Psychological science has named several types of benefits from illness or misfortune. These help us understand some of the paradoxes of human behavior - why would a child want to perform poorly on a test? Why would a spouse encourage his/her partner to see him/herself as ill when s/he is not? 

We gave our cat special food in a special bowl because he told us he was dying, but he was not. This is secondary gain, and also an example of malingering.

Primary gain is the psychological benefit that a person receives from illness. The illness or disability must precede the benefit and be the cause for it. For example, a person who doesn’t want to attend a party, and then finds himself too ill to attend is exhibiting primary gain. He no longer needs to attend the party, and the illness prevents him from feeling guilty about staying home (the primary gain). 

Secondary gain might be the easiest to see, as it is external. This is something straightforward, like when a person gets a financial benefit for injury or illness. A settlement, or an excuse from work, or charitable gift due to illness are all examples of secondary gain. 

Tertiary gain involves another person. In this kind of gain, a person experiences a benefit from someone else’s illness or disability. For example, a spouse might get lots of positive attention from the community for caring for his/her ill spouse. This kind of gain is the one experienced by the perpetrator in cases of Munchausen syndrome by proxy, but not all tertiary gain involves MSbP. 

As a clinician, this is one of the most heartbreaking things I see - a person who is watching his/her child struggle when the child won’t accept help. 

You’ve worked for years to raise this child, given up vacations and lazy Sundays to coach soccer and paint the nursery. You got him into a good school, you found a mentor, you’ve asked the priest for help, taken her to counseling, tried tough love, and given your child space. 

And it’s not that s/he doesn’t have potential! A gift for language, an ability in engineering, or musical talent. But none of it is being used. 

Sometimes, there’s a factor like depression or drug use that is holding your child back, but sometimes you don’t see anything like that. What went wrong? 

This feeling of helplessness can be overwhelming. You’re realizing that you might have done everything you could, and yet you’re not seeing the results you expected. You might’ve looked forward to watching your child grow and mature, hoping for the day s/he would achieve more than you did, and have a better and more comfortable life. Now, you’re watching those dreams fade, and it’s terribly painful. 

You’re already aware that you can only control so much of another person’s life. So now, you need to consider which of these feelings are yours and which belong to your child. For example, is your child content with life? Not, perhaps, as happy as you think they could be if they took your advice, but is s/he expressing distress or dissatisfaction? If s/he is not discontented, then the anguish you’re feeling is about your own unmet desires for your child’s future. 

You may need to seek therapy for help in accepting the current state of your (adult) child’s life. This is a period of transition for you: your child used to need you to control his/her choices and environment, and now you’ve been unceremoniously fired from that job! It’s hard to adjust to that change, and it’s even harder when you don’t see your child using the gifts and skills that you helped them nurture. Don’t hesitate to reach out for help during this time. 

If there is a safety issue in your (adult) child’s behavior, you can refuse to enable this. If yours is a drug-free home, then you cannot house your child if s/he continues to use. But in the end, an adult can do any number of self-harming behaviors on his/her own property, and all you can do is to offer help. Working with a psychological professional can help you to understand your options, find the most effective kind of help to offer, and consider your approach. 

Watching your child suffer is one of the most painful things a person encounters. Keep in mind that your adult child still needs you, but now, maybe he needs you to step back and let him face the consequences of his actions. If you’re in this situation, it’s because you are a loving parent, and I’m so sorry for how difficult it is.

A Ukranian Ironbelly overreacting at Gringotts Bank

It's easiest to see it in others - the moment when a seemingly-benign question or statement causes an outsized reaction. One minute, everything is fine, and the next minute, someone is yelling and someone else has stormed out of the office!

We all like to imagine that our brains are rational, well-ordered places, and that we have reasons for everything we do. So once you've yelled at your spouse, you’ll be likely to justify it to yourself, "S/he was way out of line! What a crazy thing to say." But we're all capable of overreacting. 

Usually, this wild swing in emotion isn't about the situation in which you find yourself right now. It's more likely that you're actually responding to something that happened days, weeks, or even years ago. Your brain is primed by that past experience, so when you find yourself in a similar situation, you react without thinking. 

In a way, this is helpful. Your brain has learned and you can be better equipped for the future - but your brain can also overfit that reaction to a much less serious situation, too. When that happens, you might be halfway through running away before you realize that you're safe. 

Then, you try to interpret what happened: "If I ran away/screamed at my dog/hit the neighbor, there must have been a good reason for my reaction." And there is! But the reason might be long distant, and you still need to apologize to the neighbor (or dog). 

When you find yourself or someone else having overreacted, try asking yourself when you remember feeling this way before. See if you can find a pattern. If it's another person who is overreacting, consider his/her past. Anything that might make their current situation more difficult for them? 

