Paper I wrote for Abnormal Psych class few years ago on BPD


Published by the American Psychiatric Associat...
Published by the American Psychiatric Association, the DSM-IV-TR provides a common language and standard criteria for the classification of mental disorders. (Photo credit: Wikipedia)


Paper on Borderline Personality Disorder I wrote for Abnormal Psych class
Disorder Paper: Borderline Personality Disorder
Borderline personality disorder is a complicated disorder characterized by black and white thinking also known as all or nothing thinking. Most borderlines are manipulative and insecure. They have low self-esteem and nearly no self-confidence. They have not learned effective coping mechanisms and are unable to distinguish between themselves and the world that they grew up in. Most borderlines have issues with boundaries and limits. They do not have their own and have a hard time allowing others to have boundaries. They tend to be impulsive in their actions and unable to think before acting for the most part. The diagnostic statistical manual for mental health disorders states,
Diagnostic criteria for 301.83 Borderline Personality Disorder- A pervasive pattern of instability of interpersonal relationships, self image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self
Impulsivity in atleast two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
Chronic feelings of emptiness
Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
Transient, stress-related paranoid ideation or severe dissociative symptoms. (DSM IV-TR)
Dr. Corelli describes Borderline Personality Disorder as, “There is a deep-seated feeling that one is flawed, defective, damaged, or bad in some way, with a tendency to go to extremes in thinking, feeling, or behavior. Under extreme stress or in severe cases there can be brief psychotic episodes with loss of contact with reality or bizarre behavior or symptoms” (Corelli). “Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone” (NIMH 2008). “A person with this disorder can often be bright and intelligent, and appear warm, friendly, and competent. They sometimes can maintain this appearance for a number of years until their defense structure crumbles, usually around a stressful situation like the breakup of a romantic relationship or the death of a parent” (Corelli). Symptoms appear to minimize as the Borderline ages. This may be due to life experience as they grow; they seem to manage their symptoms better. Their lives seem to settle down and become more stable. They commence to be able to function and manage better as they age.
There is an influential connection between child abuse, neglect, and Borderline Personality Disorder. More women than men are identified as having BPD. According to an article, “Borderline personality disorder (BPD) is a common and severe condition with substantial morbidity and mortality. BPD has a point prevalence of 1% to 2% in the general population, but the rate climbs to 10% to 20% in the mental health treatment settings. BPD is manifested by a wide array of symptoms and is associated with significant functional impairment and mortality rates approaching 10% in long-range naturalistic studies” (Gregory, Remen 2008). The DSM IV-TR states, “Physical and sexual abuse, neglect, hostile conflict, and early parental loss or separation are more common in the child-hood histories of those with Borderline Personality Disorder” (DSM IV-TR, pg.708). It also states, Borderline Personality Disorder is about five times more common among first-degree biological relatives of those with the disorder than in the general population” (DSM IV-TR, pg.709). There is some evidence of biological connection although studies have not shown clear evidence of what genetic links there are in BPD.
During recent years, there have been many studies done and treatment for BPD is more widespread now than a decade ago. There is still a stigma against people diagnosed with BPD in the world and the mental health system itself. One article advises, “Individuals with Borderline Personality Disorder are often unfairly discriminated against within the broad range of mental health professionals because they are seen as ‘trouble-makers'” While they may indeed need more care than many other patients, their behavior is caused by their disorder” (Levin 2001). It also states, “Many professionals are turned-off by working with people with this disorder, because it draws many negative feelings from the clinician” (Levin 2001). An article on the web says, “People with borderline personality disorder are among the most difficult to treat with psychotherapy, in part because their relationship with their therapist may become as intense and unstable as their other personal relationships” (Personality Disorders). Treatment providers need to set and stick with clear limits. They need to be able to provide support to the borderline but not allow the borderlines manipulative behavior to interfere in the treatment they are providing.
Over the past decade or so there have been many treatments suggested for treating borderlines but not many have shown to be effective in the long-term treatment of Borderline Personality Disorder. An article reads, “Treatment includes psychotherapy which allows the patient to talk about both present difficulties and past experiences in the presence of an empathetic, accepting, and non-judgemental therapist. The therapy needs to be structured, consistent and regular, with the patient encouraged to talk about his or her feelings rather than to discharge them in his or her usual self-defeating ways” (Corelli). The most effective treatment that has shown to be effective is DBT. Dialectical behavioral therapy first introduced by Marsha Linehan has shown to be the most effective in helping the borderline learn to live their life to the fullest they are capable of. An article states, “Therapy should help to alleviate psychotic or mood-disturbance symptoms and generally integrate the whole personality. With this increased awareness and capacity for self-observation and introspection, it is hoped the patient will be able to change the rigid patterns tragically set earlier in life and prevent the pattern from repeating itself in the next generational cycle” (Corelli). Treatment of the borderline client and its effectiveness depends on the investment of the client. They borderline needs to want to change to effectively benefit from any treatment that is provided including but not limited to; DBT, psychotherapy, medications, or other methods that has not been mentioned but may help. Borderline Personality Disorder needs to be studied more to find more beneficial treatments.


Works Cited:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Corelli M.D., Richard J., “Borderline Personality Disorder”, Retrieved October 17, 2008.
NIMH., “Borderline Personality Disorder”. Retrieved October 15, 2008. Last reviewed: June 26, 2008.
“Personality Disorders”, Microsoft Encarta Online Encyclopedia 2008. Retrieved October 15, 2008. Http:// © 1997-2008 Microsoft Corporation. All Rights Reserved.




Meeting the True Needs of Children Diagnosed as ADHD

Meeting the True Needs of Children Diagnosed as ‘ADHD’


Expert Author Dan EdmundsHow should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn’t fit into cultural norms.

In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person’s response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.

Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette’s Syndrome. Hedaya asks the question,”One might wonder-, why use methylphenidate at all?” Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.

However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children’s Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small.

Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents.

The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.

In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD.

Dr. Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic – the fact that many hyperactive children respond to Ritalin by becoming calmer doesn’t mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn’t mean they are suffering from a disease treated by cocaine. It is interesting to note Walker’s analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, EMP (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high similar to that of cocaine.   Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette’s syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHDEhowever Walker feels that these issues are most often overlooked and the person is considered to be ADHD.

F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment.  Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders. The Food and Drug Administration has noted (Walker, 1998, pg. 27) that ee acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.

There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate’s pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.

Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. Abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)

Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.

Valentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD itself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them.

Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, Epediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don’t like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it’s better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illnessEin the schools.

Breggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.

Dr. David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving children. In this program, known as the Caregiver’s Skills program, Stein states it is necessary to treat your child as normal and not diseased. He states that the children should not be taking any medications, as they are risky for the child’s health and merely blunt behaviors. Stein argues, if the behaviors don’t occur, we can’t help (them) learn new habits.

The program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.


Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)

Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)

Breggin, Peter R., Talking Back to Ritalin,Common Courage Press, Monroe, ME, 1998)

Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)

DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).

Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)

Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)

Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)

National Institutes of Mental Health Consensus Conference Statement, 1998

Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)

Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)

Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6

Dan L. Edmunds, Ed.D.

Article Source:

via Meeting the True Needs of Children Diagnosed as ADHD.

15 August, 2011 00:55


COMMITMENTS :  Cutting the Cord :  Saying goodbye to your therapist can elicit bad feelings–unless it’s handled right. Then the parting can be a chance for growth.

