s against your religion, writing may help you. If you are in therapy, writing may help you deepen your experience and make yourself the hero of your journey. If you are a parent, and want to know how to help your child deal with the recent traumas from Boston or Newtown, here are some ideas. What is the story you tell yourself about your life and what do you want it to be?

The Health Benefits of Writing

There is now a considerable body of research showing how powerful it can be to write about difficult events. Psychologists James Pennebaker, at the University of Texas and Joshua Smyth at Syracuse have found that written expression can reduce both anxiety and depression, improve immune function, lower stress levels, improve grades in college, and help people recover from trauma. What can be learned from their findings?

1. It is better for our health and well-being to express our negative feelings.

Allow yourself to have ALL the feelings that you have without judging yourself. You can tear these pages up when you are through so no one will ever see them but you. This exercise is particularly helpful for those of you who avoid conflict and never get openly angry, or for the tough types out there who never show fear or vulnerability. Although it is often preferable to talk to a “real” person such as a family member, friend or counselor, not everyone feels comfortable sharing painful truths about themselves. So even if you have no one to talk to, it is better to express yourself in writing than not at all.

2. Venting emotions is the first step in a process.

Just as the first sessions of therapy typically involve telling your story, and if you are dealing with loss or trauma, telling it with lots of emotion–the first time you write about a painful event, it will often be raw and emotional. Allow all your feelings to emerge–even if they don’t make sense–but keep on writing until you come out the other side. Suppressing or denying our “negative” feelings can make us sick or depressed but equally counter-productive is simply dwelling on only the dark side. It is easy to get stuck in resentment, but not good for our ultimate recovery from stressful life events. Describing negative emotions in moderation is most effective.

3. Writing about our problems can bring some needed distance and new perspective to bear on the situation.

After thoroughly venting about what happened, turn your attention towards what meaning you have attached to your life story. Do you notice any patterns or themes that emerge from your experiences? Are you frozen in a victim role, blaming others for all of your problems, or are you stuck in a self-defeating interpretation where you judge yourself as bad or wrong no matter what happened? A crucial aspect of the process, if it is to bring healing, is to get deeper insights into the complexity of what happened. Since most things in life are not so black and white as when we are responding with raw emotion, this part of writing allows us to view what happened from multiple perspectives. What realizations emerge as you write freely about what happened and how you responded?

4. For writing to be healing, we must find the positive parts of the story.

I often ask people to write about what was the silver lining in their painful loss or experience. In facing hardship, most people learn that they had far more courage and strength than they ever imagined. What did you learn about yourself that you never knew before? What is the sentence that is, as Dicks poetically put it, “destroying” you? It is usually a sentence of hopelessness such as “I am permanently damaged,” or “No one will ever love me.” A sentence that can open the door to change might start with, “Up until now”, fill in the blank….”I have chosen the wrong people to be my friends,” or “I have been afraid,” but “I have learned from this experience”…..fill in the blank with a new awareness…”that I am incredibly resilient” or “that I can make new choices.”

In the majority of the research on the effectiveness of this simple tool, people are asked to write about events for twenty minutes a day for just three days in a row. Even with this short amount of focussed writing, the benefits are significant. Imagine if each of us took the time to write about whatever life events still remain mired in negativity, if only once a week for a few months. My guess is that the healing power of words, if cast in the light of new understanding, will bring greater compassion for ourselves and for others. It has helped me find my voice and to be more grateful for the gifts that have come even at the darkest times. Try it, and let me know what you find.

In my last blog on the growing numbers of kids being diagnosed with ADHD, I wondered out loud about the potential negative effects in our modern culture of things like: too much time spent indoors, too little sun and exercise, too many electronics, and not enough sleep. Rather than dwell on the causes of our problems, let’s consider what we can do to reduce the impact of stress on the lives of both adults and children. Not from a medical psychiatric perspective, but from the perspective of everyday life.

Ask yourself this question: Do you or your kids suffer from Nature-Deficit Disorder?

This wonderful name was coined by journalist Richard Louv with the publication of Last Child in the Woods. His newest book, The Nature Principle: Human Restoration and the End of Nature-Deficit Disorder, offers a new vision of the future, in which our lives are equally immersed in nature and in technology.

What do we already know about the positive effects of time spent outdoors, immersed in nature?

Rachel and Stephen Kaplan, environmental psychologists from the University of Michigan, are internationally known for their research on the effect of nature on people’s relationships and health.The Kaplans got involved in studying the effects of nature back in the 1970s, and since then have done extensive research on “restorative environments” to understand the psychological benefits of time spent in nature and what types of natural environments stimulate health and reduce stress.

In order to work or study efficiently, we need to maintain focused attention on the task at hand–something that everyone struggles with–most especially those with Attention Deficit Disorder or ADHD. Too much focused attention can lead to mental fatigue and increased stress. One remedy for this fatigue is exposure to nature. The wilder the better, but even a little bit helps. Office workers with a view of nature are happier and healthier at work; kids do better academically; hospital stays are shorter with windows to nature; exercisers who walk outside in pleasant environments walk longer.

Positive Effects for Kids with ADHD

ADHD kids who participate in activities conducted in natural outdoor environments concentrate better and show less impulsivity. Published in The American Journal of Public Health, Frances Kuo conducted a national study comparing the effects of after school activities conducted in green outdoor settings versus those conducted in both built outdoor and indoor settings. Controlling for the amount of physical activity, type of activity, preference for nature, or timing of medication, they concluded that time spent in nature reduces ADHD symptoms.

