An Electronic Mental Health Newsletter from Joel I. Kimmel, Ph.D., P.A. & Associates
Volume 12, Number 4
Springtime is here and we look forward to the blossoming of flowers, plans for summer vacations, and a general sense of renewal. We are hopeful that with this season, there will be a great improvement in the world situation. Wouldn’t it be great for people to come together rather than being divisive? Wouldn’t it be great for people to truly care about one another and show it? Wouldn’t it be great if people wanted to improve themselves and others? We hope that some of this will happen during this Spring season. We urge you to do your part to help heal the world we live in.
Our April E-Letter is about Attachment Disorders and the inability of some people to connect with others. Dr. K’s blog continues and our email of the month is about a donkey and perseverance. We hope you find the enclosed information helpful and interesting. We also thank you for reading our E-Letters and for the numerous comments and messages of support we have received.
Practice News
Research study. Our practice has completed its participation in the research survey to validate a behavioral health assessment program. Thank you to all of you who did participate.
Low Cost Therapy. We are now able to provide lower cost therapy as Tara Passaretti, LMHC, has joined our practice. Tara is a Licensed Mental Health Counselor and Nationally Board Certified Counselor who has extensive experience working with children and families in private practice and in the court system. While she is being credentialed by the different insurance plans, she is able to provide counseling at a much lower fee. If you are in need of a therapist but do not have insurance or are unable to afford the high copays, Tara would be willing to see you. For more information or to schedule an appointment, call our office at . 954 755-2885. .
Testings.Support groups. Our ongoing weekly therapy groups have been quite successful. A men’s support group and a women’s support group are run by Dr. Jim Kaikobad and meets for one and one-half hours. The group is educational, supportive, and confidential and is limited to 8 people.
Benefits of these groups include significant cost reduction, time effectiveness, and the support and understanding of other members experiencing similar issues. If you or a family member would like to participate in either of these groups, please contact Jillian in our office at 954 755-2885.
Handouts from previous E-Letters can be found on our website, www.KimmelPsychology.com. We invite you to read and download them if desired.
ATTACHMENT DISORDERS: THE INABILITY TO CONNECT!
In our society, almost all images we see in commercials or other advertising media are of couples or friends hanging out together. Even in commercials for some illness treatment, there are family members or friends. Other commercials have teams or groups but seldom do you see some image of a person alone. We promote togetherness in our society, even if it is in some type of conflict.
But, what about those people who cannot connect or attach to others? It seems like the only time they come to our awareness is when they commit some horrific crime or terrorist event. The media often reports that they were loners or isolated. They had no friends. They kept to themselves. They had no caring for others. While this is an extreme case, there are those individuals who in our society that cannot connect to others to have a meaningful relationship without some sort of therapeutic intervention.
Attachment Disorders is the definition given to those people who have difficulty or are unable to form relationships. They tend to have no empathy, no caring, and an inability to be affectionate to others. They often do not develop a conscience and do not learn to trust. They may be superficially charming and have learned to “play” people to get what they want but they do not have genuine caring for others. They may be described as selfish or as loners and are easy to spot in early grade school.
Almost all people with Attachment Disorders have suffered early trauma in their childhood, usually before the age of 3. This may be due to parental abandonment, multiple foster care placements, abusive caregivers, physical or sexual abuse, or other forms of neglect. The parental bonding does not occur and without this as a foundation, it is extremely difficult to bond to others. They have not had their needs met and learn from an early age that they cannot depend on anyone to meet their needs.
As they grow up, people with Attachment Disorders often indiscriminately seek affection and attention from others. They may lie, steal, manipulate, destroy property, set fires, be cruel to animals and be overly aggressive. They may make poor eye contact, lack spontaneity, and have learning and attentional problems. They can have “weird” eating habits. They may be standoffish or be inappropriately close and clingy. They seem to be out for themselves and have little recognition or caring about the feelings of others. They do not allow people to be in control of them due to this trust issue. Their inability to enter into any relationship makes treatment almost impossible.