You’ve been in psychotherapyfor a while and feel your therapist just isn’t meeting your needs anymore, so you decide it’s time for a change. Or perhaps it is your therapist who is moving on–leaving town, going on maternity leave, retiring because of age or illness.Whatever the reason for bidding adieu, when the two of you part company, you’re not just breaking off with a mental-health professional. Therapy involves transference, in which you transfer feelings about important figures in your life onto the therapist. So you’re also saying sayonara to your mother, your father, significant others past and present, best friend, maybe a sibling or two–so many people it’s a wonder you can all fit into one office.

That period of wrapping up therapy and saying goodbye is known as “termination,” a word that evokes images of being fired from a job or being stalked by Arnold Schwarzenegger. But mental-health experts consider termination a crucial stage in therapy.

If handled properly, it provides an opportunity to re-examine the issues that led the client to seek help in the first place, to evaluate the therapy itself and to deal with feelings that might bubble up in the face of bidding farewell.

A so-called natural termination, in which the two of you agree to end treatment because your goals have been met, is difficult enough. Who, after all, likes to say goodbye, especially to someone who has helped you so profoundly and so intimately? But a premature termination, where a dissatisfied client leaves without much notice or a therapist departs before the patient is ready, can be downright traumatic.

“It’s always best if people can have time to pay attention to the process of saying goodbye,” says Carl Shubs, a licensed clinical psychologist in private practice in Beverly Hills. “If people leave too abruptly, it interferes with the process–they’re not able to deal with the sadness or anger, the mourning that occurs.”

Adds Sylvia Martin, a licensed marriage, family and child therapist in private practice in Sherman Oaks: “Termination is a time when people start to deal with all their losses. It can trigger feelings about old issues, or issues about the relationship between the therapist and client.

“If there is an old loss they have not grieved, they will tap in and experience the same feelings,” she says. “Maybe they had a feeling of abandonment when they were young and did not understand it. Or maybe they have not had the luxury before now of dealing with a loss–for example, going through a divorce with two kids.”


If it is the patient who says so long, a good therapist will try to determine if he or she wants out because the topics being discussed are becoming too painful. In those cases, the therapist will encourage the patient to remain, so as to work through the discomfort and resolve those issues.

Many times, though, the client is willing to slog through the hard stuff, but feels this particular therapist is less than able. Such was the case last year for Laura, 41, who works in the travel industry in Orange County and sought counseling for marital problems.

“I was therapy illiterate,” she recalls. “I had no basis for comparison. But I never felt I was getting help. I would drive home and think, ‘Why did I just go there?’ I didn’t expect a magic cure, but I was just begging my therapist, ‘Give me some tools to help me.’

“All she said was, I had to divorce my husband, which I wasn’t ready to do. I felt her attitude was, ‘You won’t take my advice, so I don’t know what to tell you.’ ”

Laura–who is still married and on better terms with her husband–found another therapist to her liking. But she stuck with her first counselor longer than she preferred to because, she says, “The last thing I wanted was to look for someone new to spill my guts to, to start over again.”

Indeed, for some people, leaving the current therapist is the easy part; it’s finding a new one that poses problems. Says Studio City writer Catherine Johnson, author of the book “When to Say Goodbye to Your Therapist” (Simon and Schuster, 1988), “Finding a new therapist is not like finding a new dentist. It’s extremely difficult to find a match.

“It’s a bit like finding a lover, or best friend, or a parent. You don’t just go out and find a new best friend. You have to find a real emotional fit, on top of basic competence.”

Lisa Moore, 34, a West Los Angeles advertising account executive, discovered that last year when she left the marriage and family counselor she had been seeing for 15 months because she thought the therapist had crossed the professional line and was becoming too friendly. After six weeks with a new therapist recommended by her physician, she decided to return to her former counselor.

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14 August, 2011 23:20

When is it time to say
goodbye to a therapist?

By Alexia

Chicago Tribune

Posted: 03/29/2011 01:00:00 AM MDT

Maybe you don’t like your therapist. Maybe you do, but you’ve resolved the
issues that drove you to seek counseling in the first place. Or maybe those
issues remain unresolved, with few signs of progress. Maybe your sessions feel
as if they’ve morphed into very expensive chats with a friend.

For myriad reasons, people come to a point when they wonder if they should
break up with their therapist. And “break up” is the right term for it, because
quitting therapy can spur emotions as painful and complicated as ending a
romantic relationship.

How do you know if you’re ready to stop therapy? And how should you go about
it? First, any therapy that is abusive or destructive should be stopped
immediately, said Dr. Kenneth Settel, clinical instructor in psychiatry at
Harvard Medical School. Examples of abusive therapists are those who are
disrespectful or insensitive to certain issues; those who violate boundaries;
those who reveal too much about their own problems; and those who insist on
focusing on areas the patient didn’t come in for.

But assuming you’re not dealing with that, patients should approach ending
therapy as a chance to grow, Settel said. Rather than cut and run or avoid the
topic altogether — tempting routes for the confrontation-avoidant — it’s
important that patients, well, talk to their therapist about it.

In therapy, the relationship between the patient and the therapist is a
vehicle for understanding the patient’s issues, Settel said. So the way you end
therapy can be a way of examining how you say goodbye to people, and the
feelings involved in leaving and loss.

Ask yourself why you want to move on. When did you start feeling that the
therapy was no longer helpful or productive? What happened that made it
different? Was there a change in you, in the topics being discussed, in the
therapist? Confronting that tension can be a turning point because it forces you
to work through obstacles, Settel said.

“Ending therapy can be very therapeutic,” Settel said.

Though the patient-therapist relationship can have a weird power dynamic —
you’re paying, but the therapist is the expert and knows your every demon —
patients should feel they have control of the process, said Lynn Bufka, a
psychologist and head of the department of practice, research and policy at the
American Psychological Association. Patients should feel empowered to ask
questions, steer the sessions to focus on particular issues and let the
therapist know what’s not working.

The tricky part is making sure you’re not leaving therapy just because it’s
unpleasant or difficult, which oftentimes it has to be, Bufka said. More than
make you feel better, therapy is supposed to help you understand yourself

On the flip side, therapy shouldn’t be some indefinite appointment you keep
as part of your routine. There should be regular discussions about what you’re
trying to accomplish and whether you’re meeting those goals.

“I hope that I’m going to work myself out of a job,” Bufka said.

There is such a thing as staying in therapy for too long. One warning sign is
if a patient has to run all decisions by his or her therapist, which can signal
dependency, Bufka said. Another concern is if the therapist relationship is
taking the place of building other relationships.

Another downside of staying in therapy for too long is that you don’t have
the opportunity to practice the skills you’re developing independently, Settel
said. If the therapy was aiming to help you build internal skills of
self-observation, stopping therapy can encourage growth because it forces you to
internalize the process.

Read more: When is it
time to say goodbye to a therapist? – The Denver Post

Read The Denver Post’s Terms of Use of its content:

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Free Self Help Tool. The Map.


Free Self Help Tool. The Map..

For the majority of us moments of real happiness, at the best, are

short lived. To fall back to a state of not being unhappy is a normal,

stable, workable state of being that allows the moments of real

happiness to just happen.