A therapist can help you look into your earlier experiences to help you understand your current behavior, and then help evaluate whether it's working for you, and s/he can help you understand others’ reactions as well.

Selby Gardens in Sarasota

During the pandemic, many healthcare providers began to offer telehealth services in order to bridge the gap between sessions. Several states lifted restrictions on these services so that patients could still get the care they needed. 

I offered teletherapy to my clients, too, since I was unsure when we'd be allowed to meet again and I was forbidden to open my office. Now that we can meet in person again, I still do teletherapy. Here are some considerations for potential clients: 

• Flexible schedule. Some clients have time for a session over their lunch break, but can't leave their office or home. 

• Cost. Because the costs are lower for my practice, clients get a small discount when they use teletherapy. 

• Experience. Some clients value being in the same room with the therapist and don't care for the screen. 

• Decompression time. For some clients, making the time to get away from their normal setting can be therapeutic, and they like the atmosphere of my office. 

• Privacy. Will you have access to a quiet space for your teletherapy session? This can be difficult to find if everyone in your house or office is in earshot. 

• Encryption. My teletherapy service is HIPAA-compliant, but some clinicians use things like Skype or Zoom, and those are not as secure. 

If you're ready to talk from the comfort of your own home or office, please use the contact tab at the top of the page to send me an email!

These pelicans are guilty of loud noises

Among the many issues in our criminal justice system, one of the most puzzling is that of false confessions. Why would anyone confess to something they didn't do? 

There are several reasons, some easier to understand than others. In some cases, police interrogation can stretch for hours without restroom breaks, sleep, food, or water. A suspect may confess, thinking that they will be able to leave, and then find out that the confession was recorded and is very difficult to revoke. 

Some suspects are confused. Police are allowed to interview intellectually-disabled people without an advocate, and suspects who are using drugs or alcohol, are malnourished, or dehydrated may become confused and unaware of the consequences of simply saying "yes" when asked a question. In one notable case, a suspect confessed to a murder and then asked when he could go back to his high school class because he had a project due. It became clear that he didn't understand what he'd said. 

Some police interrogators use more coercive techniques than others, suggesting details, or asking questions like, 'Did you kill her or did you just help hide the body,' or 'Did you kill her because you hated her, or did you just snap and kill her' leave no room for denials. Some interrogators will work to confuse or deceive, saying that they already have proof that the suspect is guilty and that the court will go easier on the suspect if s/he confesses, or asking a suspect to imagine how s/he would have committed the crime. 

For some people, particularly those from a disadvantaged background or community, the criminal justice system may seem inevitable. If your family and friends have been in and out of prison, and you see no prospects for advancement, it is easy to think, 'If I don't go down for this, it'll be something else,' and confess in order to get the interrogation finished. 

Most of our police officers are simply trying to do their jobs, but they have often been given poor training and bad tools, and then put in very stressful situations. For more information on police interrogation and the ways it can influence citizens, please search for the Reid Technique.

It's normal for everyone to experience 'brain fog', a kind of blunted, impaired cognition, from time to time. I'll explain what's normal, and some causes for it. 

Brain fog is a sort of mental sluggishness, lack of alertness, or dull thinking. Instead of being able to follow a train of thought, you might find yourself stuck with a blank mind. 

Common causes of this include:

• Fatigue/lack of sleep

• Drug or alcohol use

• Depression

• Cognitive load (sometimes called 'too much on your plate')

• Poor nutrition

• Physical pain or illness

These can cause temporary episodes of brain fog or dullness. Some of the solutions are obvious from the causes, like better quality sleep or refraining from alcohol use. If the cause is more diffuse, like several stressors or depression, you may need help sorting this out. 

Slowed cognition can be remarkably frustrating. If it is more than episodic, for example if it's daily, then you may want to seek professional help. A doctor can evaluate your sleep, diet, exercise, and any other factors that might contribute. 

If your cognitive slowing persists, you may want to work with a therapist. I can help you evaluate and dismiss some of the stressors in your life, and I can also evaluate you for depression to see if that is causing some of the trouble. I can teach mindfulness skills to help you focus and accomplish your work, and I can also help teach goal setting and effective time management.

With so many self-help books and curricula available, why should you pay for therapy? I'm going to point out the differences, and the places where each thing can be useful. 

Self-help books abound at the library and at used bookstores. They have varying usefulness, but a good cognitive behavioral therapy or dialectical behavior therapy book can be a great way to learn some basic skills. The books usually come with worksheets and are written for the layperson. 

If you're highly motivated, you can get a lot from these materials. You'll need to work on your skills every day, and you'll probably have some questions that you'll want to search on the internet. For people who are having a hard time finding a place in their schedule for therapy sessions, and whose symptoms are mild, I often recommend something like this between sessions. 