The Diagnostic and Statistical Manual (DSM V) recognizes two types of Attachment Disorder: Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). People with RAD have difficulty calming down and do not look for comfort from others. They seem to have little emotion and can appear unhappy, irritable, and scared. RAD can be chronic. People with DSED do not appear fearful when meeting someone. They may be overly friendly and will often go with complete strangers as they are unaware of possible dangers.
Attachment Disorders can be quite difficult to treat because of the person’s lack of trust and need to be in control. Treatment will most likely be long term and can involve a mix of family therapy, individual counseling, education, and medication. There are some controversial treatments such as “holding therapy”, “rebirthing”, and “rage education” which have little or no evidence of success.
If you live with or interact with someone who has Attachment Disorder, it would be helpful to you to learn all you can to understand this disorder. Have realistic expectations and patience. Understand that they are not angry with you. They just don’t know how to care and form relationships. You can model affectionate and empathetic behaviors but set clear expectations and boundaries. Develop trust by responding consistently and doing what you said you would be doing. Consider seeking professional help for the individual and for your relationship.
We offer the following information on Attachment Disorders: The Inability to Connect:
ATTACHMENT DISORDERS: THE INABILITY TO CONNECT!
Though surely to avoid attachments for fear of loss is to avoid life
WHAT TO KNOW!
- Individuals who have attachment disorders have difficulty forming lasting relationships as they often lack consciences
- Attachment Disorders are viewed as the result of early childhood trauma which affects a developing brain
- Trauma, neglect, abuse, or a separation from the primary caregiver usually occurs during the first three years of life
- If a child is unable to attach when younger, they may not be able to attach during the rest of their lives
- People with AD have low self-worth and do not learn to trust; they lack the ability to be genuinely affectionate and caring with others
- People with AD have a fear of getting close to anyone; safety is a primary drive and they often need to be in control to feel safe
- Characteristics of those with AD include:
- History of abandonment, neglect, abuse, multiple foster care placements, excessive numbers of caregivers, or lack of caregiver responsiveness
- Superficially engaging/charming and indiscriminately affectionate with others
- Anti-social behaviors such as lying, stealing, manipulating, fire-setting
- Destructive to self and others and cruelty to animals
- Lack of empathy, caring for others, and genuineness
- Poor eye contact and lack of physical affection and closeness
- Learning/attentional problems and lack of cause-and-effect thinking
- Most professionals believe that at the core of Attachment Disorders is deep-seated rage due to unfulfilled needs as infants
- ICD-10 recognizes primarily two types of Attachment Disorders:
- Reactive Attachment Disorder is a chronic condition where people have little or no emotions when interacting with others and appear unhappy, irritable, or sad
- Disinhibited Social Engagement Disorder where people are not fearful when meeting strangers and may be overly friendly and compliant with them
- Attachment Disorder in adults refers to the absence of distortion of age appropriate social behaviors
- Treatment usually involves a combination of therapy, parent education, medication, and family counseling
- Learn all you can about AD and have realistic expectations and patience
- Maintain a safe and stable living situation
- Keep predictable schedules/patterns to insure a sense of safety and reduce chaos
- Model caring, affectionate and empathetic behaviors consistently
- Set clear expectations and boundaries; respond consistently to develop trust
- Be understanding and respectful yet firm; sincerely apologize when wrong
- Take care of yourself, manage your own stress, eat and sleep well
- Seek professional help to develop and enhance bonding among family members
WHAT TO DO!
WE CAN HELP!
Call us at 954 755-2885 or email us at [email protected]
Joel I. Kimmel, Ph.D. P.A. and Associates
5551 N University Drive, Suite 202
Coral Springs FL 33067
Copyright © 2017 by Joel I. Kimmel, Ph.D.