If you find your normal state of being is unhappy then there is

something wrong in your life and though your unhappiness is caused

by an outside (outside of your control) influence, as I take you

through the meanings of each image you will find the path away from

unhappiness is totally under your control.

Technically, as you can see, the Map is not a map as you will know

maps to be, but with a little understanding of what the six

illustrations represent, a life journey can be planned.

Have you ever had a big life­ changing decision to make?

Did you think of, or write down, the pros and cons of the

consequences of your decision/action to give yourself something

tangible to help you make a decision?

The Map endeavours to take the idea of a pros and cons list much

further, to make tangible much more information.

Each picture depicts a place we can be mentally and emotionally in

our relationships with the world, different places for different

relationships, all at the same time.

With the Map, once understood, if we can be honest with ourselves as

to where we are in any particular troubling relationship we can then

see the steps to take to improve our situation .

There are a few rules to this type of map reading, the first, and most

important rule is that it is only for you !!

It is not possible to consider where someone else is on the Map to try

to help them.

Having said that it could be helpful for a relationship for another to

see where you feel you are in your relationship with them.

Our position in the world is defined by how we relate to everything

and everybody, how we relate to our friends, our environment, our

partner, our family, our government, our neighbours , our poverty,

our riches, our education, our boss, our workers etc. etc. Our

problems come from how all the above relates to us!

I trained as a nurse for people with learning disabilities in Liverpool

and it was during this training I gave a talk to a group of nurses and

tutors on the map, at the end of the talk I took questions and one

nurse, looking at the blackboard on which I had drawn the places of

the map, asked me “where does it start ?”

There is no start, and no end, life goes on regardless and the problems

life throws at us we rarely see coming, often we only know we have a

problem when we feel the effects of it and mostly the actual problem is

beyond our control.

With this in mind please bear with me when I say the start, new

beginnings, is at the end so we shall start at the end.

Loss, Emptiness, Broken Dreams &

New Beginnings

Emptiness describes this place, nothing but a multi platform staircase

for as far as the eye can see .

Pain and despair may have brought you here but now there is just


Life is precious, though the thought of starting again will be daunting

there is a way out.

Take the stairs.

Those stairs symbolise the concept of taking one small step at a time,

the platforms symbolise small goals you need to set yourself.

These goals will be different depending on your situation, the goals a

peasant women, after an earthquake, sitting on the rubble of what

used to be her home, mourning the death of her children will be very

different from the film star whose loved husband has just left her for

another woman. But either way both have to move on, slowly, step by


For the peasant woman her first small step could be to make a shelter

so that she can get some sleep and enough strength to go and (take her

next step) find some clean water to keep her going until the next day

when she will need to take her next step and go find food.

The film star, though her loss is incomparable to that of the peasant

woman can feel just as empty. You cannot feel emptier than empty, and

though her steps will be very different they still have to be identified

and taken.

These two examples may seem a little extreme, maybe you just feel you

are here because life for you is just ‘OK’, you go through the motions

but its all routine, you don’t feel empty because of any loss, you just

feel empty because in your life maybe there is no feeling of purpose,

or satisfaction or creativity. Possibly downloading this Map was your

first step, taking the trouble to make a a nice poster of the Map to

remind you day to day about your life path could be the next step.

As with any place on the map there are many scenarios, only you know

how you got here and what your small steps could be, the important

thing is to identify those steps and, little by little, climb the stairs to the

next level.

Lessons will have been given but not necessarily learned here, new

beginnings are created but not necessarily carried through to the end

here, it is too early, the past is too raw .

Earlier I mentioned the map is all about you, it is now that you have to

provide for you, you are both the inner child and the outer parent,

here there is no one else to provide for you, others may be able to help

but you are the one that must get that help.

It may be cold and lifeless here like a lifeless ploughed field in the

winter but plant the seeds now and in a few months you will be in a

very different place.

Key concepts for this place,



step by step

small achievable goals

provide for yourself

understand there is a lesson to be learnt

new beginnings

Decisions, Freedom, Influence, The Future.

At the bottom right of this place is the last platform at which you will

have arrived at by taking those small steps upward, back into the


This is probably the most important place on the map, it is here you

decide the structure of your future.

At this place you are free to decide for yourself, real freedom is a

strange thing, as soon as you use your freedom to decide a path

complete freedom is lost, when you commit to a future there are bills

to pay, work to be done, consequences to work through, responsibilities

to take on, all of which chip away at your freedom.

It is really worth spending a little time here bathing in your freedom

before you decide what to do next.

So what are your options?

We can take the path to the bridge and begin what looks like a very

long uncertain walk to what cannot be seen, or we can take the easier

route by going down to the jetty and getting in the boat to drift with

the current to where ever it takes us.

The Boat.

If you take another look at this place you will see the current, the

darker water, takes us through an opening to the next place we will be


This darker water, the current, is the force of influence.

We are all affected by some form of influence, what we wear, the way

we speak, what our expectations are, our drinking habits , our beliefs.

Some influences are good for us some are most definitely bad for us.

The difference between the good and the bad influence is a good

influence shows us the path that will benefit us, the bad influence

shows us the path that will benefit the influencer.

The role of the influencer will be discussed in the next two places we

will visit and need to be read before one can fully understand this

place because the first four places to be discussed form a cycle you

may be in without realising it, this needs to be understood before you

can go forward.

There is the concept of going with the flow and there is the concept of

fighting against the flow and there is a ‘Map’ concept of taking the

bridge to walk over the flow altogether.

The bridge

The bridge, over a vast expanse of water, is your path to the future

that you have decided to construct for yourself.

This is a path into the complete unknown, or to put it another way, this

is the path away from everything you have known.

OK it is easy for me to sit here conceptualising , but what does it all

mean in the real world, ‘constructing the future’, ‘into the unknown’.

It gets worse!!

You have to believe in yourself and follow your heart, do only what

feels wholesome and maybe follow some influences that have been

good in your life.

You may be sitting at a real crossroad, a real bus station, a real

airport thinking you have just read these words but the concepts do

not exist in the real world .

I don’t blame you, I have also heard and read wishy washy concepts

that at the time blur rather than clear up the problem and yet what I

have just told you to do is 99% of parenting.

Millions of parents, every day go about constructing a future for their

children, and the only guidelines they have is what the love in their

hearts tells them and what feels wholesome and right.

To believe in yourself, to follow your heart and to only do what feels

wholesome are real concepts and with the help of the Map, the only

tools you need to get where you want to be.

You again have to be your own parent, both the inner child and the

outer parent.

Keeping with the parent child theme an example in real life of this

place would be the difference between good parenting and bad


A good parent would lead their child to the bridge, away from bad

influences, a good parent, without knowing what the future holds for

their child has faith that they are equipping their child with all that he

or she will need to cross the bridge safely to the future.

Bad parenting would allow their child to drift in the boat from one

bad influence to another, possibly because neither parent or child

realise that a bridge to the future exists.

Earlier I spoke of the first four pictures or places where we can find

ourselves, form a cycle or a circle, though we haven’t yet described the

other two places I would like now to touch on what that circle is, the

reason being that it is this place where the circle can be broken.

As we will see further on, the two top pictures represent places where

you have value, that is, places where you value yourself and others

value you.

