Search Results

How our conceptualizations of ADHD and BPD have changed and intertwined. Key points ADHD and BPD share many symptoms that often are expressed together. We have developed understanding of disorders that were not conceived of four decades ago. When either ADHD or BPD is recognized, it may be prudent to look for possible evidence of the other. Two overlapping human head silhouettes, symbolizing dual perspectives or mental health. Before 1980 and the publication of the DSM-III, neither the diagnosis of attention-deficit/hyperactivity disorder (ADHD) nor the conceptualization of borderline personality disorder (BPD) existed. What would now be considered ADHD was then defined as “hyperkinetic reaction” (sometimes referred to as “minimal brain dysfunction” or other similar terms). It was estimated to exist in around 3 percent of children and adolescents and then magically vanished; adults could not qualify for the diagnosis. At that time, there was no formal psychiatric equivalent to what we describe as BPD, although other personality disorders were defined. Over the ensuing decades, our understanding of these behaviors has undergone significant reassessment. Defining characteristics of ADHD are now more refined and descriptive in the DSM-5. Prevalence is now estimated to be closer to 10 percent of children and adolescents, and the condition is now diagnosed in adults at increasing rates. Similarly, in 1980, many clinicians did not “believe in” the diagnosis of BPD, considering it to be an offshoot of bipolar disorder or an aberrance that did not exist as a separate illness. Although the formal defining characteristics of BPD have changed little in the last forty years, biological and genetic observations have reified the distinctiveness of the diagnosis. These two orphan diagnoses have now been adopted into a tribe in which they share a kind of kinship. ADHD and BPD can exhibit many common symptoms, including moodiness, impulsivity, anger outbursts, disorganization, vulnerability to substance abuse, attention-drawing behavior, impaired social functioning, and a tendency to be easily bored. Comorbidity is common. Although research data vary significantly,1 one national epidemiological study determined that the lifetime comorbidity of BPD in the ADHD population was 33.7 percent.2 ADHD and BPD each have significant hereditary features. Studies indicate that 40 to 50 percent of children with ADHD have at least one parent with the disorder. There is also strong hereditary penetration among family members of BPD patients, though it is not as large as that seen in ADHD. Environmental factors play a stronger role in the emergence of BPD symptoms. Children with ADHD behavior may be more likely to be bullied or traumatized in many ways. Other children may ridicule them and parents may be frustrated with them. Abuse is often detected in the history of BPD patients. Some researchers hypothesize that children with ADHD may therefore be more vulnerable to developing BPD. An individual is not a diagnosis. We are all a combination of genetic potentials and happenstance, emotions, and behavioral reactions. As our understanding of the human condition continues to be refined, prejudices against those whose struggles in our world are more overt will diminish. Jerold Kreisman, M.D.-Blog

Screens significantly suppress production of melatonin in teens. Key points Many factors are related to teens getting insufficient sleep. Teens are heavy users of smartphones and social media. Use of self-luminous devices at night suppresses melatonin, delaying sleep onset. Reducing screen time at night will help teens get more sleep and improve ability to focus attention in school. It is widely acknowledged that most adolescents do not get sufficient sleep, leading to lowered emotional regulation, compromised cognitive and academic functioning, and health problems. Many primary causes have been proposed by sleep researchers. Teen on her electronic device Poor sleep hygiene has been proposed, meaning behaviors such as irregular bedtimes, not adhering to a consistent calming bedtime routine, failing to ensure a dark, quiet, cool sleep environment, and consuming caffeinated beverages. For some adolescents, structural aspects of the home and neighborhood environment are not conductive to good sleep. Noise levels inside and outside the house are hard for adolescents to control as are ambient temperature and humidity. Stress deriving from family conflict, peer conflict, bullying, feeling left out, and discrimination have all been linked to poor sleep. Lack of parental monitoring and regulation of sleep habits have been proposed as problems. Many argue that early school start times do not provide enough time to get sufficient sleep. All of these are no doubt involved in combination to some degree for most teens. But of all the causes of poor sleep, there is one that I have come to believe may be the biggest cause – use of smartphones, computers, tablets, gaming devices, and TV not only during the day, but in the evening. The Pew Research Center estimates that around 95% of American teenagers have a smartphone, 90% have access to a desktop or laptop computer, and 80% or more have access to a gaming device. More than half report that they are on their phones “constantly” and estimates are that the average time of use is more than five hours daily. Around 40% report using phones eight or more hours daily. Many teens use social media in the evening before going to sleep and a substantial number do not silence their phones at night, leading to wake-ups after going to sleep. Much has been made of the fact that after puberty, melatonin release is delayed such that most adolescents become “night owls” and cannot go to sleep until late evening. In fact, this is the primary basis for the nationwide movement to start schools later. While there is much evidence for this developmental sleep phase delay, it is also true that excessive evening screen use suppresses melatonin production. One experimental study conducted in the homes of adolescents showed that even one hour of screen use suppressed melatonin by 23%. Two hours of use, the maximum screen time tested in the study, reduced it by 38%. The authors compared the results with previous studies they had done with adults (mean age 28 yrs) and found that the adolescents were more sensitive than adults to screen light (Figueiro & Overington, 2016). Beyond the fact that screen use consumes times during hours available for sleep, there is a biological basis for screen usage leading to compromised sleep. The good news is that some research suggests that reducing screen time can lead to earlier sleep onset and longer sleep. Perrault and colleagues (2019) conducted a study of over 500 12- to 19-year-old adolescents who were given instruction about how screens are detrimental to sleep. Half of the adolescents were asked to reduce screen time after 9:00 PM for two weeks and were compared with a control group who did not receive the intervention. Sleep data were collected with actigraphy, and participants came to a lab to complete surveys, have melatonin levels measured, and perform a sustained attention task. Those in the experimental group had earlier sleep onset times and longer sleep duration times than those in the control group. They also performed significantly better on the attention task. Granted, results like these are not accomplished easily. Many parents are not willing or able to enforce rules about evening screen time. Many adolescents are, no doubt, unwilling to even try reducing screen time. But the parents and adolescents who are willing and able to do so are likely to see important benefits. I hasten to add that manufacturers and providers of devices and social media platforms bear some responsibility for the unintended negative consequences of what they sell. They should be held accountable to create some technological solutions to the problems they have helped to create. Further, they should be funding education programs and intervention projects to mitigate harm. Joseph A. Buckhalt, Ph.D.-Blog