Dr. K’s Blog
April 17, 2017
I don’t know if time really does help but the pain is not as intense or as frequent. There are moments of intensity where I really miss Jill but they are less frequent. Maybe I am just coming to terms with her being gone. Maybe it’s what we call resilience. Or maybe I am just used to being alone.
Do I miss her? Yes greatly. But not as desperately as before. I think I am just getting used to being on my own. Spring has brought many firsts. For the first time in fifty years, she was not at our Seders. She is not here to plan our summer trips. She is not here to celebrate the birthdays.
But I believe she is with us in spirit. In fact, I don’t know how to explain this, but I have felt her presence. I cannot put it into words as it is just a feeling but I do believe she is with me and that I feel comforting. I miss her greatly but I am determined to go on for myself, for my children, for my extended family, and for my patients. She would want nothing less.
March 20, 2017
First, I would like to thank all of you who read this blog and have been moved to reach out to me. People who I have not seen or spoken to in decades have sent me their heartfelt wishes and their personal memories of my wife. She had a great, beautiful impact on people and she truly had a well lived life.
I question myself sometimes whether I should put my personal experiences out there yet I hope that by reading what I am going through, others can be helped. Our society does not prepare us to deal with the death of loved ones. So in some small way, maybe I can help.
As time passes, the grieving continues. It has changed a bit but there are moments which are still very difficult. The most difficult part now of the grieving process is the loneliness. It is over six months now and I still have difficulty in accepting that she is gone. I still expect her to walk through the door or see her curled up in her favorite position reading a book. But I painfully know that will never happen again.
The house is big and empty without her. I find myself filling my time with chores just to keep busy but when I am alone, it hurts. I miss her and our lives together. I feel so powerless that I cannot bring back those days. We think we are in so much control of our lives. And we are for some things, but for the most part, we are not. We just have to accept what is and what will be. Accepting what you don’t want to accept is quite a struggle.
I am dealing with the loneliness by being with friends, taking a yoga class, and seeing my son and daughter. Yet there are always those moments where it truly hurts; words cannot describe it. But what else is there to do? I have been told by others who have lost loved ones that with time, it will get better. I hope they are right.
February 20, 2017
I wish I could say that it has gotten easier but it hasn’t. Another month has passed and the hurt remains as strong as it has ever been. This month brought the first Valentine’s Day without my wife and my daughter’s first birthday without her. I now realize that there will be many, many “firsts” most of which will be painful.
It is still so hard to believe that I will never look into my wife’s eyes again. Never kiss her or touch her like I always did. Never hear her advice or support again. How does one accept never, especially when you don’t want to?
I go out a little bit more. I see friends for dinner but for the most part, the evenings remain empty. The house also feels empty. My life is different. What I thought was important before is much less so if at all. Death changes your perspective but you cannot give in or give up. I continue to work and feel the satisfaction of helping others figure out their lives.
I am fortunate to have friends who keep in touch to see how I am. I am fortunate to have children who despite their own grief, check in with me. I am fortunate to have had 50 wonderful years with my wife. So I try to count my blessings.
I now believe that the only thing that will help me in this grieving process is just the passing of time.
January 20, 2017
It is now four months since my wife has passed and I can’t say that it has gotten any easier. I have gotten busier and in that sense, I have been preoccupied and am not dwelling on the sense of loss. But those moments when I am alone and are not doing anything are the most difficult moments. Friends have called me and invited me to make sure I am busy but you always have moments of aloneness which still hurt. I rationally know that my wife is gone but I still haven’t accepted it nor do I want to. My life is different. I am different. And it will never be the same.
I don’t know how long it will take, if ever, to heal from this grief. People constantly ask me how am I doing and I find it a very hard question to answer. I know they mean well and are interested but what do you say. I am doing fine? I am not doing well? I am really just doing okay and keeping busy. That is probably the best I can say right now.
Everywhere are constant reminders of the life I used to have. Some are poignant and other very sad. We dedicated the new office in my wife’s memory and seeing her picture gives me the feeling that she is with me all day long. I am glad we did that.
