It's common knowledge. It's accepted widely among both clinical and medical circles. It's a part of treatment and recovery. The notion that alcoholism is a disease. 

In working with individuals struggling with alcoholism, I've heard the disease statement many, many times. In some instances it served a positive purpose, providing certainty and direction; in others it served a negative purpose by empowering the addiction and undercutting self-efficacy. There has always been something that doesn't sit well with me regarding the disease approach. For my therapeutic approach to addiction, click here.

The word “disease” has a medical connotation. You have a disease, you see a medical doctor, go to a hospital, have a treatment possibly with medication. That's the association that I make, maybe I'm in the minority. In many cases, a disease suggests that the condition was something out of your control. Diabetes, cancer, multiple sclerosis. In some cases, there is little to no control, in others our choices have made them uncontrollable.

A major hurdle for the field of psychology is feeling inferior to the field of medicine. The former is a social, pseudo-science; the latter a legitimate, biological science. In a grasp for legitimacy, research has rapidly become the norm in psychology. Scientific terms like “evidenced-based”, “empirically-supported”, and “etiology” are commonplace. Research certainly is not a bad thing (even though it can be fallible), many advances have come from research. However, has the drive for legitimacy and respect had a negative impact on psychology?

Why does any of this matter? Great question. A major part of treatment is based on how a condition is conceptualized. In the case of alcoholism, my concern is the use of “disease” takes away from the social and psychological contributing factors. I'm not ignoring decades of research that give credence to genetic and biological factors of alcoholism. However, I believe alcoholism grows out of a combination of social and psychological issues to become a serious condition often requiring medical intervention.

In graduate school, a professor argued feelings weren't social, biological, or emotional. They were chemical. The release of a specific neurotransmitter. It's hard to argue that point, and you can make a parallel argument for the underlying factors of alcoholism (or most any condition, disease, or disorder for that matter). Bias to my training, in most cases I lean psychological. Even when the presentation is medical, I focus on the psychological variables. I am encouraging other clinicians to shift their perspective. If you aren't convinced, then consider conceptualizing alcoholism as a social or brain disease.

To be clear, I'm not advocating that society, clinicians, or friends and family should be more critical and harsh to those struggling with alcoholism. I'm suggesting the term “disease” can minimize personal factors and increase the belief that since it's a disease it is out of a person's control. I'm not saying this is the majority belief, but it does exist. I hope this post has brought a different perspective to a condition that has impacted millions.


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Is it okay that my child at times verbally punishes his stuffed animals?

--Anonymous November 2014

This is the type of behavior I see in play therapy. Play therapy allows for access into a child's mind through their play. Kids usually don't sit in a chair and tell you how they feel about themselves, their family, or the world. This is where a child's play can be informative. A child's play is usually a projection of what they are thinking and feeling.

So in this instance of punishing a stuffed animal, I would look for a few things. Is the punishment justified, did the animal do something to be punished? If he is dishing out punishments for no reason, that's one thing, but if the toy animal did something worthy of reprimand, then that can be a healthy thing. He's coming full circle in the latter case. He was playing with the stuffed animal, it did something wrong, and he's implementing a punishment to curb the behavior. Most parents would agree that is a logical and appropriate form of parenting.

But what if it's the former, a punishment without cause? There might be a few explanations for this behavior. He might be angry, it could be part of the game, or it could be how he perceives his reality. If he's frustrated, then being aggressive in pretend play is a normal and natural way of managing frustration. As a kid, especially under the age of 5, you have minimal control or power in your life. He is directing the play, and is the punisher instead of the punished. Both give him a sense of power and control in a healthy way. It's age-appropriate.

The second option is punishment is part of his play. If so, this is a teaching and learning opportunity. If there is no apparent reason for the punishment, you can engage and co-construct what's happening. If he says the animal is in trouble because he says so, you can suggest that maybe the animal should not be in trouble since the animal did nothing wrong. You could also say the animal apologized so it should be forgiven. The play can also turn into an empathy exercise by asking, “How would you feel if you were in trouble when you did nothing wrong?”

Lastly, a child's play is symbolic of reality. So if in his play, he goes through each step (bad behavior → punishment → acceptance and apology → punishment over), then your child has a basic understanding of rules and relationships. If the animal is punished for no apparent reason, then it might be a sign that he doesn't understand why he is punished in reality. A good method to assess his understanding is to ask what he did that was wrong, why is he being punished, and what he can do differently next time. Sometimes what is obvious to a parent is confusing to a child.