Let’s address two instances of ineffective couples therapy. Key points People usually approach couples therapy as a last resort to salvage their deteriorating relationship. A primary reason for failure in therapy lies in the attempt to resolve big and complex questions on the spot. One of the most difficult challenges a couples therapist faces is resisting the couple’s haste. A couple in a therapy session, expressing concern and discussing issues with a counselor. Usually, people approach couples therapy as a last resort to salvage their relationship that has been deteriorating for 2 to 3 years, according to research.1 Yet, many leave without tangible results. While the therapist you’ve chosen might not be a good fit, there might also be things that aren’t about the therapist, their treatment approach, or their experience, so you can influence them to make therapy more successful and efficient. Let me share with you the two instances of when couples therapy is bound to fail, why, and what you can do about it. 1. Posing too general or grand questions A primary reason for failure in therapy lies in the attempt to resolve big and complex questions on the spot. Every couple (every individual as well) enters therapy with the sincere desire to be happier, improve their communication, and reduce anxiety and stress. This is pretty universal. Then, having made this initial, and no doubt, very important step, they expect a miracle. This instance of magical thinking, when one expects to get results just because they came to therapy, saps the process. Coming to therapy is a beginning, but it’s just the start of the process. It is accompanied by a dialogue between the partners and with the therapist, and inevitably with resistance on the clients’ side, because—let’s face it—changes are difficult. And so is talking about things that make one angry, sad, ashamed, guilty, or unsatisfied. Therapeutic work with couples, to a higher degree than with individuals, consists of addressing specific examples of miscommunication, the concrete instances of being unhappy, of feeling disappointment, of being angry, and so on. The study by Snyder et al., which included 55 couples who took therapy, found that deficient problem-solving communication predicted poorer outcomes and even divorce at follow-up, thus indicating that concrete problems need to be addressed.2 Therefore, to effectively deal with grand, profound questions of happiness, stress reduction, or anxiety management requires moving beyond abstract desires for better communication or to feel better. It demands a meticulous examination of specific life examples. A general wish to communicate better holds little power unless it is grounded in the particular moment from last Tuesday, when a comment about household chores escalated into a silent dinner. That’s why many couples are disappointed at the beginning of therapy, as they are already tired of (unsuccessfully) talking about these small issues between themselves, and now they need to share them in therapy, too, whereas they would like to jump to something bigger. However, this is the way, as therapy fails when it remains in the realm of generalities. 2. Rushing Most couples coming to therapy, especially for the first time, prefer to do it fast. They tend to think that fast is efficient. While milder issues can be dealt with quickly, the accumulated psychological, emotional, or communication difficulties cannot be resolved quickly. Oftentimes, couples come with underlying conflicts that are not visible immediately. For instance, a couple may present a conflict about finances, and in their urgency to find a solution, they may become fixated on a budget without ever exploring the deeper meanings they each assign to money. One partner may see financial security as a symbol of love and care, while the other may view strict budgeting as a form of control. So, the underlying conflict is not about money; it’s about love and control. Until they understand it, the conflict will migrate to a different realm of life, remaining unresolved. To help the couples in their relationship, the underlying issues need to be identified, communication styles need to be adjusted, expectations need to be established, disappointments need to be made obvious and dealt with, and emotions need to be addressed—all that in order to progress. And it requires time. To complete therapy faster, partners might unconsciously resort to different emotional tactics. For instance, William Doherty writes about partners scaring one another and their therapist. “I start emotional, you start rational, I get angrier, and you get more controlled. Then I mention your mother and you blow up, which pleases me immensely.”3 The therapist feels overwhelmed with the couple's problems, gets frustrated early, and actively advises couples to separate. As a result, the couple gets their “fast” therapy—the therapist said they need to separate, and it’s certainly faster than resolving the standing couples' challenges! So, one of the most difficult challenges a couples therapist faces is resisting the couple’s haste. Playing the couple’s rush game is losing patience and showing them that they are not amenable to treatment or counseling, which is counterproductive to helping them make progress in resolving their problems. To conclude: Coming to therapy is a wonderful first step, but it really is just that, a beginning, a start of the real work. Your therapist can't do that work for you, and neither can they magically shorten it. Bigger, heavier problems need to be broken down into smaller pieces. Tackling those smaller issues, one session at a time, on a regular basis, that's what leads to steady, real progress. Boris Herzberg-Blog

Personal Perspective: The negative bias that accompanies depression can be addressed. Key points A bias toward negativity is a clinical marker of depression. This may result in increased complaining, which can impede social functioning. Conscious positivity can help balance out unwanted negativity bias. Woman looking out the window I’ve battled severe depression for as long as I can remember, all the way back to the allegedly sunny days of my childhood. Thanks to meds and therapy and supportive friends and a host of other resources, I don’t suffer now the way I used to. I can safely say I’m actively in recovery. But I can’t say I remain untouched. Years of depression have clearly left their mark on me—most notably in the negativity I carry around with me like a security blanket. Numerous boyfriends along the way have called me out on my frequent observations about both the major and the minuscule deficits of life. “Terri, do you always have to see the downside of everything?” they’ve asked. Fortunately, some of my complaining passes as black humor, which has helped me salvage my relationships. But I’ll be the first to admit that I do see through a glass, darkly. It feels so engrained in me, this mindset, that I don’t know what to do about it. I don’t want to bring other people—or myself, for that matter—down; but my negative interpretations of life seem to pervade my reasoning no matter how hard I try to fight them. I know I’m not alone in this. In fact, one clinical journal rather poetically referred to this so-called “negative interpretation bias” as “both a clinical marker and a scar of depression.” Behavior Research and Therapy, Volume 163, 104276 (2023). This makes perfect sense to me. Despite my current stability, my mind bears the stigmata of prolonged adversity. A recent Nature article backs this up. It explains, “Depression is associated with a cognitive bias towards negative information and away from positive information. This biased emotion processing may underlie core depression symptoms, including persistent feelings of sadness and a reduced capacity to experience pleasure. The neural mechanisms responsible for this biased emotion processing remain unknown...” Nat. Mental Health 2, 583–592 (2024). So maybe negativity bias is a scar that I can’t entirely get rid of—but its external appearance can certainly be softened. I know, as I said, that I complain too much. If you’ve struggled with depression for any significant period of time, maybe you do, too. But short of taking a vow of silence, what can we do about it? Plenty, it seems. Washington Post writer Katherine Kam acknowledges that a certain amount of negativity bias is primal—to survive as a species, we can’t afford to ignore threats. It will always be safer to look out for a lurking tiger than to enjoy a pretty sunset. But if we can’t rid ourselves of negativity altogether, experts recommend that we try to balance it with “conscious positivity.” To be consciously positive, you have to first notice, without judgment, that you’re moving into complaint mode. Once you do, try ramping up gratitude; it’s almost impossible, I’ve found, to be both depressed and grateful at the same time. Or you can attempt to distract yourself and fool your mood with something overtly pleasurable (although this may not work in the depths of depression). In short, actively seek out something to smile about—even if the smile feels forced. According to Allyson Pimentel of the UCLA Mindful Awareness Research Center, “Modern science shows that even artificial smiling can activate neural pathways to positive emotions, and release neurotransmitters like dopamine and serotonin, as well as endorphins.” There are also ways to be a better complainer. You can modulate your vocal tone to eliminate all traces of a whine. Banish terms like “never” and “always” from your vocabulary—they’re surefire signs of cognitive distortion. And above all, try to leaven your conversation with some lighter observations. Oscar Wilde (of all people) advocated for “moderation in all things, including moderation.” No doubt that encompassed complaining. I realize my history of depression may have impacted me for life, but that doesn’t mean my scars always have to show. The smile I greet you with may be forced, but it’s a genuine attempt to regain my equanimity. And you know what? I’m finding it actually makes me feel better. As the late Vietnamese monk and peace activist Thich Nhat Hanh so wisely observed, “Sometimes your joy is the source of your smile. But sometimes your smile can be the source of your joy.” Terri Cheney-Blog