The authors concluded that, “While medications are effective for most children with ADHD, they are ineffective for some, and other children cannot tolerate them…and a green dose or series of green doses might conceivably reduce the need for medication by 1 dose per day, allowing growing children to recover their appetites in time for dinner and get a good night’s sleep. These studies, and hundreds of others, add to the growing body of literature that shows how exposure to nature has profound effects on the health and well being of children and adults alike.

The Benefits of More Time in Nature for Children:

1. Kids get along better.  Research has found that children who play in nature have more positive feelings about each other. There is something about being in a natural environment together that stimulates social interaction. Another study showed how play in a diverse natural environment can reduce or eliminate bullying. In several studies, researchers have found that some of the kids who benefit most are those with attention and learning challenges.

2. Imaginative processes are enhanced.  Early experiences with the natural world have been positively linked with a sense of wonder. Children are more likely to use their imagination outdoors.

3. Cognitive development is improved. Curiosity and wonder are strong motivators that make children more eager to learn. When children play in natural environments, their play is more diverse. Creative play, in turn, nurtures language and collaborative skills. Spending time in natural environments helps improve their awareness, reasoning and observational skills.

4. Physical health is improved. Children who play regularly in natural environments show more advanced motor fitness, including coordination, balance and agility. They get sick less often. Just getting their hands in the dirt can bring exposure to “good bugs” that stimulate the immune system.

5. Kids are less stressed out. Nature buffers the impact of life stress on children and helps them deal with adversity. The greater the amount of nature exposure, the greater the benefits. Nature helps children develop powers of observation and creativity and instills a sense of peace and connection to the planet. Haven’t you noticed how kids can do whatever they need to do when they are out in the wild? They can just sit and stare at bugs or scream at the top of their lungs.

6. Kids are more psychologically mature.  A boost in maturity comes from the increased independence and autonomy that free play in nature encourages. Children with more contact with nature score higher on tests of concentration and self-discipline. The more green, the better the scores. In a study of kids with ADHD, it was found that those who played in windowless indoor settings had significantly more severe symptoms than kids who played in grassy outdoor spaces. School classrooms with outdoor views even help.

7. Kids are more likely to love and protect the environment. When people like John Muir and Teddy Roosevelt spent time in places like Yosemite Valley, they realized that these wild places were “America’s treasures,” needing our stewardship and protection. In order to teach children how to treasure nature, kids must be allowed to explore it in their own way, and be given the time and opportunity to “dig in” and immerse themselves in its mysteries. Like a perfect mother, the earth welcomes us all with open arms.

What Are the Facts?

The number of American children leaving doctors’ offices with an attention deficit hyperactivity disorder (ADHD) diagnosis has risen 66% in 10 years, according to a Northwestern study. ”The magnitude and speed of this shift in one decade is likely due to an increased awareness of ADHD,” explains first author Craig Garfield, M.D., perhaps causing more physicians to diagnose the disorder. Researchers also found that psychostimulants have remained the most common medication, prescribed to 87% of children with ADHD in 2010.

No matter what the reason, it is frightening to think about.  Not only are kids being given psychiatric medications at younger ages, more young adults than ever before are now taking ADHD medications, usually powerful and addictive amphetamines like Adderall. In the past four years, IMS Health reported that the number of monthly prescriptions has more than doubled for Americans ages 20 to 39. The use and abuse of stimulants is on the rise.

Far too many kids, once 18 and away from home, decide on their own to get a prescription. Certainly some of these kids have legitimate difficulty keeping up with their studies because of real attention problems. Countless others look up the symptoms on the web and act the part. A 2010 study  by researchers at the University of Kentucky compared two groups of college students– those diagnosed with ADHD and others with faked symptoms–and found they were indistinguishable on the standard tests typically given. Once your kids become adults, there is nothing much that parents can do. But, is there anything you can do NOW to stem the tide? I think so.

What Can Parents Do?

When you think about some of your happiest memories as a child, what do you remember? My husband spent countless hours of his childhood playing on his own or with pals in the woods near his home. No adults supervising. Hours building forts, throwing acorns, damming the creek, climbing trees, playing hide-n-go-seek.

And mine? Summer nights with a dozen kids of all ages, catching fireflies in jars, playing kick-the-can while being dive-bombed by bats. Or going to the dump in Wisconsin with my dad, where we were almost guaranteed to see bears or other animals foraging after dark.

Even as recently as the 1970′s, American kids still spent most of their free time exploring and playing outdoors, using the sidewalks, streets, playgrounds, parks, and vacant lots with little or no restriction or adult supervision.Throughout all but the last tiny sliver of human history, adults and children alike were in constant relationship to nature, working with its rhythms of dark and light, sometimes in harmony, often struggling with its unpredictability. Two hundred years ago, most children were still surrounded by fields and farms. Little by little since then, our lives have become more urbanized.

Sunshine Lowers ADHD Rates

Enter a glimmer of hope. A new study  published in the journal, Biological Psychiatry, found that fewer children have attention-deficit hyperactivity disorder where sunshine is plentiful so they can play outdoors. Study leader Martijn Arns from the Netherlands suggests a link between increased screen time in the hours leading up to bedtime, less quality sleep, and attention problems. So here’s what parents can do: get your kids playing outside during the day and to sleep early at night. Nix the computers and gameboys right before bed.

What if part of the cause of the epidemic of childhood disorders–not just ADHD but depression, anxiety, and childhood obesity too–comes from our kids being deprived of their relationship to good old Mother Earth? What is even part of the problem is that simple: too much time indoors, too little sun and exercise, too many electronics, not enough sleep…These are simple solutions to a complicated problem. But as parents, these are variables that you CAN control. Have at it.