Friends and How to Make ‘Em

At this time in September, we welcome the beginning of Fall. Here in South Florida with 90 degree temperatures, it still seems like summer. Yet vacations are over and school is in full swing. As you may not know, September is National Self Improvement Month. This is the time to take a good look at oneself and choose one thing, yes just one thing, you want to improve about yourself. Maybe it’s an old new year’s resolution, or a promise made to oneself, or a decision to do something when you had the time.

Well, now is the time to do it. Why wait? Why put it off any further? Starting something which is the first step is often the hardest. But you wanted to do it. You said so and maybe even promised yourself. So focus on getting started and see how far you can go to improve that area within yourself. Remember that life is what happens while you are waiting for your life to begin. Get up and get going.

We also would like to take this opportunity to wish our Jewish friends a very Happy and Healthy New Year and an easy fast.

In this September E-Letter, we present information about Friendship, our Ask the Doc question is a case study of selective mutism, and our email of the month is about Aging and Growing. We hope you find the enclosed information helpful. As always, we appreciate your questions and feedback.

Parent Education and Family Stabilization Course. We have been certified by the Department of Children and Families, State of Florida, to offer the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, this 4 hour class is state mandated for divorcing parents of involved children. This course is intended to teach parents about the effects divorce has on children, to lessen the impact of difficult transitions, and to improve the ways they communicate with each other and their children. Our course is provided live and in small groups. Please contact our office at 954 755-2885 for further information.

Testings. If you are concerned about your child’s school placement for the next school year, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Qualified Supervisor. Dr. Joel Kimmel has been certified by the State of Florida to supervise mental health counselors seeking supervision to meet the licensing requirements. If you or anyone you know needs a qualified supervisor to meet these requirements, contact Dr. Kimmel for further information.

Low cost counseling: Denise Champagne, M.S., is offering low cost counseling as a mental health intern. She is currently seeing patients and is available to take on new patients. This allows those individuals who cannot afford treatment to obtain it and allows her to get the required training. If you or someone you know is in need of counseling but just cannot afford it, please call the office and ask for Denise. All treatment provided by Denise will be reviewed and supervised by Dr. Kimmel.

Our E-Letter this month focuses on an important and necessary ingredient in our lives, Friends. These days our country seems to be filled with people who vilify others. The media is quick to find and broadcast the mistakes and embarrassment of others. And if that is not enough, they have an opinion panel of experts eager to give an opinion about these blemishes.

What happened to civility and respect for others? What happened to treat others like you would like to be treated? We seem to have become a society where people look to put others down to show how much better they are. The smear and slander political campaigns only seem to desensitize people to rudeness, disrespect, and hostility. What was once offensive now becomes the norm. Just listen to the language on television, in music, and in films. Simple minded television shows get their laughs by making fun of people. Embarrassing others seems to be funny according to the laugh tracks. And consider the behaviors of certain Congressmen who blame others and act as if they are above the law, saying and doing anything without consequence. It’s no wonder that believing in and trusting others is in short supply.

For this reason, we have decided to focus on friends and why friendships are important. We hope that with this discussion, people will reject rudeness and contempt and value having true friends that they can respect and trust.

Human beings have a basic need for affiliation. They want to have close, long term relationships where they can confide in others, feel they belong, and can give or get support. Having a friend means that one is not alone to face life’s challenges. Can you imagine not having any one to talk to or to share events of your day with? Can you imagine no one being interested in you? Loneliness can be a devastating, depressing feeling. Having strong social ties is the key to happiness. Research has also shown that having quality friendships lengthens life, boosts immunity, and decreases the risk of depression. Friendship increases your sense of belonging and purpose, reduces stress, improves your self-esteem and self-confidence, helps you cope with trauma or emotionally difficult times, and can encourage you to have a healthier lifestyle.

True friendship is a relationship between two people who hold respect, trust, and mutual affection for each other. It is a two way street or it won’t last long. Friendship contains sympathy, empathy, honesty, respect, understanding, compassion, the desire to do what is best for the other, and the enjoyment of each other’s company. Perhaps one of the most important qualities is the ability to be one’s true self, that is to say or do what one really feels or believes without being judged or made fun of. Reciprocity is critical to maintaining trust. Friendship is in effect life enhancing.