If you take the bridge you are valuing yourself, this may mean taking a

course, learning a trade, trying your luck in a new place, whatever it is

that you do it is something that feels wholesome for you, you are

developing your creativity for you despite what others may say, I add

despite what others may say because there always seems to be someone

who given the chance would exert their influence over you for their


Not valuing yourself is very common, though you wouldn’t get to this

place and consciously say to yourself “I have no value” the fact that the

real creative you has never had a chance to emerge is likely to make

you feel you are not capable of crossing that long bridge so you decide

to take the boat and drift along straight back into the cycle or circle

taking you to the next place we shall discuss.

Key concepts for this place.

Decisions made by what feels wholesome

Construct your future

Freedom to be you

Influence and influencer

Valuing yourself

Not valuing yourself

Listening to what your heart tells you

Believe in yourself

Lies, Powerless, Drifting.

Here is the source of the current of influence, the rock to the left, to

the bottom right is a break in the border, the entrance through which

the current will bring you if you took the decision to get in the boat.

The current takes you off into a misty swamp, a marshland where the

mist hides the truth and the many winding channels hide the real

direction you are going .

To the middle of the picture there is another break in the border, this

is the entrance to the last picture in this cycle or circle.

If you live on a desert island, completely self sufficient, only then you

will not find yourself here.

This is the place people in power, represented by the rock, manipulate

the rest of us to live to a constraint that will keep them in power.

I am not just describing dictators, terrorists, bullies and wife beaters

they are obvious power hungry influencers.

The sayings, “kept in the dark” or “taken for a ride” describe this


To be taken for a ride requires an influencer and an ‘influenced’

In real life this can be something mildly annoying like trying to get

your money back for faulty goods or services from a faceless

impenetrable bureaucracy, ranging through to life destroying incidents

like debtors hounded to the point of suicide.

In this place it not just that an act or situation is being imposed on you

it is you allowing it to be imposed by sitting in the boat going with the

flow that is controlled by your influencer, you know something is

wrong but you cant quite put your finger on what that is, this is

because with all the twists and turns of the channels in the swamp you

end up with no idea where you are, or where you stand, and if you

look for the truth all you find is a thick mist that hides it.

In the previous place I spoke of following your heart and only doing

what feels wholesome, how many times have you thought “I knew

there was something not right about that” but didn’t take any action?

Well that is what believing in yourself is all about, believing in those


The usefulness of this picture, of seeing this place , is that instead of

going down the downward spiral in the next place, the last place of this

cycle, after the second or third unanswered call, the second or third

excuse, the first couple of attempts at manipulating you, the reaction

that makes you think your not valued or just the feeling that

something is wrong, then look at the this place and ask yourself are

you drifting through a misty marshland of lies, do they have all the

power in this situation?

If they do then it is time to get out of that boat, step into the sticky

mud and sum up all your strength to walk, step by step, back to the

bridge, away from the influencer.

In real life it will mean you saying to yourself “ I have had enough of

the truth being hidden, of not being valued, of not treading my own

path, of going with your flow, your direction, for your benefit”

As in real life, it is not that simple, do you know the difference between

wishful thinking and your heart’s intuition and are you just being

paranoid and fearful that the ‘they’ have all the power?

With an understanding of this place in some situations its so obvious

that you are in the marshlands, in other situations it is all far more

subtle .

The truth is that we have all been in this misty marshland of lies as the

victim, the influenced, and also we have all at some time been the


The way to tell if you are being paranoid or just wishfully thinking

somehow everything will turn out for the best is to honestly ask

yourself are you , or do you aim to be, the influencer?

In the previous place I spoke of constructing your future, is the

influencer not constructing their future, of course they are, so what is

the difference?

The difference lies in the intention. To return to the parent child

analogy, every parent is capable of being an influencer, the parent

holds the power in a parent child relationship.

As an example a child comes home from school exhausted, the parent

notices the child’s tiredness and sends them to bed early, this is a

parent on the bridge leading their child to the future, the parent’s

intention is wholesome. On the other hand a parent sending their

child to bed early because the parent wants to have some grown up

time is being the influencer. (child “but why?” parent “because I say

so!”) the intention is one of benefiting the influencer.

Another example can be found in politics, many go into politics to be

influencers with the intent to use the marshland of lies to gain wealth

and exert power, but on the bridge a few honest souls in politics have

the intent to make sure that bridge to the future is well maintained for


In life we all have to get stuck in, earn a living , bring up children and

every day we interact and relate with others, make choices about who

to trust and invest in that trust. A good term of reference when we are

deciding who to trust is to step back and ask ourselves are they

showing us our way on the bridge to our future for our benefit or are

they pulling us along through the marshland for their benefit?

Is your doctor a healer or a businessman/woman? Is your boss a

provider/facilitator or an influencer, does a significant other care or

do they manipulate, the difference will always be their intention.

It is hard sometimes not to be the influencer, was my website designed

to influence you into buying this PDF? Do you now feel like I am

pulling you through the marshland of lies?

Well I will tell you that what you have paid for is a lifetime of my life

experience and over ten years thought and my intention is that we can

all have a better life in this exchange.

The website and this PDF were both designed with the intention to not

be an influencer and yet promote, sell and deliver a concept.

Or am I lying??

Sorry I don’t want to confuse you, taking you one direction and then

another but I wanted to make the point that truth is what you feel it to

be not just what others tell you, what feels wholesome is your guide, it

is your guide to the truth and your guide to your path. And, if you can

believe me, this whole project feels wholesome for me.

So are you being over sensitive or paranoid? Well first I can tell you

the difference between wishful thinking and intuition, intuition more

often than not tells you what the bad things are, where as wishful

thinking only tells you what you want to hear, also intuition is felt in

the body, wishful thinking is just made up thoughts in the head, fun

but meaningless.

Now have you just read all this and think you are being paranoid

about people having power over you? Well forget what you think, take

more notice of what you feel and if you feel you are in this place then

you probably are, whether you are paranoid or not you will be right,

you will always be right, whether you are right or wrong you will

always be right, because if you were wrong it was right for you to be

wrong because you had a lesson to learn.

You are not alone, we all have lessons to learn.

Key concepts for this place.

being influenced

having no direction

not being valued

being conned


giving up your power

a test for your intuition


Downward Spiral, Pain, The End.

This is the place where wishful thinking has been smashed.

Where the awful truth that the lies were hiding has been uncovered.

Or the realisation of loss.

From any part of the map we can find ourselves at the bottom of the

spiral staircase in a second, it could be a phone call, an act of nature,

an accident or an act of malice. One moment everything is or appears

to be (depending on where you are on the map) fine, the next moment,

that piece of truth, that earthquake, that landslide, that road accident

and you are here.

So there are two ways to this place, the instant calamity or the slow

progress through the marshland to the edge and then metaphorically

pushed down the steps by your influencer.

As there is not a lot we can do about the instant calamity let us take a

look at the area we can do something about and that is the influencer.

Here there is the base of the rock , the power, the influencer, and next

to it is a slimy dripping spiral staircase, in fact it is a one way staircase

going down!

The influencer is very powerful, very solid and immovable but it has

one vulnerability, the moment you touch it the influencer’s power

dissolves so it will fight to the end to prevent you touching it.

The closer you get to the influencer the closer you will get to being

thrown away down the stairs.

There are some rare exceptions, some tenacious souls have found a

way through the marshlands above and instead of arriving here have

managed to touch and destroy the influencer.