The key to navigating the rollercoaster of teen years is knowing how to hold on. Key points Teens pose a different challenge than younger children. Your challenge is learning how to adapt to their needs. The keys are not confusing ends and means, rewarding the positive, setting clear goals and bottom lines. Think of yourself as a consultant rather than an authoritarian. Help them to explore but with boundaries. Teens can be difficult—sullen, argumentative, impulsive, hormonal—and their prefrontal lobes (the rational brain) are not fully developed. Everyday life can be an emotional roller coaster that many parents barely manage to hang on to. Unlike the 5-year-old that you can pick up and put in their room, the 6-foot, 200-pound teen who refuses to move is immobile. And while the biggest dangers with 5-year-olds are likely to be crossing the street, now the risks are higher—car wrecks, addiction, pregnancy, violence—enough to keep you as parents awake at 3 am. Here are 11 tips for you and your teen to successfully navigate these challenging years: Mom and daughters taking a picture together. 1. Pick your battles Teens, because they are differentiating—pulling away to define who they are—are understandably sensitive to parental control. It’s easy for them to feel micromanaged, over-lectured, and over-advised. Because the over-controlled child will either become dependent and fearful or rebellious, your challenge is not to abdicate your power but shift from being the autocrat to a consultant. To do this effectively, be selective and clear. Decide on your bottom lines —what you’re willing to go to the mat for: one or two things, not twenty. For many parents, their bottom lines center on health and safety. But most importantly, it’s time to stop coaching or criticizing them about what they wear to school; it’s okay to set expectations about staying up to date on schoolwork or about calling if they're running late. 2. Don’t confuse means and ends You think it would be good for your teen to be involved in a school sport or try out for a school play. Great, but what they hear, and feel is pressure to do what you think they should do. Rather than getting into a battle over sports or not, ask yourself, “If doing sports is the means, what is the end, the goal, the purpose—be less isolated, get into better physical shape? Be clear about the end and then be willing to negotiate with them about other ways to get there. 3. Help them do what they can’t Stepping back, what are the one or two things your teen struggles with most? Think macro, not micro: Quitting when they get frustrated or holding on too long; being too self-critical, too risk-averse, too self-centered; unable to regulate their emotions, or too shy to ask for help? Get your concerns on the table, try to gain buy-in, and develop a plan together to help build those skills. 4. Talk in terms of worry and concern rather than frustration or anger People respond better when you use “soft” emotions rather than “hard” ones. This is in the same skill set as using I-statements rather than you-statements. Not only will the conversation go better, but you’re helping your teen learn about you – what goes on in your head as a parent, what is driving what you’re saying and doing. They get to see you not only as “the parent” but as a concerned fellow human being who cares about them. 5. Reward good thinking Many teens are like lousy lawyers: They try to make a case for what they want, but it doesn’t really make sense. But when they do a good job and show clear thinking, reward this thinking by going along with it or at least reaching a middle ground. 6. Be emotional around the positive; be matter of fact about the negative This is a basic mantra for any parenting. Remember that you are essentially your child’s favorite toy. When your child or teen does something positive, get out the confetti and balloons. If they do something negative, drop the emotion and talk about the consequences in a deadpan way. Don’t train your child to seek negative attention. 7. Circle back and repair You make what you think is a neutral comment, and your teen overreacts or rolls their eyes. Mop up then or later but mop up: I’m sorry —I didn’t mean to hurt your feelings or upset you. Why did you get upset? This is about repair and not having misunderstandings become fuel for future explosions. It's about learning the moral of the story of what just happened. 8. Create quality time Gone are the days when your 8-year-old couldn’t wait to hang out with you all day long, but that doesn’t mean they don’t want your company and attention. The key is to be proactive and build in choice: “I was thinking that maybe we could do something together this weekend. Think about it; we can do whatever you’d like. Let me know.” And then remind them on Friday and do whatever they suggest. It’s not about the activity; it’s about having a shared experience. 9. Allow surrogates to step in Your teen may resist your advice, but they may better hear the same advice from a grandparent, an aunt, their best friend’s mother, or a counselor at school. Stand aside, let them do their magic. 10. Judge how they’re doing by looking at the big picture As a parent, it’s easy to get worked up and worried about the small things—the English assignment they’ve been putting off, the latest boyfriend they’re hanging with. To help you not go crazy, step back from these details and drama and instead take stock of how they’re doing overall: Do they have good, relatively wholesome friends? Are they able, overall, to be responsible, manage their emotions, challenge themselves, and envision a positive future? Can they bounce back after an upset? Can they ask for help? Look at the big picture of how well they are running their lives. 11. Seek help And if they are struggling in some way, don’t sweep it under the rug, or cross your fingers and hope they’ll outgrow it. Be proactive: Get advice from someone you trust or an outside professional, or, better yet, put your concerns on the table. Again, don’t confuse means and ends, but help them move forward and learn how to successfully run their lives. Bob Taibbi, L.C.S.W. -Blog

