Category Archives: Book Excerpts

Unmet Needs of the Troubled Child

Unmet Needs of the Troubled Child

What Do You Do With A Child Like This?Excerpted from What Do You Do with a Child Like This? Inside the Lives of Troubled Children, by L. Tobin

It is not difficult to determine a troubled child’s primary unmet needs. An unmet need is made obvious by the child’s inability (1) to delay meeting that need; (2) to express that need; or (3) to elicit a healthy response from others to that need.

If a child cannot wait to have a need satisfied, you will probably spend a lot of time fighting it: trying to keep the child from talking, touching, or eating.

If a child feels a need but is unable to express it, the absence of this natural response will become conspicuous. You may notice that he has no friends, doesn’t like to play, or is afraid to laugh.

If a child no longer believes that others will fulfill his needs, you may be confused by the contradictory nature of what the child elicits from you and others. For example, unable to make friends, the child appears intent upon making enemies; or unable to experience structure and consistency in his life, he sets out to create hourly chaos.

Troubled children are distinguished most clearly by the frustrated expression of needs. They actively elicit the opposite of what they really need.

To identify a child’s unmet needs, ask yourself: “what makes this child different? What does he spend his time doing or avoiding? What self-defeating response does he elicit that appears to be the opposite of what he really needs?”

The Need for Acknowledgement

Troubled child looking out a windowI raise my hand each morning and tell you that I am “present,” but no one ever talks to me. I walk to school alone. No one asks me how I feel, wishes me a good day at school, or even acknowledges that I am awake. Until someone stops long enough to look into my eyes, touch me, awaken my spirit, welcome me into the world, let me know that I matter—until then, how can I be sure that I am really “present?”


  • The child who cannot wait for acknowledgment may pester for attention.
  • If she cannot express the need for acknowledgment, she may appear lonely, lost in the crowd.
  • If she no longer believes she can get acknowledgment, she may withdraw or rebel.

Being acknowledged by someone, welcomed into the world each morning, is as important to a child as a good breakfast. Acknowledgment “breaks the fast” of a lonely night, providing essential nutrients for the spirit.

  • Who could the child check in with each morning before class? A favorite teacher, principal, janitor?
  • What morning responsibility would give importance to his presence? What first-hour activity could put him in contact with at least one other student—get him involved?

The Need for Communication

Mom and Dad fight a lot. Sometimes they hit each other. That’s what I wake up to most days. I get in fights on the bus. The kids pick on me and I have to fight back. That’s what my life is like before I come to class. Some days it’s worse. You tell me to talk to you about things. Well, every morning is a story—a story I have to tell someone before I can try to get on with my day.


  • The child who needs to tell her story, may annoy you by not being quiet.
  • If she doesn’t talk about her troubles, she will worry about them and be distracted.
  • If she believes no one cares about her problems, she may be troublesome, constantly acting out.

Children with home problems come to school emotionally loaded. The earlier you deal with it the better.

  • What short morning class routine could free you to speak with the child, if only for a short time?
  • Could the student write in a journal on difficult days? You could respond in writing later.
  • Could you provide peer counselors or arrange time with a close friend?

The Need for Socialization

I live with my grandparents. There are no other children to play with. Weekends are so boring. School is the only chance I get to be with other kids. I’m not very good at making friends—I haven’t done it much; but it is exciting to be with everyone. I want to learn to play and talk to other kids. These are the kids I’m going to spend the rest of my life with. I wonder if they’ll like me?


  • The child who has an unmet need for socialization may talk constantly.
  • If he hides his longing for friends, he may be isolated, a loner.
  • If he is frustrated by his inability to make friends, he may be aggressive and set out to make enemies.

Boys relational cultural theoryUltimately the child’s personal and job success as an adult will be determined more by an ability to get along with others, than by specific skills.

  • Which children have few opportunities to be with other children outside of school?
  • Which first-hour activities could be done in pairs or small groups—even if only for selected students?
  • Which kids have the most to learn from each other, and how can you facilitate this connection?

The Need for Humor

Dad doesn’t laugh much since Mom left last year. He comes home from work with a lot on his mind. He gets upset when I giggle, so I try not to get silly anymore. Friends don’t come over these days. Our home is not much fun anymore. So when I go to school I sometimes try to make people laugh. I go to school earlier and earlier these days. Does life really have to be this serious all the time?


  • The child who needs laughter in his life, may become the class clown.
  • If he hides his need for humor and fun, he may become overly serious, the “adult” child.
  • If he believes he will never find joy and laughter in life, he may appear cynical, morose, or even sadistic.