I also went to the cemetery with my daughter and it was emotionally, one of the most difficult things I have ever done. Yet when we left I felt some comfort.
I think my period of grieving will be over when I can truly accept that my wife has gone and that she had a wonderful life. I hope I can do that one day.
December 19, 2016
Another month has gone by and it doesn’t get any easier. In fact, the holidays highlight the emptiness and the loss. These are very difficult times and the powerlessness of not being able to change what happened is overwhelming. Keeping busy helps as it distracts from the grief yet even around people I feel alone. I grapple with acceptance and I am not there yet and probably won’t be for a long, long time.
I also realize that I have changed. No longer do I have my best friend to travel with, to talk to, to learn from, and to share my private thoughts. My wife and I grew up and grew together and we shared many, many wonderful experiences. Now those experiences are over and all I have left are the memories and the possessions. Yes, my children are wonderful and we have a very good relationship. But they too have their own grief to deal with.
I have found that death is the hardest part of life. Rationally, I understand that we will all pass at some time. But are we ever prepared for it? I give thanks that my wife did not suffer long; that is a blessing in itself. But I miss her.
I have learned that despite all we control in our life, we are never really in control of what matters the most. I am glad that we had such a close and warm relationship yet, precisely because of this, it hurts now that she has passed.
November 21, 2016
It is now 2½ months since my wife died and the transition to acceptance is extremely difficult. Cognitively, it sounds like an easy task. But emotionally, it is one of the most difficult tasks I’ve ever faced in my life. I have spoken with others who have lost loved ones who seem to be the only ones who can understand what I am going through. They know the depths of emptiness and loneliness that one can only experience when one loses one’s partner. It is almost like a club of grievers who never ever really stop grieving. They just seem to put it aside to go on with their lives for the sake of themselves and others. They say that it gets better but the pain never leaves.
How does one go from sharing everything with another to being alone? Things we were going to do, places we were going to travel to, renovations to the house, movies we were going to see, friends we were going to visit, and new experiences we were going to learn from are now all gone. They have to be done by me alone and yes I will do some of these but it is not the same. Ideas that I usually bounced off my wife or opinions where I needed her input now have to be decided only by me or by family and friends. Everything has changed internally since I am now a “me” and not a “we”.
Thanksgiving is just around the corner and it has always been a family holiday for us. Yes I will be with my adult children but our loss will be paramount. As we always do, we will give thanks for our health and everything we have in life. We will also give thanks for having had my wife in our lives for as long as we had her. We will also give thanks that she is suffering no longer and we will remember her joy, her wit, her love for people, animals, and books, and her love for us.
Email of the Month
We would like to thank Richard L. for the following email:
THE DONKEY
One day a farmer’s donkey fell down into a well. The animal cried piteously for hours as the farmer tried to figure out what to do. Finally, he decided the animal was old, and the well needed to be covered up anyway; it just wasn’t worth it to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed a shovel and began to shovel dirt into the well.
At first, the donkey realized what was happening and cried horribly. Then, to everyone’s amazement he quieted down.
A few shovel loads later, the farmer finally looked down the well. He was astonished at what he saw. With each shovel of dirt that hit his back, the donkey was doing something amazing. He would shake it off and take a step up.
As the farmer’s neighbors continued to shovel dirt on top of the animal, he would shake it off and take a step up. Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily trotted off!
MORAL:
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells just by not stopping, never giving up! Shake it off and take a step up.
Till May…
The information provided in this electronic newsletter is not a substitute for professional treatment. It is the opinions of the writers and is provided solely for educational purposes. For mental health care, seek a qualified professional.
If you no longer wish to receive future E-Letter reminders, please send an email to [email protected] requesting to be removed from this list.
If you find this information interesting or helpful, please forward this E-Letter to your contacts and friends. Copyright © 2017 by Joel I. Kimmel, Ph.D. P.A. and Associates.