The solution to loneliness is not being around more people. Key points Loneliness is not just being alone; it’s feeling unseen. Healing starts with self-compassion and the belief that we still deserve connection. Some relationships may not meet your depth; clarity allows space for those that do. Young man sitting alone Loneliness is not just about being alone. It is about feeling unseen. It is the quiet ache that surfaces when we are surrounded by people but still feel disconnected from ourselves. Emotional loneliness happens when we cannot bring our full selves into connection. We may have friends or partners, but we sense that parts of us are hidden. We edit what we say. We shrink what we feel. We keep the most tender parts of who we are safely tucked away. It is not the absence of people that hurts most. It is the absence of authenticity within those relationships. The Cost of Inauthentic Connection Many of us learn early that authenticity can be risky. We might have been told that certain emotions were too much or that being honest, created tension. So, we learn to perform connection rather than inhabit it. We smile when we are hurting. We offer care but do not ask for it. At first, this performance works. It keeps us included. It helps us avoid conflict. But over time, it creates a distance between our inner world and our outer life. We feel unseen, even when surrounded by others. Loneliness grows in that gap between who we are and who we think we are allowed to be. Our bodies often notice before our minds do. We feel drained after social events, anxious before seeing friends, or numb in conversations that should feel close. These signals are the nervous system’s way of asking for authenticity. Why Authenticity Feels So Hard Authenticity requires safety, and safety is not guaranteed. Many of us have learned that being fully seen once led to rejection, shame, or abandonment. Our bodies remember that pain. Even when we long to be open, something inside says, Protect yourself. My journey with authenticity began in 2015 when I read Brené Brown's Daring Greatly during a particularly hard time in my life. I had just gone through a breakup, was a newer therapist, and felt like an imposter. That book, and her other works, have fundamentally altered the way that I live and show up. Here's what I learned: We crave connection but fear the cost. We want to be known but worry that honesty will drive people away. The result is a constant tension between the desire to be real and the instinct to hide. Authenticity asks us to risk something. It asks us to let go of the version of ourselves that pleases others and step into the one that feels true. That shift can be uncomfortable, but it also creates freedom. When we stop performing and start allowing ourselves to be seen, we give others permission to do the same. Shame and Loneliness At the heart of emotional loneliness is often shame. Shame tells us that parts of us are unlovable, that if others saw the truth, they would turn away. To protect ourselves, we hide those parts. But shame thrives in secrecy. The more we hide, the more isolated we feel. Healing begins with self-compassion. When we can say, This is me, and I still deserve connection, shame starts to loosen. Self-acceptance becomes the foundation for authentic relationships. You cannot feel seen for who you are if you are never showing who you are. The Way Back to Connection Authenticity begins with small moments. It might look like telling the truth about how you are really doing or saying no when you want to say no. These acts teach your body that honesty is not dangerous. Sometimes, authenticity means accepting that some relationships cannot meet you at the depth you need. That realization can feel painful, but it is also clarifying. When you stop trying to belong where you must hide, you create space for relationships that can hold the real you. Loneliness begins to soften when you stop abandoning yourself to be accepted by others. The antidote to loneliness is not just being around people. It is being able to be yourself with them. And the first step is identifying what blocks us from being ourselves. Real connection begins when you allow your truth to be seen. It's a journey: This is a process I've been in for more than 10 years now. It does get easier and more will constantly be revealed. Hannah Rose, LCPC, -Blog

10 tools for handling the next best steps after a mental health diagnosis Key points Receiving a mental health diagnosis often comes with a multitude of feelings and responses. Allowing time to pause, having patience, and asking for support can help. A diagnosis can be the start of traveling the roads of life more effectively. Most mental health providers utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a reference for classifying and coding symptoms. This manual is updated at regular intervals (the most recent version being the DSM-5-TR) in an attempt to provide a standardized way to diagnose mental health conditions and establish a common language. Woman having counseling session Diagnoses can assist in increasing understanding; they are not designed to be critical, limiting, or over-pathologizing. Diagnostic criteria are ever-evolving, often imperfect, and sometimes controversial, but the advantages of having a diagnosis can range from getting insurance coverage for treatment to allowing the formalization of accommodations in various settings. Receiving a mental health diagnosis for yourself or someone you care about can bring on a flood of emotions. Depending on the situation, feelings may include shock, relief, confirmation, confusion, disbelief, and even anger. It is normal to notice a variety of reactions, especially at first; hopefully, however, there can also eventually be a readiness for figuring out the next best steps. Here are 10 steps for better coping that utilize a series of road and driving metaphors: Pausing in the Breakdown Lane Just as when someone pulls over into the breakdown lane to check on an engine light or attend to a crying baby, getting a new diagnosis might require pulling over into the breakdown lane to allow for some moments to reorient. It can be like an emotional flat tire that needs attention. The sudden need to integrate new information and recenter around new routines may not be convenient or planned, but different actions might be needed nonetheless. Pausing, crying, and taking a breath before getting back on the road is absolutely valid and legitimate. Eyes Adjusting to the Dark When we are in the dark trying to find our keys or locate a door handle, we might be disoriented and confused at first. But then, slowly, we begin to see shapes and outlines again. Our eyes and brains need some time to adjust to the dark. Receiving a mental health diagnosis, especially if it's unexpected, can feel like the lights have been turned off temporarily. Allowing ourselves some adjustment and acceptance time is crucial. Visual acuity will return, though new lenses may be needed to adequately perceive different hues and to effectively navigate through new thoroughfares. Studying the Map A new diagnosis provides some overview of the roadways, entrances, and exits. We might need to better understand where the bridges, detours, or road closures are at this current point on our “map.” Learning about our own mental health diagnosis in a curious, compassionate way can provide us with an avenue for more growth and learning. The more we know, the more we grow. And while social media influencers and TikTok videos might help us feel less alone in the journey, maintaining a critical consumer attitude is highly recommended. Finding reliable, science-based information is important. Getting Navigational Guidance Mental health conditions, from ADHD to Zoophobia (fear of non-human animals), are better managed with guidance, especially in the beginning. Mental health providers can provide information about best paths and ideal itineraries given one’s specific situation. Clinicians can help suggest alternative routes or additional tools that might be needed to travel more effectively along the roads. Knowledge is power and gaining new understanding on how to proceed more effectively can be instrumental. Finding Our Lane We all belong on the road, no matter what particular challenges or setbacks might periodically occur. We shouldn’t all be driving in the fast lane; we need to find our own right paths. There may have been confusion in the past about why others seem to have been able to pass along different roads so easily, but awareness of patterns can assist in honoring our needs. Different is not bad, and diagnoses don’t need to be damaging dead ends. Trusting the Engine at Its Core A diagnosis is not a synopsis of who we are. It can be information that might hopefully provide some insight about what is going on, where to possibly remediate, and how to accommodate. The goal is not assimilation. Just as car engines might vary in style, size, and technological advancement, they are still all built to help a car mobilize. Humans are still humans, no matter what set of emotional or behavioral patterns is present. And all humans deserve respect and support in their journey through life. Consider Displaying Those Bumper Stickers Unlike getting a new medical diagnosis, a mental health diagnosis sometimes has more mystery, stigma, or misunderstanding surrounding it. Individuals are sometimes more hesitant to speak with family and friends about this than they might be about a medical issue, but sharing more openly can often be helpful. Telling trusted friends or family members what is going on for you can help them better support you. Using the Horn as Needed We may highly value independence and solo coping, but asking for assistance is a strength. No one can read our minds or automatically know when we need more support, so asking clearly and directly is imperative. And even though proactive or preventative “tapping lightly on the horn” would be ideal, using full-force “horn-beeping” in times of crisis or overwhelm is warranted as well. Using Rest Stops Working on recovery steps with a mental health condition takes work and can work, but individuals also need rest and times of simply engaging in regular life activities. Supporting time to rest and reset, separate from active therapeutic intervention, is invaluable. We need time to focus on what is strong and not just on what feels wrong. Honoring the Unknown We may not know what is around the bend, whether a rainstorm might impact our speed, or if a traffic jam may befall us. But we can keep going despite the unknown. It’s impossible to prepare for all the possible bumps and potholes we will encounter in the miles ahead, but we can aim to trust in the fact that we will figure it out. Sandra Wartski, Psy.D. -Blog, Website