Humor heals.

  • There is healing power in laughter. Could you laugh at yourself more often, more heartily? Could you model the human comedy of errors and self-forgiveness?
  • Are there situations that could be lightened with a joke or a story? How will you do it?

Children running and playing

The Need for Physical Activity

My brother and I live in the city in a small apartment. He’s in third grade and likes school. He wakes up at 5:30 each morning, runs around the house and drives us all crazy. I get up at the last moment and drag myself to school. My mind tries to work but my body wants to be in bed. His body wants to work. We’re very different, but we’re both in trouble with teachers before 9:00.


  • The child who needs physical activity may appear sleepy or overactive.
  • If he avoids activity, he may appear listless, unenthusiastic.
  • If the need for activity is frustrated, he may appear resistant and unwilling to undertake activities.

All vertebrates stretch to begin the day. Tension flows out of active muscles. All bodies need activity and oxygen to stay awake, and, with kids, all you need to do is provide the occasion.

  • Could you begin the day with a stretching routine? And repeat it throughout the day?
  • Could you begin some activities with a series of deep breaths?
  • You move about the room as you supervise students. Students also need to move frequently. Could you accommodate that need by scheduling short breaks?

The Need for Structure

My world changes every day. I never know who will be at my house in the morning. Sometimes Mom wakes me up; other times I have to get up by myself. I never know if there will be food for breakfast. Sometimes my sister shares my room; some nights I live with my Dad. I never really know what I will come home to at night, or where we might be next month.


  • The child who is trying to create structure in her life may constantly ask, “What do we do next?”
  • If her need for consistency is hidden, she may be resistant to any change in routine.
  • If she has given up on trying to discover order in her life, she may be chronically unprepared and appear to thrive on chaos.

Child learning in classFor many children, school is the one constant in their life, the one structure they can depend upon. You may notice that even those who hate school and everything about it are seldom absent.

  • Post and review the schedule every day, noting even insignificant changes.
  • Which children need to be informed individually of any changes in the structure of the day?
  • Which routines should be followed consistently, every day?

The Need for Relaxation

My family argues. Each morning my older sisters fight over the bathroom. Mom doesn’t like mornings so she yells at all of us. Dad yells at Mom. The radio in the kitchen drowns out the television in the next room. I walk to school with my Walkman blaring so I don’t hear the traffic and sirens in our neighborhood. I come to school already stressed out.


  • The child who needs to relax, may appear reclusive, withdrawn, or exhausted.
  • If he doesn’t know how to relax, he may remain agitated, nervous, and “wired.”
  • If he is under severe stress and is frustrated in his efforts to deal with it, he may appear oppositional and despondent.

Relaxation is a direct route to enhanced learning, creative problem solving, anger management, stress management, and general health. It is what we placed kids in “time-out” to acquire. We know now that relaxation must be taught. Books, CDs, and MP3s are available to help us teach relaxation skills.

  • How could you include relaxation instruction in your classroom? Deep breathing before a test? Neck and shoulder stretch during a test? A relaxation CD or MP3 to bring them back to a peaceful world?

The Need for Encouragement

Since first grade I have hated school. I don’t read well and I’m not very good at math. I make a lot of mistakes. My parents say I’m lazy—that I never try to do my best. I used to try. Now I just do everything I can to avoid work. I don’t want anyone to see how stupid I am, so I never turn in my assignments. I know I would just fail anyway. I don’t know why they make dumb people like me go to school anyway.


  • The child who needs encouragement may seek constant reassurance.
  • If she is afraid of failure, she may say, “I can’t,” and avoid trying.
  • If she becomes discouraged by failure, she will say, “I won’t,” and refuse to try.

Find the occasion to answer these questions for each child.

  • What is it you like about me?
  • How am I unique?
  • What do I do well?
  • How can I affect my world?

All students come to school with unmet needs. Most have the ability to delay these needs. Troubled children focus on nothing else until these needs are met. Meet the needs early or consume your time fighting them. The choice is yours, not theirs.

Ten Principles for Using Icebreakers

Excerpted from Icebreakers a la Carte

By Sandy Christian, MSW and Nancy Loving Tubesing, EdD

All groups need icebreakers. The world is full of shy people who need focus and a very specific way to talk frankly about themselves. Icebreakers provide a vehicle for sharing select personal information, freeing people from constraining anxiety, and guiding participants into authentic, purposeful, often touching conversations.