You can also gauge your child's knowledge by asking similar questions as you watch a cartoon, read a story, or see another child who is doing something positive or negative. These situations are great ways of speaking indirectly to your child, rather than putting your child on the spot. It's always rewarding when your child is well-behaved; but poor behavior, even a meltdown, is an opportunity to learn and improve. 


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In the last two posts, I provided tips for both parents and teens. I wanted to be clear that both the parent and the teen have a role in the parent-teen conflict. The assumption in both posts was a fairly healthy parent-teen relationship.

Unfortunately, this is not always the case. Some parents and teens report avoiding each other at all costs, fighting, disrespect, and even counting down to an 18th birthday because that means the teen is leaving the house. So what if the parent-teen relationship is already bad?

1. Be realistic. All parents have fantasies of being the go-to person for your kid. That's just usually not the case. If your relationship is rocky, don't expect for it to improve to an unrealistic level. Be okay if the relationship improves but you aren't best friends.
   
   
2. Contain your pride and hurt feelings. If a relationship has soured there is probably a history of pain, hurt, and disrespect for all involved. You can't undo the past, but you can learn from it. Remember, the goal is to contain, not bury negative feelings.
   
   
3. Start over. Literally. Have a conversation about starting over. Sometimes your laptop is so infected with viruses you have to reboot. A start over is only possible if you can contain hurt feelings.
   
   
4. Do different. When parents and teens fight, it's usually in an intellectualized way, meaning the argument is based on thoughts and opinions. If your arguments feel like a debate, your conversations are intellectualized. Try using emotional and curious statements. Expressing a feeling or curiosity about the opposing view can positively shift the direction of an argument.
   
   
5. Common ground. Find common ground. Is there something you all can mutually agree on? If you can, this is a good way to open dialogue and rebuild a relationship. Even if the agreed thing is something small like not cursing or yelling, it's a start.
   
   
6. Use incentives. A lot of parents say they are weary of a reward system because they don't want to "pay for good behavior." Incentives are what motivate people, whether it's money, status, praise, or a sense of accomplishment. Is it really the worst thing if your teen follows the rules just so they can go to a concert on the weekend?
   
   
7. Co-create house rules. If there has been long-term conflict, the current rule system isn't working. Co-creating house rules means everyone knows the expectations and consequences. The rules should apply to everyone, even the adults.
   
   
8. Be consistent. This is a hard one, because the fury of a teen who feels shackled can be overwhelming. If you have agreed upon rules, you have to be consistent and enforce them. I can't tell you how many times a teen has said to me that they aren't worried because they know their parents are “all talk.” Be consistent with punishment and praise.
    
9. Find a mediator. It might be a friend, family member, or a professional. Having another person in the room can ease tensions. A mediator can provide objectivity where there is little. Just because you're an adult doesn't mean you are equipped with skills for any situation. Sometimes being a great parent is acknowledging your weaknesses. 
   
   
10. Keep perspective. I routinely have parents who come for a second session and say they haven't seen any improvement in the past week. The conflict is usually years in the making. That doesn't mean positive change will take years (it might) but it will take longer than a few sessions.
    
    
11. Savor wins, even tiny ones. If your family sits through a meal without fighting for the first time in months, savor that moment. That doesn't mean be content, it means value “new” positive experiences, even if they seem insignificant. It's a start. 
    
    
12. Share your experience. Your family is certainly not the first or millionth family to have problems. Share your experience with peers to gain insight, ideas, and perspective.
    
    
13. Hang in there. At some point, maybe 1, 5, 10 or 20 years down the road, your teen will come to a realization (usually when they are a parent) and gently ask, “Did I ever give you trouble?” That will be the bonding moment you've been waiting a lifetime for. Hang in there. 
    
    

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With my previous post about parenting teens, I certainly didn't want to give the notion that teenagers are a population that you have to approach with caution or tiptoe around. Whether it's kids, teens, adults, or parents, each of these groups have qualities and hallmarks unique to their group. With that in mind, I thought it would be helpful to give teens some tips on how to talk to their parents. 