Why your children pull away or turn against you and how to rebuild connection. Daniel tells me his wife has turned their children against him, blaming him for the divorce. Maggie tells me that her children refuse to see her, talk to her, or even respond to text messages. Poppy, who is only 12, says she wants nothing to do with her father and is prepared to starve herself until the judge changes the custody arrangement. These situations are all too common in divorce and heartbreaking to witness. The rejected parent feels helpless, anguished, and desperate. The child often feels abandoned, enraged, confused, and overwhelmed. Father and child having a talk Why do children sometimes reject a parent? It’s complicated. Divorce is emotionally overwhelming for children. They may feel caught in loyalty conflicts or blame one parent for the divorce. They may be anxious about the changes, the custody arrangements, or the financial instability, and cling to one parent for security, rejecting the other. The conflict between the parents is the single most damaging aspect of divorce for children. Parents who speak negatively of each other or pull their children into disputes are setting up a situation where kids feel they need to pick sides. The child may feel they need to support the more vulnerable parent or the parent they believe was “wronged.” Sometimes a parent consciously or unconsciously tries to ally with the children, causing the children to reject or refuse contact with a parent. At times, this evolves into “parental alienation.” Sometimes older children reject both parents. Sometimes the rejection of a parent stems from the relationship or attachment with that parent from before the divorce. If a parent was distant emotionally or less present physically, the child will cling to the parent who has felt more secure or stable. Younger children are apt to cling to the parent who has been their primary attachment, as they fear loss and abandonment. Older kids may have a strong sense of morality or judgment, or anger, and are developmentally more likely to assert their control or independence when their lives feel out of their control. The stressors of divorce can contribute to the rejection. Children are stressed by big changes such as selling the family home, moving, going to a new school, living in two homes, or when there is a new parental partner. Divorces that are litigated, or high conflict, impact the children, and they may gravitate toward the parent who seems to need their support, or who seems the safest. The good news is that the rejection often can soften, although this can take time. This happens when the parents end their conflict and find ways to communicate respectfully. The rejected parent stays patient, loving, empathic, calm, and consistent while the child feels safe expressing their emotions. Family therapy can help to rebuild trust. Daniel and Maggie each grieve the rejection by their children and seek advice. We talk about how to keep the door open to their children, without forcing them to come through it. What can the rejected parent do when this happens? You can’t control your child’s feelings, but you can control your own behavior. You may not understand why your child has rejected you, but your anger, defensiveness, guilt trips, or manipulative behavior can cause your child to withdraw even more. Remind yourself that your child is emotional, confused, and stressed, so your role is to be consistently calm, warm, and steady, even when your child rejects you. Keep communication open but non-intrusive. Boundaries may be a sensitive issue if your children have refused all communication. Periodically send gentle texts or cards reminding your child that you love them and are here for them. Keep messages brief and loving but without pressure. Remember that you cannot persuade your children to reconnect. The goal is to demonstrate to them that it will be safe for them should they reach out to you. Your child needs to feel that it is okay to love both parents. If you and your child are in contact, focus on listening, asking open-ended questions about their life. Take some time to reflect on your relationship with your child before the divorce. Were you reliably present and emotionally available? You may feel that you need to apologize for behaviors or absences, or any way that you may have contributed to their pain. Even if you feel that you have no reason to apologize, it is always helpful to express empathy. Never badmouth the other parent, even if you believe that parent is alienating the children. Poppy complained about her parents “trash-talking” each other and felt that rejecting her father would end her mother’s vitriol about her father. (It didn’t.) Work through your own grief and emotions with an experienced therapist. You may consider family therapy and/or reunification therapy (which may be court-ordered). What not to do: These are traps that will almost certainly undermine your efforts to reconnect. All of these make your child feel controlled and/or unsafe. They never work. Don’t argue with your children about “the truth.” This pushes them back into the loyalty bind. This is one of the hardest challenges for rejected parents. Don’t press them to see you or choose sides. Don’t guilt-trip them. They experience this as manipulative. Don’t pull in other family members (e.g., grandparents, etc.) to advocate for you. Don’t give up and don’t give up hope. Giving up will be felt as another abandonment and may even end the chances of reconciling with them. The reconciliation or reconnection may take months or years. The keys are patience and consistency. If your child is open to reconnecting, go slow and keep it safe. Poppy ultimately sought a relationship with her father after she finished high school. She blamed her mother for turning her against her father, and while she remained in contact with her mother, she kept strict boundaries when her mother began to talk about the divorce. Daniel eventually reconnected with his children after he remarried and moved to another state. He describes his relationship with his children as cool and continues to blame his ex-wife for the disruption. He tries to avoid defending himself to his children and notices that “they withdraw when I go down that road.” Maggie reconnected with her daughter when the daughter married and had a baby but has only superficial contact with her son. “My daughter and I had a few sessions of therapy, and that really helped to clear the air. I hope my son will agree to this someday, too. I will always keep that door wide open for him.” Ann Gold Buscho, Ph.D. -Blog, Book