Therapy is different. While we'll work on some of the same skills between sessions, and we'll talk about them in the office, I will also be helping you to connect the events and feelings in your life so that you can better understand what's holding you back from your goals. An outside observer can often see your story more clearly, and I've been trained to notice the patterns and connections in human behavior. 

I will be there to answer any of the questions you have and the guide you to master the skills you learn, and to address the day-to-day challenges in your life. Some days, you may just need to tell someone what's happening in your life and get some neutral feedback. One of the questions I often answer for people is, "Is this normal?" I can help you examine your options in a given situation, and I also help people who want to rehearse a difficult conversation. 

If you are looking for the insight and personal attention that a therapist can provide, use the contact form on the website to get in touch with me!

May the Fourth be with you! In honor of Star Wars Day, I'm going to be sharing some psychological insights found in the popular series. 

"Do or do not; there is no 'try.'" 

When Yoda says this, he is expressing a part of behavioral therapy - that if you tell yourself that you will try to do something, you're already doubting your ability. A decision to try is a decision to accept inactivity. On the other hand, if you begin on a task, you can say that you got part of the way to finishing it, whether you finish it or not. Behavioral therapy teaches that, when asked before and after a projected activity, most people experienced more pleasure or less pain than they expected to, so it's in your interest to begin on the activity. If it is intolerable, it's still possible to stop. 

"You're going down a path I can't follow." 

Padme shows us the importance of knowing when to let someone go. When she finds that Anakin has taken immoral actions, even though she loves him, she must let him go on without her. One of the errors in thinking that is taught in cognitive therapy is the mental filter - paying attention only to what one wants to see - and Padme has done some of this with Anakin. But in the end, she finds that she has to see his true character and act accordingly. 

"I take orders from just one person: me." 

This Han Solo quote points to the idea of being the actor in your own story. Reframing your life from 'I have to' to 'I choose to' can change your outlook. You don't have to pay your taxes, but you might choose to do so in order to avoid penalties. Solo has decided that there are things he's not willing to do, and he sees himself as independent, giving himself the high confidence that he shows in the movies. When you find yourself faced with an order at work, remember that it's still your choice to obey or to find a new job. No one can force you to act. 

When a minor in your family seems to be struggling and is showing worrying symptoms, it makes sense to send that person to therapy, right? Yes, but - your minor child isn't struggling in a vacuum. 

S/he lives in a home with family, and together that system has worked to get the minor to his/her current state. This means that you will have to work together to reach health. 

Sometimes, this means that your child or teenager may begin to set boundaries and to act differently, and that you'll have to adapt. In some cases, your therapist may need to see the client and parent(s) together in order to work on the problem. If this is the case, don't expect to simply tell your side of the story and then watch the treatment happen. You may have to learn a new skill, too. 

In many families, the person who is referred to me (the identified patient) isn't the person who has the biggest problem, they're the one whose problem became obvious first. Other members of the family also struggle, but they might be better at hiding it, or they may have more socially-accepted ways of dealing with it. 

You're probably familiar with this in your family of origin, but it can be harder to see when it concerns your own child. That's part of my job, and it's something we can work together to identify. 

I like to see the parent and child/teenager together for part of the session so that I can get all sides of the story, and usually I'll ask the parent to join us periodically. So if you want me to help your kid, come ready to help yourself, too! 

Upon finding out that I am a psychology professional, some people ask, "Are you diagnosing everyone you meet?" I usually answer, "Not unless you're paying." But of course, the answer is … kind of. 

I can't turn off the part of my brain that notices patterns in behavior, so I do recognize when a friend's thoughts or actions fit a clinical diagnosis. But it's unethical for me to treat a friend or relative except in very specific circumstances, so I usually keep those thoughts to myself and just enjoy being with my friend. 

Another reason that I'm not diagnosing you is that I'm not all that fond of diagnosis codes. They can be helpful shorthand between practitioners, but since every person with depression experiences it differently, I don't like thinking of my clients in those terms. I'm more likely to think about the person's circumstances than about their diagnosis. 

I usually have a diagnosis in mind, and clients always have the right to ask for my thoughts on this! Sometimes, it's necessary to provide a label in writing the psychological equivalent of a sick note, or a note for accommodations needed at work or school. Other clinicians will sometimes ask for this information as well. 

The reason that I don't feel the need to tell my clients their diagnosis right away is that I find it often hurts more than helps. Some diagnoses carry a stigma that my clients shouldn't have to bear, and some of them come with worrisome implications for my clients' rights. Since each person's challenges and circumstances are different, it's impossible to judge a whole category of people the same way, and I don't want my clients to see themselves as their diagnosis code first. 

Particularly in the case of a younger person, a diagnosis may become a part of identity, which it's not! We're hoping that, as we work together, your diagnosis no longer affects your daily life. 

If you have questions, please ask, and your clinician will be happy to give you diagnostic impressions and help you understand what s/he's seeing.