Before the tips, let's consider where parents are developmentally. For the first 12 or so years, parents are used to being the confidant, chauffeur, bank, best friend, rule-maker, and many other things for their kids. As I mentioned in the previous post, the teenage years result in a significant shift not only for the teen, but also for the parents. Both parent and teen identities are changing. Part of the process of a new identity is confusion, uncertainty, and anxiety. This is a recipe for conflict. Here are some tips that might be helpful:

1. Trust your parents. If your parents have been loving and trusting thus far, keep trusting. This doesn't mean you have to agree with them, just listen to their perspective.
   
   
2. Manage your anxiety. Your life is rapidly changing. Puberty, peer pressure, social demands, etc. That's a lot of pressure, and sometimes stress can affect your relationships. Figure out if your feelings are truly about your parents or something else.
   
   
3. Ask your parents ahead of time. I know, sometimes things are spontaneous. Parents don't expect you to know Tuesday what your plans are for the weekend. However, be proactive, and give your parents enough time to make a decision.
   
   
4. Keep promises. If you promise to be home at a certain time or to take the trash out, then do it. When your parents see you following through on a promise, they'll give you more independence.
   
   
5. Humor your parents by talking to them. If you talk to your parents, even about superficial stuff, parents will ask less questions. If you are secretive, don't be surprised when you are interrogated.
   
   
6. Introduce your friends. The introduction doesn't have to be hours, even a short 5-10 minute conversation can work. Then when you say you are hanging out with so and so, your parents will feel better because they have actually met the person.
   
   Quick thought: If you don't want to introduce your friends, what does that mean about your friends?
   
   
7. Want more independence, act responsibly. No one expects you to be perfect, but be responsible. If you make a mistake, own it. If your parents trust you, then maintain that trust by doing the right thing.
   
   
8. Timing is everything. If you have a request, wait for the right time to ask. If you and your parents aren't on the best of terms in the moment, it's probably not the best time to ask for something.
   
   
9. Be honest. Parents always tell me what hurts the most is when their teens lie to them. Teens will counter with they have to lie because their parents will be mad. Sometimes parents should be mad, but when lying enters the game, trust leaves.
   
   
10. Ask for space. Life is hard, being a teen is harder. If you need space, ask for it. Let your parents know that you don't want to talk right now, but give them a specific time when you will talk to them.
    
    

Keep in mind these are general tips. Many teens and parents are probably reading this and thinking these tips aren't realistic. This is true in some cases, and that's why the next post is going to focus on when there is already conflict in the parent-teen dynamic.


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Parents often say the teenage years are the toughest to navigate. From a developmental perspective, it makes complete sense. The teenage years are when kids shift their attention from family to friends and personal interests.

From birth until about age 12, a child's world is centered around the primary caregiver(s) and family. Social gatherings, activities, and relationships are family-oriented. Children, for the most part, go along with family decisions. Kids certainly have relationships other than with their parents and siblings, but the central relationships revolve around the family.

By the teen years (and a year or two before), a significant shift occurs in most teens' lives. A shift in attention goes from the family to peers. Teens no longer identify themselves as a son, daughter, brother, or sister. They want to spend much more time with friends, and less time at home or with the family. This is a natural process.

Underlying this social shift, is the formation of a new identity. Teens certainly don't want to be identified by hobbies or acts of younger years, they want to be seen as young adults moving from a state of dependence to independence. This is what leads to most of the conflict in the parent-teen relationship: the shift from dependence to independence. Here are some parenting tips to keep in mind when thinking of your teen(s):

1. Trust. If your teen has been trustworthy thus far, keep trusting. Teens often report their parents rules are based on what happens with other teens.
   
   
2. Manage your anxiety. Parents worry. Sometimes it's legitimate, but sometimes your own personal anxiety is misplaced into your parenting.
   
   
3. Set the rules and consequences ahead of time. Be proactive, not reactive. Setting the rules ahead of time allows for you to be able to say, “We talked about this, it was clear.” It also allows you to say, “We agreed that if you were late, you have to come home early next Saturday.”
   
   
4. Set the rules...mutually. Your relationship has a much better chance of being healthy if you mutually agree on rules. This doesn't mean letting your teen run wild, it means compromise. Give a little to get a little. Pick your battles. It's a great life lesson, too.
   
