Without sadness, there is no happiness. Without hate and apathy, there is no love. Without betrayal, there is no loyalty. Understanding the despair and aching pain of betrayal can make one understand the importance of loyalty. The author Anna Godbersen once wrote, “So this was betrayal. It was like being left alone in the desert at dusk without water or warmth. It left your mouth dry and will broken. It sapped your tears and made you hollow.”
Loyalty is a value closely associated with trust, commitment, patriotism and devotion, to name a few. Loyalty and all of its related values are reflected in the biopsychosocial aspects of an individual, affecting a person throughout the developmental trajectory and at every ecological level. The value of loyalty has also been historically important in the development of Latino nations; it is a value that takes precedence in times of war, and is important when speaking about allegiance, patriotism, and changes in government. To Latinos immigrating to the United States, loyalty to the Latino culture becomes a topic of thought and conversation as parents and children acculturate to life in the United States, possibly having concerns about how much they can allow themselves to acculturate while still remaining loyal to their own culture and background, and asking themselves questions like, “Are we traitors to our culture/country if we become too Americanized?” For Latino immigrant parents and their children, who are acculturating at a faster rate than their caretakers, the issue of cultural loyalty seems to be present, with parents interpreting their children’s acculturated behaviors as being disrespectful to family traditions and cultural beliefs. Lastly, loyalty is a significant interpersonal value in all attachments and relationships, including the client-therapist dyad which suffers inevitable ruptures (e.g., sick days, holidays, tardiness, hurricane days, empathic failures) that can feel like betrayal to the client.
During my time in Costa Rica, the value of loyalty evinced itself in various situations that differ from the traditional views on loyalty; however, the vast applicability of loyalty as a value makes it all the more interesting. The most memorable encounter with loyalty in Costa Rica was when one of the host mothers spoke of how Costa Rican husbands cheat on their wives. She spoke about it in a matter of fact way, as if a cheating husband is part of the marriage vows and that type of behavior should be expected and tolerated if the husband is able to continue providing for the family and be present at important family functions and occasions. This was baffling to me, and I was disturbed to hear some of my peers tell me that their host mother’s had the same mindset. In this case, the husband is not being sexually loyal to his wife but is acting in a socially acceptable way if he remains loyal to his family by providing monetary support and being a physical presence during holidays, birthdays, etc. The idea of a divided or compartmentalized loyalty never occurred to me and made me realize that not only can loyalty be understood in a variety of contexts but the value itself is quite dynamic.
For Latino immigrant parents who are experiencing conflict with their acculturating children, the value of loyalty can be integrated in interventions by reducing conflict and increasing effective communication between parents and their children. Through perspective taking exercises and psychoeducation about the differences between Latino and. American values, parents and children should be able to understand that: 1) Children are not being disloyal and are not betraying their culture by engaging in some behaviors that are typical of their American peers; and 2) Parents are not old fashioned and are not trying to prevent their children from having experiences that their American friends are having. Another important aspect is including a treatment component that increases the children’s pride and involvement in the Latino culture, and, in other words, sustains their cultural loyalty and works toward biculturalism, the most adaptive form of acculturation. As the children become more acculturated to life in the United States, and if they are able to hold on to their Latino roots, they grow in their position to successfully navigate both cultures and the advantages of effective biculturalism are great for themselves as individuals, their families, and their communities. From a biopsychosocial model, working to reduce the chaos of conflict in families of different acculturation statuses per generation provides the opportunity for each family member to add a protective/resiliency factor that could promote overall good mental health.
Some hold the belief that much of the COVID-19 pandemic is political; once the election is over, we will stop seeing spikes in cases. Others are terrified of the repercussions of the deadly virus. There are also those who think the virus as a whole is a hoax. Regardless of your standpoint, quarantine has brought on a time of social isolation. The entire world has been forced to spend months at home quarantining away from work, family, and friends. Humans were not built to live in this type of aloneness; so, we must work to stay healthy by managing our mental health. Help your neighbor and help yourself- work as a community!
While we face the reality of physical isolation, many have unintentionally resorted to social isolation as well. This does not need to be the case! Keep in touch with your friends. Stay connected, take a walk, appreciate the outdoors, and get together with a small group of friends.
In accepting this new reality, we realize that everything is different- our work schedules, environments, support systems, and expectations. Change is not expected to be easy or learned overnight. Be kind and patient with yourself. Allow for flexibility within your schedule and expectations; know that this is a time to learn new ways to navigate your life. Understand and accept when you need support, and be on the lookout for coworkers and friends that may need support.
Self- help is the key to successful mental health. A good starting point in coping with COVID is to help others by helping yourself. However, we must also work together as a community. Do not only support yourself but also model your mental health as a priority so that those around you recognize their own mental health as a priority. Always remember that some have experienced a grief reaction to the pandemic. Reach out to your friends, and have each others’ backs. Utilize professional help when necessary.
Be a positive role model for your children. This is a confusing time for them, and they need guidance. Show them that when they are down, it is okay to express it. When you are grieving, it is okay to show them your vulnerable side. Let them know that sometimes we get stressed out, but it is important to take the correct steps towards healing yourself.