Even if their symptoms look the same, not all depressions are created equal. Key points Depression is not one uniform condition but a signal communicating issues and struggles in one's inner world. Similar depressive symptoms will have different meanings and functions depending on our personality make-up. Therapy that helps you understand depression in the context of your personality can foster change from within. Depression is often spoken of as if it were a single condition, a uniform experience of sadness, fatigue, or lack of motivation. However, if we look beyond these experiences, we will understand that not all depressions are alike. Psychodynamic depression therapy begins with this premise: that depression is not just a symptom to be removed, but a communication from the psyche, a signal, like a fever, that something within us is struggling for expression or repair. Depressed women looking out the window. Depression as a Signal When someone enters therapy describing a pervasive sadness or emptiness, it’s tempting to look for external causes: loss, stress, trauma, politics, or neurochemical imbalance. These factors might, in fact, matter deeply. Yet how we relate to them depends on our own individual psychological structure—our personality—which gives meaning to our emotions. When we talk about “personality,” we do not mean personality “disorders,” but the ways in which we have come to make sense, consciously and unconsciously, of our own past and present experience. Depression therapy must be attuned to the underlying personality structure rather than treating all depressions as the same “condition.” Depression and Personality Types The four personality styles used as examples below—depressive, narcissistic, borderline, and obsessive-compulsive—do not refer to personality disorders. Instead, they are some of the personality styles that can shape, to a greater or lesser degree, how we organize our experience. Depressive Personality For some people, depression lies close to the core of their personality, as they live with a deep, ongoing struggle around worth, love, and loss. For some of them, depression reflects an internal conviction that something essential about them is damaged or unlovable. Disappointments are experienced as confirmation of their inner badness, and they blame themselves for things that are not truly within their control. For others, their suffering centers more on the fear of abandonment. Depression arises from the terror of being alone or losing attachment figures. Love feels necessary for survival, and when connection is threatened, despair floods in. The person may oscillate between clinging to others for reassurance and withdrawing preemptively to avoid being left. Depression becomes a form of protest and mourning for the real, anticipated, or imagined loss of attachment. In depression therapy, the task is to discern which story the depression is telling—whether it speaks of guilt and unworthiness or of fear and abandonment, and to help the person find words for that internal experience. The work is not to silence the symptom, but to translate its meaning into the language of the self. Narcissistic Personality People with a narcissistic personality style tend to be preoccupied with their standing in relation to others, often displaying grandiose fantasies to mask an internal sense of emptiness. When their fragile sense of self and self-worth collapses, perhaps after criticism, failure, or the loss of admiration, they may feel devastated. The world suddenly seems meaningless, and the person themselves, hollow. Depression might be experienced as shame, emptiness, or humiliation rather than sorrow or guilt. This form of depression is not about loss of a loved object but about a collapse in the structure of the self. The depressive state expresses a crisis of identity, as this personality will tend to fluctuate between grandiosity and self-loathing. This depressive crisis might lead the person to either doubling-down of the illusions that shape their personality, or to emotional numbness; both cases represent defensive mechanisms to avoid pain. In depression therapy, understanding the symptoms in the context of this personality organization involves helping the person tolerate vulnerability without disintegrating, to experience disappointment and limitation without falling into despair. The therapist’s task is to provide a steady, reality-based empathy that can withstand the fluctuations between grandiosity and self-loathing, allowing a more stable and authentic self to emerge. Borderline Personality For people with borderline types of personality organization, typically marked by volatile and unstable relationships with self and others, depression often carries the intensity of relational trauma. Feelings shift rapidly from despair to rage, from fear of abandonment to numbness. The depressive experience is often entwined with the terror of losing connection, of being left or rejected. The person may experience their emotions as overwhelming and uncontainable, oscillating between clinging to others for survival and pushing them away to avoid anticipated rejection. Depression in this context signals an unbearable sense of aloneness, often rooted in early experiences when attachment figures were inconsistent or emotionally unavailable. In therapy, the work involves creating a relationship stable enough to bear the turbulence. Depression therapy becomes less about symptom reduction and more about helping the person develop a capacity to recognize and regulate emotion, to see their moods as part of an ongoing inner dialogue. Over time, the depressive states become less catastrophic and more thinkable, an internal weather that can be survived rather than annihilating. Obsessive-Compulsive Personality For those with an obsessive-compulsive personality, who strive to maintain order, mastery, and control to avoid the anxiety that uncertainty and unpredictability creates, depression often manifests through overcontrol, rumination, and self-reproach. When they fail to meet their own strict and demanding standards, depression sets in as a kind of punishment, a moral or logical consequence of imperfection in a context in which chaos or guilt can feel overwhelming. Here, depression serves as a custodian for an inner world governed by harsh demands and expectations. The mind, striving to stay in control, suppresses spontaneity and emotion, leading to a sense of lifelessness. The person may not describe sadness so much as emptiness or exhaustion, the fatigue of sustaining an internal dictatorship. In depression therapy, progress comes from loosening these rigid internal rules. The therapist helps the individual develop a more compassionate inner dialogue, allowing the emergence of feeling, play, and desire without catastrophic guilt. Depression lifts not because the person gains control, but because they can tolerate losing it. How Depression Therapy Helps Across these personality syndromes, depression is not random or a collection of emotional symptoms. It speaks the language of the personality that carries it, one that can be listened to in therapy. The depressed person’s suffering is, deep inside, an expression of their underlying conflict between love and aggression, connection and autonomy, idealization and reality. What looks like the same symptom—a withdrawal of energy, loss of interest, or self-blame—has profoundly different meanings depending on its psychic context. As a result, working with depression in therapy requires us to understand our characteristic emotional world. When we trace the threads of depression back to the structure of the self, we begin to see that it is not an intruder but a messenger. When we listen to depression as communication, we can begin to hear the unconscious story it is trying to tell. Santiago Delboy, MBA, LCSW. -Blog, Website

Identity and world confusion stem from trauma and dissociation. Judith Herman observed that "the conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma" (Herman, 1992). This tension manifests in how many trauma survivors inhabit a kind of psychological superposition—simultaneously experiencing the life they have and the lives they might have had, in worlds and lives half-real, and half-imagined. Hand reaching toward sunlight in a forest. The will to proclaim These alternate universes aren't idle speculation. They're vivid, persistent mental realities that shape self-understanding and recovery, reflecting both the proclamation of loss and the denial of pain. Existing in dissociative spaces of the might-have-been, in fantasy and conflict with real life, in dreams which sometimes feel more real than waking life, running in the background to have real hidden impact. (The quantum mechanics language is purely metaphorical here—this describes subjective experience, not physics.) Consider the person who experiences significant loss in childhood. The self that emerged from that event develops along one trajectory, while an imagined alternate self—the one who never faced that loss—remains a haunting presence. It feels a bit like we imagine the "many worlds interpretation" of quantum mechanics, the what-ifs of infinite possibility. This can be more overt—who might I have been if my mother hadn't become ill with cancer, and died young, when I was a child? Or more subtle—what if one's parents had been more competent and resourced, focused on the child's developmental needs, enabling