The 1970s era Pulitzer prize journalists Woodward and Bernstein are

a good example of the exception. Their fight to discover the truth led

to the forced resignation of the then USA President Nixon. For more

information ‘google’ Watergate or/and Woodward and Bernstein

But for most of us we neither have the strength or the resources to

‘touch’ our influencers. It would have been better to have turned your

back on the influencer in the marshland but for what ever reason you

believed your influencer, blindly ran towards the influencer with open

arms but just before you were able to embrace your influencer you

found yourself at the bottom of the spiral staircase.

An example of arriving here would be the first an unsuspecting spouse

finds out there is something wrong with their marriage is that

moment of horror and disbelief when out of the blue they receive the

divorce papers!

Jimi Hendrix’s ‘Castles Made of Sand’ tells of a girl about to commit


‘There was a young girl, who’s heart was a frown

Cause she was crippled for life,

And she couldn’t speak a sound

And she wished and prayed she could stop living,

So she decided to die

She drew her wheelchair to the edge of the shore

And to her legs she smiled you wont hurt me no more

But then a sight she’d never seen made her jump and say

Look a golden winged ship is passing my way

And it really didn’t have to stop, it just kept on going…

And so castles made of sand slips into the sea, eventually’

We don’t know if the ‘golden winged ship’ cured her or if it was

symbolic of her being taken to heaven.

For a discussion on the meaning of these lyrics see ­

I believe that the castle she had built out of sand was the plan to

commit suicide, I believe Hendrix meant when he said

‘But then a sight she’d never seen made her jump and say

Look a golden winged ship is passing my way’

was that in her moment of despair she saw something beautiful.

I don’t believe she was cured physically, golden winged ships don’t

exist, I do believe Hendrix meant emotionally, in a moment, the

cripple girl saw the beauty of life, saw, despite her disabilities that

there was value in her being and symbolically the sight she saw

washed the despair away from her heart.

The golden winged ship didn’t stop and neither did her disability, all

that changed was a shift in her outlook on life.

I mention the cripple girl to try to to paint a picture of the despair that

one can feel here, this is the place that people consider suicide as an

option to escape this place, people who have committed suicide have

felt this is the only option here but they were wrong.

A couple of times I have spoken of both being the parent and the child

and parenting the child within you, conversely here it is possible to be

both the influenced and your influencer. If you are telling yourself

suicide is the way out of this place then you are trying to influence

yourself, pulling yourself through a marshland of lies, hiding the real

truth in a mist of emotional despair.

Here is the end of the four picture cycle, NOT the end of your life.

Below is the url for listings of helplines and centres throughout the

world helping those considering suicide or suffering with depression

From here as the initial shock turns to numbness you arrive at the

bottom of the metal stairs where we started, the place of loss and

emptiness, the place of broken dreams but most importantly the place

of New Beginnings .

And so we complete the lower cycle or circle that you may be in for the

first time or may be back in again and again.

Life in this cycle is hard and sometimes painful but there are two other

places to be in on this map away from this vicious circle of pain, loss,

having no direction or value, lets return to the bridge to the future

and decide to never get in that boat again, and walk our own path on

the bridge to the future, to the next place on the Map.

Key concepts for this place.

Shock realisation of loss and finality

getting too close to the influencer

thoughts of suicide

the end of something for you

the end of the cycle

Letting Go, Forgiveness, Closure

After a hard long walk, along the bridge to the future you will arrive

at this place.

As I said before in real life you may have been trying your luck in a

different area, doing a course, learning a skill or trade or maybe you

remained living in the same place, staying at the same job, keeping the

same social circle but importantly made small wholesome changes to

your life, your changes for you.

There is a misconception about ‘living life to the full’, when I hear that

phrase it is usually describing someone with lots of money who is

spending it unsustainably on short term pleasure.

To really live life to the full you have to create. You have to invest in

your creativity to live life to the full sustainably. Developing our

creativity is how we develop our personal growth and how we can

value ourselves and how others can value us.

It doesn’t matter what you do all that matters is that you do

something, something that feels wholesome. Wholesome doesn’t mean

it has to be safe and boring, it just means that it metaphorically tastes

good and is nourishing, or to use another phrase, it doesn’t leave a bad

taste in your mouth! You don’t even have to be good at what you do

you just have to do it and enjoy it.

To have reached this point you will have been developing your

creativity and will value yourself but to carry on your path to the

future in sight you will benefit by a short stop at this place.

You have come a long way, now you can see the end of the bridge, just

past the bridge is a path that goes through a valley between the fertile

hills ahead, a path to walk to turn a good future into a good present.

But before the end of the bridge we can see an island with a faint path

going down to the water,’s edge, you need to walk that path before

getting to your future.

If you used the Map to get here, most probably you will still be

carrying some of the darker past with you, short of being given a

lobotomy there is no way to delete the past from your memory, even if

we could we would also delete those hard learned lessons which we

certainly do not want to do.

From here on your life, or your input into your life, should be balanced

and informed, we have to discard any influence from the past that will

confuse or put you off balance.

So what exactly are we going to do?

To help define something vague it helps to look at what its opposite is,

the opposite to this place is getting revenge! A past incident has so

taken over your thoughts and emotions that you want someone to pay

and you will do anything to make them pay, your mission in life is to

make them pay, there was an incident, you were the influenced they

were the influencer and now you want revenge by turning the tables, if

not in reality, certainly in your mind, day in day out you scheme. But

take a look at the map, do you really want to become the influencer?

Forever stuck solidly in the ground in a place of pain and suffering,

looking out over a swamp?

We don’t want to remove the memories, we don’t want to remove the

lessons learnt but we do want to remove the angst that the memories


Closure, letting go, and forgiveness are all about closing the book of

the past releasing the angst, lightening the load so life can move on, but

how is it done?

When doing research for the Map the image for letting go most used

on the internet was a pretty girl with her arms outstretched and a dove

or butterfly flying away, for forgiveness there was mostly religious

themes and for closure there didn’t seem to be anything helpful.

Everything here in the map is from my experience of travelling with

the map, I have experienced religious forgiveness which worked great

but didn’t last because I lost faith in the religion, having said that if

you are of a religion that embraces forgiveness I thoroughly

recommend you discuss it with them.

I am not sure there is a difference between closure and letting go, but

for me the image for closure and letting go would be dancing at a


I didn’t add a ‘raving’ image because it was too specific to me but

that is how I achieved letting go and closure. I danced out my angst.

I would let the thoughts come and go, let the feelings flow over me, let

the rhythm move my body.

As I danced through the night, in my mind, my past was replayed,

sadness, happiness, regrets, pain, guilt, lost love, hate evaporating in

the heat and sweat and sound.

Dancing through the night, dancing out of my own darkness into the

light of a new dawn.

I give this example to show that the concepts of forgiveness, closure

and letting go are very real things and are not just intangible mumbo


I mentioned earlier I didn’t think there was a difference between

letting go and closure but I do believe there is a difference between

forgiveness and the other two, for example the parents of a child gone

missing, for them closure and letting go may mean the abandonment

of the child, something they could never think of doing, but forgiveness

is something they could consider to help them move on with their lives

while at the same time not abandoning hope for the return their

missing child.