Friendships also occur across species. People often get more from relationships with pets than they do from other people. Friendships between pets and humans can be quite therapeutic as can be seen in the increase in service dogs who visit schools, hospitals, prisons, and soldiers. Friendships can also occur between animals such as a dog and cat who can be quite loving of each other.

One must be aware however of the dilution of friendships due to technology. Frequent emails and long work hours have tended to decrease real human contact. And social media sites such as Facebook has used the term “friend” to form contacts between people who are strangers or distantly known to each other. Being a friend on Facebook does not necessarily mean you are a true friend. When people are unfriended, they are more likely to experience rumination, rejection, depression, and other negative emotions.

So how does one make friends? Be attractive as a person. Smile, act confident and show interest in the other person. Make an effort to show up every possible place where you can meet people. Join a group of people who have interests common to yours. Talk nicely and respectfully about others and don’t gossip or talk behind one’s back. Accept invitations offered to you and invite that person in return. Attend community events and volunteer at hospitals, museums, etc. Take a class or work out at a fitness club. Make friends with friends of people who are already your friend. Most of all be persistent and do not get discouraged easily. Remain positive and realize that you may not make or want to be friends with everyone you meet but you will make some good friends. Get out there.

We offer the following information on Friends:

• Friendship can be defined as a relationship between two people who hold respect, trust, and mutual affection for each other
• Friendships include empathy, sympathy, honesty, understanding, compassion, reciprocity, and the desire to do what is best for the other
• Friendship allows for a person to be oneself, to express one’s thoughts and feelings, and to make mistakes without fear of rejection or judgment
• High quality friendships leads to increased self-esteem, self-confidence, happiness, and contentment with who one is
• A strong friendships may be THE KEY to happiness as it allows for: never feeling alone and unwanted, the ability to confide in others, and a way to give and get support
• Loneliness and lack of social support lead to higher mortality rates and an increased risk of heart disease, viral infections, and cancer
• Friendships are common among humans and dogs and cats and can also be cross-species such as a dog with a cat
• Research has shown that 25% of Americans have no close friends and that the average total number of friends per person has dropped from four to two since 1985
• Research has also shown that adolescents were less likely to get in trouble when their friends did well in school, participated in activities, and avoided drinking
• Technology has contributed to decreasing amounts of true friendships as email and longer work hours detract from personal communications and emotional connections
• Social networking sites have also diluted the true meaning of a friend as friend requests from strangers or distantly known people are accepted
• Frequent users of Facebook when unfriended are more likely to experience rumination, rejection, depression and other negative emotions

• Smile, act confident, be interested in others and allow them to feel important
• Make the effort and just show up at every place you can to meet people
• Set a goal of how many people you want to talk to at an event
• Join a group of people with common interests and attend regularly
• Talk nicely about other people and be respectful
• Work out or take a class regularly and become familiar with others
• Accept invitations to social gatherings and return the favor
• Volunteer your time at a hospital, museum, etc. to meet people with mutual interests
• Attend community events and consider joining a religious congregation
• Make friends with friends of people who are already your friend
• Nurture budding friendships by continuing to hang out with them
• Remain positive and realize that you may not make friends with everyone you meet but you will make some friends
• Be persistent and do not get discouraged easily
• Seek professional help if you have difficulty making and keeping friends

Instead of our usual Ask the Doc question this month, we are presenting a case review of the treatment of selective mutism. The therapist and writer of the following article is Denise Champagne, M.S. We hope you will find this case interesting and educational and give you some insight into how therapy is conducted.

The Small Silent Child

The 9 year old girl, B.H., waits in the lobby with her mother and father. When I arrive and greet her, she looks down and hides her face against her mother’s shoulder. She does not speak. Her parents have brought her into therapy, as she suffers with a disorder called Selective Mutism Disorder.

Selective Mutism Disorder is an anxiety-based disorder in which silence is used to reduce feelings of anxiety. Typically, children with this disorder are described as “very quiet” or “very shy” and suffer with social anxiety or social phobia.