If you are worried about a friend, do not be afraid to ask about suicide or depression risks. Ask your friends about their safety. Asking someone if they are suicidal is not likely to push them to consider it. Asking is the only intervention that can lead to prevention.
Resilience can be accomplished through a feeling of belonging. Work to band together as a community, offer support to those around you, and model personal growth. Self-help is hard work but is entirely worth the effort. We are going through the pandemic together, so let’s work as each other’s support systems!
Jay D Tarnow, MD
W. Walker Peacock, Psy.D.
Twenty-six bells rang across the airwaves this morning to honor the twenty-six lives that were snatched away exactly one week ago. Each bell toll felt like a kick in the gut as I pictured the faces of the victims. There will come a day when it doesn't hurt so badly. There will come a day when we laugh again. There will come a day when we can drop our children off at school without fear, when December 14th is more a reminder to finish holiday shopping than a reminder of unspeakable tragedy. But that day isn't going to be here for a while, and nor should it.
We can not rush this process. I understand the desire to get through this and stop hurting. It's only been a week, and already I'm emotionally fatigued. I'm tired of fighting away the tears each time I turn on the news or see another picture of a child whose life was taken. A child who just as easily could have been my own. I'm tired of this heaviness in my heart that makes it difficult to breathe. Of this pain I feel for those children, those teachers, and their families. I cannot even imagine the level of their pain, how badly they want to move on. But we need to hurt. We need to grieve. We need to understand this tragedy as best as we can in order to, with the best of our abilities, prevent another like it from ever happening again.
But in our search to understand, we must exercise caution. Too often, we tend to categorize monsters as a way of explaining their behavior. As if we can put them into a box and feel better about ourselves because we don't fit into that same box. But what about those that do? In the hours after the shooting in Connecticut, I read that the shooter was diagnosed with Asperger's Syndrome and Obsessive Compulsive Disorder. We need to be very careful here as we try and find what or whom to blame. Diagnosing this kid postmortem does a tragic disservice to the tens of thousands of people with Asperger's and OCD for whom the thought of harming a child would never cross their mind. The shooter may have also had diabetes, or a peanut allergy, or had a fear of heights. But we would never hear about those, because mental illness is sexy. It's sensationalist. It makes an easy target. It is irresponsible and lazy journalism to speculate about this young man's possible diagnosis without discussing the aspects of these diagnoses that may - I repeat - may have contributed to his actions.
The truth is that we simply don't know anything definitive about this boy's mental and emotional health. All we have are reports from family, neighbors, and classmates that he was socially withdrawn, and that his mother was an eccentric with survivalist tendencies and a collection of firearms. We don't know the quality of care he received, or if he received any care at all. The only speculation I will make with any confidence is this:
- He was in a tremendous amount of pain
- He didn't feel like things were going to get better
- He believed his only release would be to make the world feel as horrible, and as broken, as he felt.
I'm not offering my opinion as an excuse or a justification for his behavior; there is no justification for such acts of evil. I only offer my opinion as another voice pleading that we lose the stigma associated with mental illness. There seems to be this belief that visiting a psychologist or psychiatrist is some indication that an individual is broken. When your tooth hurts, you go to the dentist. When your knee hurts, you go to the orthopedist. Why should it be any different when your heart hurts? To carry the analogy further, visiting your dentist or pediatrician for regular check-ups helps ensure that all is well and that any health problems that could arise can be identified early and dealt with while they are relatively small. Therapy works in the same way. Regularly checking in with a professional can help clients to stay aware of their processes, and of the potential struggles that can throw roadblocks in their way. When problems arise, we make a plan and work it through. I tend to see my clients more frequently when times are tough, or when we can predict that rough weather is ahead. Otherwise, it may be weeks or even months between sessions.
Every teen that walks into my office for the first time has a wary air of defense about them as if to say, "I don't need to be here. I'm not crazy." I always tell these clients the same truth: I don't know any crazy people. I know people who hurt. I know people who are frustrated. I know people who have identified something in their lives that they want to change. All of my clients are individuals and each of them comes in with unique histories and goals. What they all share, however, is the bravery to admit that there is something they want to make better and the courage to face the challenge head on. Irresponsible and sensationalistic reporting like I'm seeing around the Connecticut shooter isn't doing anybody any favors in this regard.
I realize that if you're reading this piece, you're probably a client of mine, a client of the Tarnow Center, or a colleague in mental health. Which means that I'm preaching to the choir. But what I hope we can do is get people talking and demystifying mental illness so that we can more easily dispel the notion that mental health care is only for the broken.
I have had several clients concerned about their productivity working from home for the next month. Especially for our clients with ADHD, it may be difficult for them to stay focused. Here are some tips:
1. Change out of your pajamas. When you wake up it’s imperative that you change out of your pajamas if you’re working from home. This helps set the mood that "this is not a 'lazy day,' it will be a productive one.” Encourage all members of your family to change out of their pajamas and put on clothes that feel more motivating.
2. Complete your morning routine. Just because you are working from home doesn’t mean that you can skip out on your structured morning routine. Wake up at the same time you’re used to waking up. Take a shower, make a healthy breakfast, and sit down for coffee.