At times the map has surprised me with its truth, when I was writing

the description of the previous place I realised that this place is the

place of a controversial practise, legal in some countries, and a

practise I have no views on worth writing but this place is also the

place of assisted suicide.

The dying patient of sound mind and balanced emotion who wants to

take control of their inevitable death, to save themselves maybe a

month or two of intense pain, tie up any loose ends and say goodbye to

their families, and importantly to facilitate forgiveness, letting go and

closure for their informed family.

As in all places within the map, your particular circumstances will

dictate your particular actions that need to be taken, you will have to

find your own way down the path to the water’s edge to forgive , to let

go and get closure.

Key concepts for this place.

Keeping the memory, removing the angst

Letting go



Seeing the beauty in Life

This is the place to be, if you have arrived here then you have arrived

at your future . Its not an exotic holiday destination, no money in the

world can buy this place, neither is it an unattainable dream world,

this place is in your back yard, in a smile in a kind word.

This is not really a place as the others are its more a level of personal

development .

To get here takes hard work, I cannot tell you what your future holds

for you but its all there behind those green hills, at the end of the

bridge along that path through the valley, this place is the other side of

the green hills, think of it as weekend away from day to day living that

takes place behind those hills, there you are sat under the tree

watching the sunrise.

This place in reality may be the exact same place you were living when

you were in the misty marsh or climbing your way step by step out of

your emptiness, the difference is now you can see beauty in the life

around you.

If you can feel the beauty , and I don’t mean to intellectually see

something could be seen as beautiful, I mean actually feel it, to be

actually touched by its beauty, then you have learned how not to be


And if you have learned how to not be unhappy, you live in the potential

to be happy at every opportunity life can give you.

Key concept for this place.

To have the ability to see and feel the beauty in life.

How to Use the Map as a Map.

As an example as to how to use the map I thought it would be

interesting to type into my search engine ‘the most asked question

ever’ and use whatever came up here, the first question that seemed

mildly usable was ‘what is the meaning of life?’

Hmmm I thought, if the map can tell us that then maybe I should up

the price a few euros!!

So I put some music on and sat looking at the map asking it to tell me

what the meaning of life is.

The map is about all the places in life we can find ourselves, the dark

places as well as the light places with all the shades of grey between, as

I looked at the map it became obvious that the meaning of life is that

you and me actually have one, a life that is.

In fact its the wrong question, the real question is does life have

meaning? For me looking at the map now, in some places on the map

one could really be forgiven for thinking ‘my life has no meaning’ but

those places are transitional, even if in real life you can see no way out

from those places the map shows there is a path away that finally leads

to the top left hand place, sitting under the tree marvelling at the

beauty of the sunrise. I guess another way to put it is that the meaning

of life is living life through the ups and the downs until you get to the

point where you can see the beauty in life, at which point the meaning

of life is irrelevant, just a silly question you have no need of asking.

This isn’t the best example of how the map was designed to be used but

it is what life gave me to work with as opposed to me picking a subject

that I may be biased towards. So how did the map tell me the answer I

have given? Very simply, within the question ‘what is the meaning of

life?’ my mind immediately jumped to the thought that it would only

be the influencer, possibly a harsh dictator who would act as if life had

no meaning (everyone else’s life that is). As we know the influencer is

only out to get what it can from us to sustain it and never tells the

truth, therefore the real truth must be in ‘normal life’, life itself has

value and meaning.

Coming to the conclusion life does have meaning how did the map

define that meaning?

The whole map is about carrying on living through life’s adversities to

achieve the potential of happiness from which I deduced the meaning

of life is simply just to live.

Then I pictured myself seeing and feeling the beauty of life and it just

seemed that having achieved that joy the question itself would be

completely irrelevant.

As I said the above is not the best of examples so, though of course

biased towards the workings of the map, here is another example

which shows the strengths and the weakness of the Map.

Whether you are single, a parent, an adult or a child the next example

will be easy to understand.

Your child comes home from school, clothes torn, in tears and runs

straight to his or her room and locks the bedroom door. You stand

outside calling them until eventually they let you in, you eventually

find out they have been suffering for weeks at school being bullied

which has ended up with them being roughed up.

Probably your first reaction is one of anger, so if we take a look at the

place for anger on the map what do we see? Ooops there is no place for

anger on the map!!

Metaphorically and in reality there is no place for anger on the Map.

That is not to say you will not be angry in any of the places on the

map, what has to be understood is that to use the map one needs some

degree of rationality, and anger is not the best place to make the

rational decisions you need to make.

So a couple of hours later the shock has gone and you realise

something has to be done so you look at the map to see where your

child could be on the map to help them deal with this problem. Ooops

cant be done, the first rule of this type of map reading is it is only for


This highlights a problem in the way we live and a weakness in the

Map. I do not believe children would have any problem understanding

and using the Map, their problem is that they are more or less

completely powerless to change anything.

It would empower a child if the parent or significant other sat down

with the child and the map and really listened to the child when they

pointed out where they felt they were on the map and why . In this case

the parent or significant other would act as a facilitator to empower

the child’s decision making.

For any children or young adults reading this who feel in need for

some outside help at the bottom of this link is in alphabetical order

worldwide child lines, for example just click ‘U’ to take you to a

selection of UK child line help centres.

So to return to our example, to sum up, you know the map is only

about you, you know the situation is effecting you and your family and

you know you have to do something to sort out the situation.

You look at the Map and it dose not take long to realise the pain you

feel is being inflicted by the bully, the influencer. You may feel you are

in the marshland or you may feel you are about to be pushed down the

downward spiral stairs or maybe you feel you are at the bottom of the

stairs either way it becomes obvious that it is the influencer who has

taken control.

Now in reality what we have here is a mass of complicated inter

relationships going on, there is the bully, why do they bully? Why did

they pick on your child? Will action make it worse? Will the

authorities help? Will the authorities themselves try to take you

through the marshlands? Does the bully need a stronger force to

control them as in punishing, if so what would that be?

If you think like this then your brain will probably explode and you

will be no use to anyone!!!!

Look at the map, for this example’s sake we will say you feel you are

just about to be pushed down the downward spiral.

When you hand your child to the school they have the responsibility to

take reasonable care of your child, you have to trust this is the case.

I’m afraid if the authorities knew how to deal with bullying there

wouldn’t be any bullying, as we know this is not the case.

So you look at the map, the influencer has all the power and you are

about to be pushed down the downward spiral, what do you do?

You have two choices, touch the influencer to destroy them, remember

the influencer is stuck in the worse place on the map looking out over a

swamp, maybe it would be possible to touch them (the opposite to

punishing), to touch their heart to destroy the influencer inside of the

them. The second choice is to get out of the boat and into the sticky

mud and with great effort step by step carry your child back to the


The boat represents the trust you put in the school authorities who

have let you down. Carrying your child back to the bridge would be

representative of putting your child in a better run school.

I am not suggesting you need the map to have made the decision to

change schools. I am not suggesting you invite the bully round for tea,

I am not suggesting changing schools would be easy or in fact even be

the answer.

The real answer could only be found if it was a real situation you were

really in, only you would know the full facts and how you felt, and of

how it effected you.

What I am trying to show is that the map would have an answer to

your problem.

Your problem solved would solve your child’s problem.

This example raises a question, am I suggesting running away is

always the answer? You may be asking are there not times one has to

just stay, stand up for ourselves, show a bit of back bone, show a bit of

strength, stop feeling sorry for ourselves and just get on with it?