   
5. Let your teen make mistakes. Yes, you read that correctly. That doesn't mean allow your teen to put themselves in dangerous situations, but it does mean let them learn by making mistakes. Would you rather them make mistakes while under your supervision, or when they are in college and learning from other 18 year-olds?
   
   
6. Try to have dinner nightly as a family. Sometimes it's impossible, but aim to have dinner together daily at a certain time. It's a great way to keep up with your teens' lives and to maintain some sense of normalcy for your family. 
   
   
7. Check-in or have family meetings. Call family meetings when there is a problem and when things are going great. You don't want your teens to become averse to you saying “let's talk.”
   
   
8. Invite their friends for dinner. This shows your teen that you are interested in their life. It also gives you a chance to get to know their friends. If the stars are aligned, the friends might even have a good time and disgust your teen by saying you are “cool”.
   
   
9. Be a nonjudgmental listener. You have a much better chance at a healthy relationship if you listen without being critical. Over time, your teen will learn and notice this, and will be more likely to come to you when there is a serious issue.
   
   
10. Talk to other parents of teens. Compare notes, generate ideas, and find support from other parents.
    
    
11. Be imperfect. Parenting is messy. The teenage years are messy. Many teens feel relief when they realize they don't have to be perfect. Show your teens that making mistakes is human. It can positively impact their self-image and confidence. Saying "I don't know" can be the right answer.
    
    

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Someone I know has an addiction. How do I approach them about it? 

-- Anonymous October 2013

Addiction is a challenge to overcome. There is a reason why it can take multiple attempts to kick an addiction. You hear about people who stopped smoking cigarettes cold turkey, or conquer an addiction after (re)committing to their faith. These stories happen, but more common is the personal struggle and loss of what is important in life due to an addiction. How do you handle someone struggling with addiction? First, let's understand the underlying process of addiction.

For me, all addictions have the same psychological underpinnings. Whether we are talking drugs, alcohol, porn, or any other vice, they all have the same root. Addiction is a mixture of a biological predisposition + a void in one's life + inadequate and inefficient coping skills and resources. Before I say more about this addiction mixture, there is a great presentation on TED Talk about addiction and the brain. It's a an excellent resource.

Biological predisposition. I believe people have a predisposition to everything. Whether it's depression, obesity, or artistic ability. There is a potential within us for anything. Factors (e.g., environmental, family, biological) in our lives moderate the maturation and expression of a predisposition. These factors over time can lead to a sensitivity and affinity to certain predispositions.

Personal void. Every person I have worked with who is struggling with addiction has a personal void. Whether it's a chaotic childhood, loneliness, attachment issues, or a failure to manage daily stress, there is a glaring void in their lives. An addiction serves two purposes: 1) it superficially fills the void and 2) it pushes personal inadequacies out of consciousness, for that moment.

Ineffective coping skills. You can argue that any psychological issue is the result of having limited coping skills. With addiction, the same applies. The specific, unhealthy behavior gains an addictive quality because it is helping the person cope with something that had been unmanageable. This is what makes addiction so hard to overcome, it's difficult to let go of an effective coping mechanism, even if it's unhealthy. A major component of addiction treatment is understanding triggers and how to cope with these stressors..  

So how do you talk to someone with an addiction?

In a previous post, I wrote about how to have a difficult conversation with someone you love. Similar rules apply to addiction, but there are differences.

1. Speak gently and non-critically. You are talking to someone with limited coping skills and an inability to manage daily life. Keep the stress level low.
   
   
2. Be consistent and honest. You don't have to be critical to say the person's choices have negatively impacted their life and yours.
   
   
3. Speak with love. Make sure it is clear that you are approaching them out of love. “I'm talking to you about this because I love and care about you.”
   
   
4. Ask for honesty. It may not work, but it's worthwhile to see if the person is in denial or wants help.
   
   
5. Listen. Allow the person to talk. Ask questions that are open-ended, that allow for dialogue.
   
   
6. Have resources ready, and be prepared. If the person has a specific addiction, do some research and see what supports are available in the area.
   
   
7. Establish boundaries by taking care of yourself. Support the person, but not at the expense of you. This will be the first exercise for the person to learn about healthy boundaries.
   
   

Being there for someone who is struggling with an addiction is difficult. Find your own support to ensure you remain healthy.  

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