one to choose a career more out of passion, rather than pure necessity? Sometimes these lives re-emerge later on in development; sometimes we carry them, unlived, to the grave. Somewhere in the space between these selves lies the work of integration: a reconciliation not just of loss, but of identity itself. Thinking the unknowable: The better universe Counterfactual thinking—persistent "if only" and "what if" thoughts—is nearly universal, but for many survivors of severe trauma and loss, the intensity is next-level. Research suggests that these thoughts are associated with increased PTSD symptoms and emotional distress, particularly when they highlight the gap between one's actual self and an idealized alternate self (Brancu et al., 2016; Caramanica et al., 2018). Emotional numbing can be pervasive and associated with emotional dysregulation and loss of a coherent sense of self, tantamount to a fracturing of the personality known as "structural dissociation" (Steele, van der Hart & Nijenhuis, 2005). The simplest is primary structural dissociation, where one is divided into a world-facing "apparently normal part" of the person (ANP) and an "emotional part" (EP). More severe levels are fragmentation into many EPs but one ANP, and then many ANPs and EPs (paralleling dissociative identity disorder). Some of these selves, the EPs, hold the might-have-beens, the fantasies and anguish of lost lives which, to them, can only be imagined. Phobias, within this model, ward off integration into a fuller personality. These alternate selves become a language for grief. In the better universe, survivors imagine themselves unburdened by hypervigilance, undistorted by defensive adaptations, with access to relationships and opportunities that trauma foreclosed. This imagined self transcends fantasy—it represents honest mourning for a blind developmental path. There is recognition of how unfortunate events actually must have changed what could have been, which nevertheless may be experienced as tormentingly out of reach... unlike the alternative universes which, in some science fiction narratives, are accessible—though at the expense of displacing the me who is already there. The better universe extends beyond individual identity into relational life. Survivors imagine how they might parent differently, love more freely, trust more easily, who they might have met or married, the ones who got away because of residual problems, or the ones we stayed with who we otherwise might have left. Early parental loss, for instance, profoundly shapes adult attachment patterns, emotional regulation, and capacity for intimacy (Høeg et al., 2018). From a psychoanalytic perspective, fantasies of perfection can both motivate and paralyze (Rothstein, 1984; Colombi, 2017). When survivors strive relentlessly toward an idealized self, attempting to "undo" the past through achievement or flawless relationships, they may unwittingly reinforce the notion that their present, imperfect self is unacceptable. The better universe may become a prison of impossible standards. The Worser Universe The opposite comparison is equally important: the universe where things went worse. "Others have it worse than me." "At least I wasn't..." "Real trauma is what happens to combat veterans, refugees, or abuse survivors." This is the other extreme—the will to deny. This defensive comparison serves multiple functions. It minimizes psychic pain, protecting against fully experiencing it. It lets us move on, near-mortally wounded. Most insidiously, it disqualifies one's experience before anyone else can. Contemporary stoicism—valuable in its original philosophical form—may be misappropriated for this purpose. What begins as wisdom about focusing on what one can control becomes a weapon against legitimate suffering. The hierarchy of trauma is pervasive and damaging. My trauma isn't "good enough," itself often a post-traumatic reaction. Chronic illness, emotional neglect, persistent bullying, medical trauma—don't seem "bad enough" to count. The worse universe they imagine validates this dismissal: Someone else always had it harder, so their pain doesn't count, or is just an unlucky roll of the dice. This comparison is as much a barrier to healing as idealizing the better universe. Both prevent inhabiting the universe within which we are, where we can have real impact. The Before and After Problem The integration work differs depending on trauma type, following the chasm created by overwhelming trauma. Discrete trauma may require integrating two (or more) distinct selves across a visible divide—the me who was born biologically, and the me born as an adaptation. Complex trauma demands making sense of a self that developed within adversity, starting with restoring safe attachment, a "relational home" (Dorahy & van der Hart, 2015), where there may be no clear "before" to remember or idealize (Herman, 1992; van der Kolk, 2014) for those with disruptions of autobiographical memory and narrative. We need a "good enough reality" (Brenner, 2025)—not a perfect one. Either way, the developmental reality remains: We become ourselves through these experiences, not in spite of them. We "come to terms" and "fake it until we make it." The adaptations that once ensured survival—hypervigilance, emotional constriction, perfectionism, self-doubt—dissolve into the fabric of identity, integrated and not rejected or abandoned. They're not foreign objects to be extracted but aspects of self to be understood, honored for their protective function, and amends to be made with gratitude for services rendered. The ordinary world Neither the better universe nor the worse universe is where we actually live. Healing isn't about choosing which alternate timeline is "true" or denying impact. It's about making the most of the developmental paths actually open to us, and expanding those possibilities as we move forward, looking back to learn from rather than be fixated on the past. Self-compassion is essential here. Research consistently demonstrates that compassion strengthens resilience and rewires the brain, helping survivors regulate emotions, reduce PTSD symptoms, and develop adaptive coping strategies (Neff & Germer, 2013; Hoffart et al., 2015; Friis et al., 2016). The practice of compassion alters brain networks, updating our operating system when it comes to the kinds of relationships we can have with ourselves (e.g., Kelly & Huffman, 2025) while enabling us to see better futures and move toward them as good stewards for ourselves. The alternate universes may always whisper in the background, and that can, in time, turn into a more rewarding than tormenting experience. Healing happens in the present moment, over and over, one at a time—the only place where choice exists, where one can read while writing the next chapter rather than endlessly revising earlier ones. Grant Hilary Brenner, M.D. -Blog

Whether you stay or go, it's vital to change how you interact with a narcissist. Key points Specific traits must be present for someone to be diagnosed with narcissistic personality disorder. The term "narcissist" is now frequently overused; not all jerks are narcissists. If you love someone with these traits, it's vital to learn to avoid destructive emotional interactions. Two people having a serious conversation over coffee in a cozy café. Narcissism. That word gets thrown around a good deal these days to describe someone who’s self-absorbed, grandiose, or abrasive. These may be annoying personality traits, but standing alone, they don't reflect narcissism. So, what is a true narcissist? A narcissist displays a terribly inflated ego or sense of importance and seems to believe the world should revolve around him; he can be impatient, critical, and lacking in empathy. He blames you for problems despite your repeated attempts to prove otherwise, and can accuse you of maliciously plotting against him. He may frequently threaten to cut you off, and might even follow through at some point. And perhaps the worst—he makes you question your very sanity or logic, tending instead to undermine the way you see or remember things. It's called "gaslighting," and narcissists do it on a regular basis as a means of control. When these dynamics are part of someone's relationships with almost everyone their life touches, it's termed narcissistic personality disorder. Yet just because someone is a selfish jerk doesn’t mean he's a narcissist. Someone can easily struggle with narcissistic traits, like grandiosity or a tendency toward self-focus. So, what can you do if you love someone with narcissistic traits? 