Of course I am not saying running away is always the answer, but I am

saying its better to run towards a better future than it is to be stuck in

an unfulfilled past.

Admittedly standing up to the influencer from the beginning may have

solved a future problem but the Map is for all those times in your life

you just don’t have the necessary resources to do that.

Reading the map is simple, intuitive, bring your question to the map

honestly, locate your present place in whatever the problem you have,

once you know where you are then you can plan your way forward,

knowing where you are is the second rule of this type of map reading

(the first being it is only for you, it is not possible to read the map for

someone else)

Honestly locating where you are is the key to success with the map,

and is the most difficult part of reading the map, if the truth is you

have got where you are through something you are not proud of it will

not help you to hide this from yourself, for example possibly you tried

but failed to exert your control over others which has left you feeling

no one likes you when in fact it is just that the others really don’t want

to be controlled.

Sometimes your problem will be because you were the influencer,

sometimes it will be guilt telling you that you were the influencer when

the real truth is you had no choice.

If you are honest with yourself (which is why you cannot read the map

for some one else) the map will help you make the next move.

After reading this you will have a ‘flavour’ of each place just relax and

look at the map, sometimes an answer will be automatic, other times

you may want a week or so to think about your situation on the map,

let your mind and heart ‘jam’ (as in jazz) with the map and see where

it takes you, you can’t really go wrong.

Good Luck

I wish you a wonderfully wholesome future.

Steve Dove

Creative Commons License
The Map by Steve Dove is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.


Marsha M. Linehan works with seriously suicidal people, having faced the same struggles when she was younger.


Expert on Mental Illness Reveals Her Own Fight


Published: June 23, 2011

Marsha M. Linehan works with seriously suicidal people, having faced the same struggles when she was younger.


may 13 2006

i am doing prettywell since i got out of the hospital…i am not depressed or suicidal…but my anxiety is still very high…i finally will see my psychiatrist on monday…i am hoping he can do something to help me…i have been very bored lately and need to find something constructive to do with my free time…i miss my children very much and i am working hard to try to get them back…my son is still having a hard time…but the baby starting walking…she is doing well…and the other 2 r doing great…my husband and i are doing better…and we might be getting housing…my brother has been out of jail for almost 3 weeks he has been in california but he is coming back to mass…my husband and i are going to mass for a few days on the 22nd…we are getting a new car from my mom…i got into my first car accident last week but it was nothing…but anyways that is the update on everything i think i didnt leave anything out if i did owell i will add it later… take care everyone

Read more:

Psychotropic Drug Abuse in Foster Care Costs Government Billions


Psychotropic Drug Abuse in Foster Care Costs Government Billions

Seven-year-old Gabriel Meyers didn’t want soup for lunch one Thursday in April, 2009. When his 23-year-old foster brother sent Gabriel to his room for dumping his soup in the trash, Gabriel threatened to kill himself. He kicked his toys around his room, then locked himself in the bathroom.

Police reports say Gabriel was home sick that day from his elementary school in Margate, Florida, under the care of Miguel Gould, his foster father’s son. Around 1 p.m., city police responded to Gould’s frantic 911 call and found Gabriel had hanged himself.

A troubled child who had previously suffered from neglect, sexual assault and abusive parenting, Gabriel spent the previous year shuttling among several foster parents while taking a constellation of anti-psychotic medicines, including Lexapro and Vyvanse, to control his depression and attention deficit hyperactivity disorder. Like most children in Florida foster care, Medicaid paid Gabriel’s medical expenses.

Just one month before his suicide, Gabriel’s doctor prescribed him Symbyax, an anti-depressant restricted for treatment of children. The medication’s FDA-required label features a warning that use of the drug by children or teenagers can lead to suicide.

Symbyax does not meet criteria established by Congress for Medicaid reimbursement, so it is illegal for Medicaid to pay for a prescription of the drug to a child. Sohail Punjwani, the doctor who prescribed Symbyax for Gabriel, received a stern letter from the FDA about his history of over-prescribing mental health drugs.

According to a number of foster care experts who spoke with Politics Daily, children in foster care, who are typically concurrently enrolled in Medicaid, are three or four more times as likely to be on psychotropic medications than other children on Medicaid. Alarmingly, many of these drugs are medically prohibited for minors and dangerous to the children taking them. Often young patients under state supervision are also prescribed three or four high-risk drugs at a time — all paid for by Medicaid.

State foster care programs and child protective services have had mixed success addressing the pervasiveness of dosing their clients with prescription psychotropic drugs. Using federal Medicaid money to purchase dangerous prohibited prescriptions for children, which cost the government up to $600 per dose, is technically a violation of the law.

Now, the Senate Subcommittee on Federal Financial Management, chaired by Sen. Tom Carper (D-Del.), has asked the Government Accountability Office to look into the drugging of foster care children. The investigators will attempt to account for estimates in the hundreds of millions of dollars of possible fraud arising from prescriptions for drugs explicitly barred from Medicaid coverage. The GAO is collecting data from Oregon, Massachusetts, Florida, Maryland, Minnesota and Texas, to search for patterns of abuse. This effort marks the first time suspicion of Medicaid fraud related to psychotropic drugs has been examined at the federal level. According to Senate staffers working on the investigation, the committee will likely hold hearings on the matter later this year.

Psychotropic medications act on the central nervous system and alter brain function, mood and consciousness. The GAO investigation is chiefly focused on anti-depressants, widely used in foster care in dangerous combinations, and for so-called “off-label” uses to treat symptoms for which they have not been medically approved. Anti-psychotic medications have been a factor in a number of children’s deaths.

Statistics on psychotropic drugs in foster care have until now come out in scattered reports, mostly from investigations of foster care failures by individual states. For example, in 2003 a Florida Statewide Advocacy Council study found that 55 percent of Florida’s foster children were being administered psychotropic medications. Forty percent of them had no record of a psychiatric evaluation. Another Florida report also indicated anti-psychotic medication use increased an astonishing 528 percent from 2000 to 2005.

A Texas state study in 2004 revealed that 34.7 percent of Texas foster children were prescribed at least one anti-psychotic drug — and 174 children aged 6-12 in the care of the state were taking five or more psychotropic medications at once.

Last April, an investigation by the Atlanta Journal-Constitution exposed several companies operating foster care homes in Georgia repeatedly used anti-psychotic medications to “subdue” children in their care. Despite being cited repeatedly, none of the agencies were fined more than $500.

According to child care experts and assessments by both advocacy groups and state government agencies, many states lack efficient records management and adequate oversight of foster care, contributing to a pervasive lack of medical continuity for the children. Social workers have oversized caseloads of foster children, who are often shunted between families and prescribed anti-psychotics from doctors unfamiliar with their medical histories. Without a case history, experts and foster care alumni say, doctors are more likely to add medications than take them away, resulting in record numbers of children dispensed several anti-psychotic medications at once. In many cases, the drugs are prescribed off-label to youngsters with behavior problems.