B.’s parents explain that she has always been quiet, even as a baby. She speaks audibly only when she is alone with certain family members and trusted friends. In order to help her to communicate when needed in front of others, her parents allow her to use gestures or whisper in lieu of speaking aloud to others or even in the presence of others. These are called “compensating behaviors” as they take the place of audible speech. All of B.’s family and friends have adapted to her lack of speech and assist her in having her needs met by speaking for her.

B.’s teachers have adapted to her method of communicating by allowing her to gesture or by not calling on her to speak in the classroom. Her parents have now realized that in order for her to be successful in school as she moves to higher grades, she will need to be able to communicate verbally in class when presentations are required or even simply to properly participate in class discussions.

The goals of therapy are: 1) to reduce anxiety; 2) to reduce compensating behaviors; and 3) to increase audible speech in all areas of her life. In order to change B.’s behavior, I explain that we first must change the behavior of those in her life who allow the compensating behaviors.

Together, her parents and I developed a set of hierarchical steps for each of us to work through in order to change her behavior. B. and her parents were first trained in relaxation techniques in order to help her manage the anxiety inherent in these types of anxiety disorders. Then, each parent was charged with disallowing the compensating behaviors in order to increase speaking opportunities and successes. We agreed that we would all work on our hierarchies over the summer. When school begins in the Fall, we would meet with the new teacher and help B. to expand her new behaviors into the school setting.

In my individual sessions with B., I worked on my own hierarchical steps to develop communication at ever more open and verbal levels. During our first session, B. used a marker and paper to communicate her answers to me in writing.  Then, I explained to her that we would work on different ways to communicate and that I would have certain expectations for her each time we met. At the end of our first session, I encouraged her to say “hi” to me in the lobby the next time we met.  Her parents were asked to help her to plan for the next visit by using relaxation breathing and reminding her that she would say “hi” when she saw me. With smiling eyes, the girl did say “hi” to me the next time we met, covering her mouth with her hand. One very small step toward our goal was achieved.

After four months of therapy and dedicated work by her parents, B. has dramatically improved her verbal communication skills within the family, with extended family members, and even with new acquaintances and friends. She now reads entire children’s books aloud to me in therapy and speaks to me when we play games together. Her father and I met with her new teacher during the second week of school. As we began to explain B.’s disorder and discuss methods needed to assist her in verbalizing in the classroom, the teacher stopped us. The teacher stated that she did not see any problem with B. at all.  She said that she has been verbally answering her questions aloud in the classroom since the first day of school. She has also made friends with the children in her class group, with whom she speaks openly.

With patience, dedicated focus on our plan, and anxiety-reduction techniques, this little girl has her voice back.

We would like to thank Elaine Z for the following:

At my high school prom many decades ago, the organizers chose Billy Joel’s “Just The Way You Are” as the theme. I thought it was the most ridiculous choice, and I voiced it loudly. Why wouldn’t we change? Mention high school to any adult and very few would want to go back. Now with many years between that time and this moment, I have reached a point where I see more wisdom in the desire to stay just the way we are.

As the years pile on, life’s travails, challenges, and triumphs coat us with experiences. The layers add on and we become hardened and affected, for good and bad, by what we have learned along the path. For sure, we gain wisdom, understanding, and hopefully maturity. And yet we forget some of the truths we know about ourselves; what we like, what makes us happy, what gives us meaning. They get buried unintentionally under the layers of the years though they remain dormant, like seeds buried deep in the earth.

How many years did we all spend growing up? As some distant achievement we looked to the future to be grown up. There was much mystery in that aspiration because we couldn’t necessarily predict what we would turn out to be like. But then at what point does it change when we flip the switch and we turn to growing older?

Maybe the answer is in the growing part. Just as a seed grows from the root and develops and blossoms, so too should our root system remain strong. That’s our core. Uncovering the layers to rediscover ourselves, to find once again the essence of our being, allows us to celebrate that person we once knew. We are ever in the need of nurturing our own root system, our very core. Grow up or even grow old, just don’t stop growing; for that is just the way you are.