3. Schedule out your day. Just because you’re not leaving the house and going into the office does not mean your responsibilities disappear. After your morning coffee, take about 15-30 minutes to schedule out your day. This helps us avoid procrastination and take advantage of our ability to work from home.
4. Take regular breaks. It is important to take scheduled breaks throughout the day to reduce burnout. Every hour or hour and a half, take a 15-minute break to help clear your mind. Go outside in your front or backyard and soak up some Vitamin D. Listen to a podcast or your favorite song. These breaks will help break up the monotony of work and keep you motivated throughout the day.
5. Exercise! I know most gyms are closed, but that does not mean that we have to discontinue our fitness routines. There are plenty of exercises that you can do from home. My personal favorite is the “Sweat” app, by Kayla Itsines. Her 28-minute workouts are challenging, but can all be done from inside the home with little to no equipment.
6. Try to limit mainstream media exposure. I know it can be tempting to turn on the news, and while staying up to date on current information is necessary, too much news exposure can actually increase panic. The goal is always to remain calm and optimistic. Too much media exposure can increase fear and anxiety, ultimately reducing our productivity.
7. Define when you’re finished for the day. Before you begin, decide on a time you will finish working each day. These should be similar to your hours at the office. Just because you’re working from home does not mean that you’re obligated to work more hours than you are normally required to work.
8. Get sleep. To avoid a difficult transition back to the office, it’s imperative to maintain your regular sleep schedule. This means going to be at your regular time, and waking up at the same time every morning. Make sure to have at least 8 hours of sleep each night, so you’re waking up rested and motivated.
Caitlin Bailey, LPC
Meaghan Devlin, M.Ed., BCBA, LBA
Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) and family members of individuals with ADHD may experience unique challenges. Among these challenges, understanding and managing executive functioning difficulties is crucial. Executive functioning refers to a set of cognitive skills that enable individuals to plan, organize, focus, initiate tasks, and regulate emotions and behavior. In children and adolescents with ADHD and other types of neurodiversity (autism, dyslexia, other learning disorders, etc.), these functions often present differently or with limitations, making daily tasks and academic performance more demanding. In adults, executive functioning challenges can impact job performance and career advancement. This article aims to provide insights into executive functioning and how to improve these skills effectively.
Recognizing Executive Functioning Challenges
The executive functioning challenges faced by individuals with ADHD often manifest in various ways:
- Impaired organization and planning: These individuals may struggle to organize their school or job responsibilities, manage their time effectively, and plan ahead for assignments or tasks.
- Difficulty with attention and focus: Maintaining attention on tasks, especially those that are not immediately engaging, can be challenging.
- Poor impulse control: Impulsivity can lead to impromptu decisions, difficulties in following instructions, and trouble with social interactions.
- Emotional regulation issues: Emotional outbursts, mood swings, and difficulties in managing frustration are common.
- Weak working memory: Short-term memory problems can make it challenging to follow multi-step instructions and remember important details.
A Combination of Strategies for Best Results
Medication and therapy are two primary treatment approaches for ADHD. In fact, medication alone may not address all executive functioning challenges. Behavioral therapy, such as executive functioning coaching and social skills training, can be immensely helpful. These therapies provide individuals with tools and systems to manage impulsivity, regulate emotions, and develop coping strategies for executive functioning challenges.
Where Executive Functioning Coaching Can Help
Individuals with ADHD often struggle with time management, planning, prioritizing, beginning and finishing tasks, and organization, to name a few. An executive functioning coach can assist by:
- Establishing routines: Consistent daily routines can help to know what to expect, reducing anxiety and impulsivity.
- Teaching time management skills: Use tools like timers, alarms, and calendars to stay on track with assignments, responsibilities, and activities.
- Prioritization: Help to identify and prioritize tasks, focusing on the most important ones first.
- Clarifying instructions/expectations: Break down instructions into manageable steps, and use simple language to enhance comprehension.
- “Chunking” or breaking tasks into smaller steps: Breaking tasks down into smaller, more manageable steps can make them less overwhelming while also making progress more immediate.
- Developing visual aids: Visual schedules, charts, and reminders can assist in organizing tasks and keeping track of responsibilities.
- Utilizing organizational tools: Provide tools such as binders, folders, and digital apps to help with organization, time management, and task completion.
Finding Strategies that Work
It's essential to foster independence and self-advocacy while using strategies that are helpful and sustainable for a particular individual. Effective executive functioning coaching will assist in finding tools and systems that an individual is likely to benefit from throughout their lives. These strategies are likely to include:
- Self-monitoring: Observe and assess progress and recognize when breaks or adjustments are necessary.
- Self-advocacy: Effectively communicate needs with those around you. This can involve asking for clarifications, extra time, or specific accommodations.
- Setting goals: Establish achievable short-term and long-term goals, which can provide motivation and direction.
Understanding executive functioning challenges in individuals with ADHD and other types of neurodiversity is crucial to help them reach their fullest potential. By recognizing these difficulties and implementing strategies to support improvement, executive functioning coaches can help neurodiverse individuals thrive academically, socially, and emotionally.