Julie Zito is a professor of pharmacology at the University of Maryland who conducted a 2008 study of the Texas foster care system that found 41 percent of the children prescribed psychotropic drugs received three or more different medications. She told Politics Daily what little research has been done suggests children in foster families are rarely assessed properly, a failure leading to serious effects. There has been no research on multiple-drug regimens, Professor Zito explained, and “blitzes” of medication have become a pervasive way of dealing with behavior problems in foster care. “We’ve expanded the medication practice in response to children not getting better,” she said, and children who fail to improve, “are getting more medication.”

Pharmaceutical companies manufacturing psychotropic drugs have played a major role in encouraging their increased use on foster care clients. Drug companies participate in aggressive marketing, conduct misleading research about efficacy and safety, and in some cases, “bribe” psychiatrists to prescribe their drugs, according to Zito and Jim Gottstein, an Alaska lawyer and founder of the Law Project for Psychiatric Rights, who has mounted several lawsuits against pharmaceutical corporations.

For example, last year the St. Petersburg Times reported that a psychiatrist in Jacksonville, Florida, was paid for speaking engagements to encourage her to prescribe Seroquel, a drug used to treat bipolar disorder and schizophrenia, and a neurologist in Tampa received free trips to Spain and Scotland from AstraZeneca, the drug’s British manufacturer, for her innumerable prescriptions of the drug for headaches. Seroquel is the top-selling anti-psychotic drug in the United States, with more than $4 billion per year in worldwide sales. AstraZeneca recently paid $520 million to settle lawsuits — some brought by doctors who had been offered swag in exchange for prescriptions — over its illegal promotion of off-label uses for Seroquel.

According to Jim Gottstein, the increase of anti-psychotic use in foster care amounts to “drug companies sacrificing children’s lives on the altar of corporate profits.” Gottstein recently filed a citizen’s suit on behalf of the state of Alaska against several doctors, drug companies and insurance companies, claiming that they knowingly promoted Medicaid fraud.

Reform Attempts

In response to the devastating study of the Texas system in 2004, that state’s top health agency introduced a new set of guidelines stressing specific treatment goals for medication and “informed consent” of parents and guardians. That effort led to decreased use of psychotropic drugs relative to the number of children enrolled in foster care from 2002 to 2009, according to data from the Texas Health and Human Services Commission.

In May 2005, Florida expanded foster parents’ rights to reject psychotropic treatment for the children in their care. Four years later, however, a review found that the new requirements were being flauted, and the panel that investigated Gabriel Meyers’ suicide concluded that every level of the Florida system had missed “warning signs” that Gabriel’s care was inadequate. Thirteen percent of Florida foster children were on one or more psychotropic drug, and 16 percent of those were not approved by parents or guardians.

In 2008, Rep. Jim McDermott (D-Wash.), the only psychiatrist in Congress, introduced a bill titled Invest in KIDS Act, which included stronger oversight for prescription medications in foster care. McDermott held a hearing on the use of psychotropic drugs in foster care, but the bill died in committee. Near the end of George W. Bush’s second term, Congress passed a law, co-sponsored by McDermott, that included increased oversight for “mental health” in foster care, but did not specifically mention psychotropic drugs.

“Some children in foster care may need and benefit from psychotropic medication,” McDermott told Politics Daily. “But these drugs should not be used as a shortcut to treat foster children when more effective treatments, including counseling, might provide long-term benefits.”

Federal and state agencies have pursued drug companies that illegally market their drugs for off-label uses, a practice that experts say heavily contributes to the overuse of psychotropic drugs in foster care.

Last year, a Justice Department action against Pfizer led to a $2.3 billion settlement, the largest in the department’s history. Companies convicted of major health fraud are barred from participating in Medicaid and Medicare. But worrying that a conviction would cause Pfizer to fail and cost its employees their jobs, the government allowed Pfizer’s shell company, which exists solely to plead guilty in lawsuits, to be charged instead, and the drug company paid a fine. Pfizer maintains that it did not break the law.

In 2006, The New York Times obtained a batch of internal documents that showed Eli Lilly, the maker of Zyprexa, a medication approved exclusively for treating the severe mental illnesses of schizophrenia and bi-polar disorder, was suppressing information on the drug’s harmful side effects and advertising it illegally. Lilly paid $62 million to settle lawsuits with 32 states and the District of Columbia, and agreed to ensure that its marketing complied with the law.

How to Fix It

The problems that lead to drug abuse in foster care are complex and deeply entrenched, but activists and advocates have proposed a number of solutions for limiting the overuse of anti-psychotics. Foster care experts, including a current task force of the American Academy of Pediatrics, believe that getting foster children a “medical home” — one physician who manages their care over the long term and has access to relevant records — would reduce the overprescription of psychotropic medications.

“Having a drug to take the edge off the pain and fear and sadness saved my life a time or two, but it’s not a lifestyle.” said Misty Stenslie, a former foster child who is currently the deputy director of Foster Care Alumni of America. Children under the protection of government agencies deserve the assurance of safe and decent health care. Especially, as Stenslie points out, “We can’t give kids what they really need, and that’s a family and love.”


Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book


English: Arnold's appraisal theory of emotion
English: Arnold’s appraisal theory of emotion (Photo credit: Wikipedia)


Applying Learning Principles to Thought: Cognitive Restructuring – Psychological Self-Tools – Online Self-Help Book


Cognitive Restructuring (sometimes known as “reframing”) is essentially the core technique from cognitive behavioral therapy, a highly regarded, scientifically validated psychotherapy format. The technique is designed to help you alter your habitual appraisal habits so that they can become less biased in nature and you less moody. You alter your appraisal habits by becoming aware of them as they occur, and then criticizing and critiquing them. Usually there is no logical or rational basis for your appraisal bias. When you really examine your judgments carefully, looking for evidence to support them, you find that there is none. You are then in a position to form a new, more accurate appraisal.


Appraisal habits cannot be manipulated directly, but the thoughts that carry them can be. The first task in cognitive restructuring is thus self-monitoring; learning to become more aware of your thought behaviors. Habitual appraisal habits are not conscious things, and neither are the thoughts that carry them. In addition to the thoughts you are conscious of having, there are also all manner of unconscious automatic thoughts which flit through your mind without you noticing. Automatic thoughts are not inherently unconscious; they are just so common that you’ve habituated to them and no longer notice them.


You become more conscious of your automatic thoughts by self-monitoring. We don’t want to count thoughts, however, so much as we want to record them. A good way to do this is to write down all the thoughts that occur to you shortly after some event has occurred that causes you to feel bad.


Automatic thoughts are often situation specific instances of more core fixed beliefs about yourself and the world. While automatic thoughts reflects your reaction to a given event, core beliefs describes your general expectations and identity. For example, if you have recently done poorly on a test, your automatic thought will probably reflect your situation, “I’m so embarrassed! I should have done better!” , while your core belief might reflect a deeper fear: “I’m a stupid person!” Core beliefs influence appraisals, and thus are a major source of bias. They are not always obvious or conscious. The way to identify them is to examine multiple instances of your automatic thoughts over time for the repetitive themes that underlie them. You will likely be able to distill some of your core beliefs by examining your self-monitoring thought records, and by asking yourself the question, “Why am I reacting this way?”.


Writing down your automatic thoughts and core beliefs makes it easier for you to get a handle on them; to view them from an outsider’s perspective rather than your own. When you actually get to look at what you are thinking and believing, you may find that your thoughts and beliefs are inaccurate, incorrect or irrational, and that with a little work you can correct them so that they better reflect “reality”; the shared social consensus.