Icebreakers are not just for getting acquainted. They are especially useful for groups of strangers; but even well-acquainted groups can use icebreakers to ease into a course or group discussion, provide focus for group activities, and establish the proper climate for learning. From first meetings to final farewells, icebreakers pave the way for people to be real.

Icebreakers make the group, and its members, attractive to participants. Not everyone will like everyone else in a group, but the more people are attracted to other participants, and discover common interests, goals, and values, the more eager they will be to participate. Icebreakers induce people to share in spontaneous ways that stimulate lively interaction and draw people to one another.

Icebreakers affirm the rights of participants. Everyone who joins a group has human rights: to be recognized as individual, to have input into some group decisions, to have an equal opportunity to participate in the group, to establish goals and work towards them, to have others respect personal privacy, and to have the group be a safe, secure place in which not one is belittled or degraded. Icebreakers direct participants into activities and behaviors that uphold and affirm these rights in words and actions.

Icebreakers should be relevant to all participants. Everything you do should be relevant to the culture of the group, and its members. Icebreakers as well as other group activities should be presented in the context of participants’ life experience and be relevant in language, values, and style.

Trust is the most important variable to consider when using icebreakers. Icebreakers help establish trust and contribute to its strength throughout the life of the group. The bottom line is, “Can I be honest here and say what I really think and feel?” If the answer is no, the group is constrained from lively, spontaneous communication and deterred in its purpose. Icebreakers remind people, over and over, that open, heart-searching communication is like a wind blowing the group spirit in the right direction.

Icebreakers are vehicles for shaping open group systems. The best environment for learning is an open system, one that accepts and welcomes diverse people, invites honest communication, expresses warmth and affection freely, challenges individuals to grow, shares warmth and affection freely, challenges individuals to grow, shares power and will its members, provides support for people who need it, respects personal boundaries, and honors the limits of the group itself.

Icebreakers provide a way of quickly introducing these values to the group in action and words. Since the rules of the system are often decided in the first few minutes of interaction (without ever talking about them, just by watching each other and the group leader for clues about how to behave), it’s all the more important that icebreakers be used early on to lay the foundation for an open system.

Equal, active participation is an implicit goal of all icebreakers. Successful groups are the responsibility of all participants. The more you inform people about their choices, the more they can take responsibility for group learning. Knowing what the leader has planned, why a particular activity was chosen, and what their roles want responsibilities will be, helps group members make clear decisions about how they want to participate.

Most groups need a balance of activities. Too much of any one thing creates a lop-sided group; overly friendly, chatty groups may never get down to business, while “all work and no play” groups may suffer from boredom. Most groups function beset with a mixture of activities, some light-hearted, others serious.

Experiential, holistic learning is ideal. Learning involves the whole person: mind, body, spirit, relationships, and emotions. When group activities incorporate all these aspects of learning and accommodate the different learning styles of individuals, the chances are great that group members will have a complete experience, one they can integrate with previous experience and apply to everyday life, resulting in a genuine change of attitudes, perceptions, feelings, thoughts, and behaviors.

*For use with your clients: Cartoon Captions, a zippy method of applying humor to challenging situations. Be sure to check out the two variations.

Icebreakers a la Carte

Relational-Cultural Theory

What Is Relational-Cultural Theory?

By Judith Jordan, PhD

Transforming Community Relational Cultural TheoryExcerpted from Transforming Community

Relational-Cultural theory (RCT) posits that we grow through and toward relationships throughout our lives and that growth-fostering relationships are the source of meaning and empowerment. The Five Good Things (Miller & Stiver, 1997) characterize these “good relationships”: (1) zest, (2) clarity, (3) sense if worth, (4) productivity, (5) a desire for more connection. We need connection the way we need air and water. Relationships are central to our lives, not secondary or peripheral. Self-interest is a social prescription rather than a biological imperative.