1. Don't get stuck arguing about how you're a good person. You aren't going to win any battle with him; he'll rarely, if ever, allow that. The answer is to disengage from the emotionally volatile battles that might be raging between the two of you. You won't win. 2. Confront the demeaning treatment you've absorbed and set a boundary. Challenge the validity of the abusive labels he has called you, not to him directly, but within yourself. You may have internalized far more than you realized. If you're depressed, seek professional help. You can learn how to structure your communication with him, so if and when he becomes abusive, you can set a boundary that you're not going to accept his bad behavior. You can decide your own limits of what you'll be around for—and what you simply will not. Going into therapy is sometimes vital for this step, as you can learn how to stop emotionally responding. Instead, you can respond with logic and clarity. 3. Take responsibility for being attracted to your partner's initial charm. The over-the-top attention you first received somehow swept you up. You didn't view it as possessiveness or see the warning signs that were more than likely there. Maybe that was due to your own shaky sense of worth, or maybe because you were tired of being alone. If you recognize you're part of the dynamic, it's more probable you'll be able to detach from what keeps you stuck. 4. Realize how your strengths are manipulated. Often, a narcissist will seek out partners who pride themselves on taking responsibility, who are conscientious, and who will work hard to please. They seek those who love so deeply that they will deny how abusive things are. They will manipulate that and use it against you—if you allow it. 5. Decide that you can tolerate that your partner will initially blame you. You have to learn to not accept the blame and calmly step out of their attempts to do so. If you stay or if you go... Work on these five commitments so that you can begin the process of believing in yourself, valuing who you are and what you stand for. If you stay in the relationship, detaching with logic and reason is the answer—avoiding and simply not participating in long, drawn-out emotional battles. He may not like it, but with enough practice, he'll hopefully respond. If you leave, things will likely also get worse for a while. His rage at being called on the carpet can boil over and become ugly. Don’t allow yourself to be drawn into the battles; you won’t convince him of anything. If there are children involved, it's particularly painful. You're likely to watch them realize what the narcissistic parent is unwilling, if not incapable, of providing. And that can be very difficult to watch. It's highly likely that if you attempt to intervene in their relationship, it will only escalate your past partner’s behavior. The best you can do is to provide steady and consistent support for your child. It's hard loving a narcissist. It's important to remember that he's miserable underneath his entitlement; yet it doesn't mean you have to be miserable along with him. Margaret Rutherford, Ph.D. -Blog

The aftermath of a parental suicide increases the child's risk of suicide. Key points Children internalize feelings of shame or self-blame in the wake of a parent who chose to die by suicide. Children who have lost a parent to suicide are three times more likely to die by suicide. This association may not only be because of trauma, but by hereditary and environmental factors. A young person sitting thoughtfully and talking with a therapist According to the World Health Organization, more than 720,000 people die by suicide each year, and it remains the third leading cause of death for 15- to 29-year-olds. Many children are left to grieve the loss of a parent to suicide, a painful experience that often leads to mental health struggles such as depression, anxiety, and even thoughts of suicide themselves. There is a 3.8 percent lifetime prevalence of suicide exposure within a family, which means that about 1 in 25 people will be directly affected by this tragedy. There are many adverse outcomes of dealing with parental suicide for children, including psychological issues such as post-traumatic stress disorder and substance use, social challenges around building healthy relationships or fears of intimacy, and even physical health concerns like cardiovascular disease. Madelon Sprengnether, regents professor emerita at the University of Minnesota, reflects on her own experience grappling with the loss of her stepfather to what she believes was an intentional overdose. She recalls, “My feelings in the immediate aftermath of my stepfather’s death were a mix of horror, guilt, shame, and something like numbness.” Guilt is a common response when suicide occurs within a family. A study by Clémence Ceruzé and colleagues emphasizes how these feelings of guilt can complicate social connections. Children often internalize their emotions and develop feelings of shame or self-blame in an attempt to understand why a parent might choose to die by suicide. Sprengnether’s struggles reflect the findings in Ceruzé’s research on the impact of suicide on social relationships: “My understanding now of what happened to me in the aftermath of my stepfather’s death is that I shut down emotionally. My natural shyness deepened, which made it hard for me to make friends in college, much less to find a boyfriend—both typical experiences for girls of my age.” Alarmingly, research shows a significant increase in the risk of suicide and suicide attempts among the children of parents who have died by suicide. Specifically, children who have lost a parent to suicide are three times more likely to die by suicide and twice as likely to attempt suicide than children with two living parents. Psychotherapist Colleen Mousseau serves as the clinical director of a therapy practice that supports grieving youth dealing with the loss of loved ones. Having worked with many child survivors of parental suicide, Mousseau understands the common occurrence of suicidal ideation among these bereaved youth and how this experience is relatively different from the grief associated with other causes of parental death. “Many other causes of death can be explained in a way that quickly resolves feelings of guilt and responsibility. When someone dies by suicide, it can be difficult for those who are grieving to know where to place the blame. There can be deep feelings of betrayal, abandonment, and confusion that are difficult to resolve after a suicide.” Several key factors may contribute to the higher prevalence of self-injurious behaviors among youth who have been previously exposed to suicide. Genetic factors like impulsive aggression and neuroticism can predispose a child to suicidal behaviors, as well as environmental influences before and after a parent's suicide, such as neglect, abuse, and family adversity. Imitation of a caregiver’s actions as a coping mechanism can also be a risk factor for suicide. Finally, the trauma of a parent’s suicide is enough to increase the likelihood of self-harm. To help bereaved children, Mousseau suggests a safe and supportive space to understand, gain information, express feelings, and provide opportunities for connection with the person who passed away. Group-based support can especially help mitigate the isolation and loneliness associated with grieving parental suicide. It is crucial to avoid placing blame on the family or child. It’s also important to use age-appropriate language and work with the surviving parent or other bereaved family members to encourage open, honest conversations and promote healing. This approach can be key in helping a child navigate their grief. The need for effective therapy treatments, evidence-based programs, and family support interventions continues. A 2023 study explored a therapy program aimed at improving parenting practices known as the family bereavement program, which effectively reduced suicide risk among parentally bereaved children 6 to 15 years after the intervention. In the aftermath of the tragic reality of suicide, loved ones are left to grapple with a range of intensely painful emotions. For children, especially, this can be confusing and even more devastating. However, healing is possible, and though the journey might look different for each individual, it often begins with having the right support. Fostering understanding and connection, rather than shame or isolation, is crucial in helping children cope with parental suicide. Robert T. Muller, Ph.D. -Blog, Link