What has come to be known as Relational-Cultural theory was created in the late 1970s by a collaborative group of four women clinicians (Jean Baker Miller, Irene Stiver, Janet Surrey and myself). Foundational to the model was the work of Jean Baker Miller who wrote her best-selling book Toward a New Psychology of Women in 1976. Seated in Jean’s living room in Brookline, Massachusetts, beneath an antique quilt (undoubtedly the creation of several women from another era with a recognizable pleasure in creating something together) these four women came together to better understand clinical practice and the psychology of women. Jean Baker Miller could see the ways in which theories of personality and development, written by men (mostly white, well-educated, straight men), when applied to women, often led to distortions in understanding. Jean invited us to listen to women, to hear their stories, to understand their needs and motivations, to see strengths where others often saw weakness or deficiency. As we tried to represent women’s voices we sought to understand the impact of race, culture, sexuality, and sociopolitical power issues. Thus began a re-working of the dominant psychological theories of the time. The journey would take us from a celebration of the Separate Self to an appreciation of the centrality of relationships in our lives. Much to our chagrin, critical feedback from marginalized people pointed to the irony that in trying to describe “woman’s voice” we committed the very same hubristic error we had accused male theorists of. We presented our model as if there was one, homogenous voice of women. We have worked hard to listen to and represent the range of experience of women and to move beyond our own white privilege with its incumbent blind-spots (and other sources of unearned advantage such as class, sexual orientation, gender.) We have tried to represent many of the voices of women. We sought to “challenge assumptions of a powerful mythic norm that would define woman as a white, economically privileged, able-bodied, and heterosexual female. Unchallenged, this norm becomes a standard against which all women’s existence is interpreted and evaluated” (Jordan, Walker & Hartling, 2004, p.3).

RCT examined the ways in which chronic disconnections from empathically failing and non-responsive relationships early in life get encoded as relational images which shape our expectations for current relationships. Acute disconnections offer opportunities for re-working earlier relational failures; in fact when we can represent our authentic feelings and find respect, responsiveness, and empathic attunement we build trust and a sense of relational competence. When, however, disconnections are disregarded and a person is treated as if he or she doesn’t matter, she learns to twist herself to fit into the relationships with powerful others in her life (e.g. parents for children; bosses for employees). The misunderstood individual becomes less and less authentic, mutuality ebbs, and the disconnection becomes chronic. In such situations we see depression, low energy, confusion, immobilization, isolating, self-blame; the opposite of The Five Good Things of zest, worth, clarity, productivity, and desire for more connection.

Boys relational cultural theoryTraditional models of psychological growth at the time that we began our theory building (late 1970s) emphasized that humans move from dependence to independence; that the goal of healthy development is to be able to stand on your own two feet, to be independent, to be rational and autonomous. Unrealistic standards for adulthood left many people, both men and women, feeling inadequate and ashamed. In many ways, the restrictions placed on boys in terms of emotional vulnerability (necessary for the formation of mutual relationships) and demands for unattainable self-sufficiency (to encourage functioning in a hyper-individualistic society) are deeply destructive for boys (Stone, 2011).

In the last decade, modern neuroscience has validated almost all of the early tenets of Relational-Cultural theory: We need relationships like we need air and water; exclusion and isolation create real pain for people; the brain is wired to register the pain of exclusion in the same way it registers physical pain or absence of water and oxygen. We are simply hardwired to connect. We come into the world with the underpinnings of empathic ability (mirror neurons). Just as we need others for survival, we need to give to others and to participate in the growth of others. This model points to the mutuality of human growth. Our inevitable interdependence provides us with a sense of meaning and belonging. When society sets up expectations that are at odds or clash with our neurobiology, when a connection-seeking being is met with cultural conditioning that valorizes self-sufficiency and standing on your own two feet, emotional stress and physical ill health ensue. Chronic stress, resulting from this mismatch wreaks havoc with our overall well-being. We now know that exclusion and isolation cause pain… real, demonstrable neurobiological pain. We know that there is amazing plasticity in the human brain; we also have learned that empathic attunement alters brain function. We are born with an impulse to connect which is not based only on satisfaction of biological needs. We are hard-wired to connect. We need to engage in and participate in relationships that go beyond just needing others to take care of us or resonate with us. We have a need for mutual empathy, resonance; we need to contribute to others. And we need to build community together.

Intense AnxietyWhile this work was quite controversial in the late 1970s, modern neuroscience, with its revealing functional MRIs, has confirmed almost every position put forth regarding the power of connection in people’s lives. Social Pain Overlap Theory (SPOT) has demonstrated that the pain of social exclusion (or even the anticipation of exclusion) travels the same neuronal pathways to the same brain area (the anterior cingulate) as physical pain (Eisenberger & Lieberman, 2004). This tells us that relationships are essential to our survival; physical injury and isolation are both wired to demand our attention, to send out survival alarms.

Although initially the model was widely accepted by many female therapists (“It’s what I knew in my heart about therapy and people”), other traditional therapists at first overlooked it, then labeled it “dangerous”, and later often concluded: “We knew it all along. Relationships heal.” While RCT is a relative newcomer to the psychological community, it has gained widespread acceptance, and has engendered a significant amount of research (Jordan, 2010; Jordan, in press). The American Psychological Association invited RCT into its “Psychotherapy monographs series”, noting it was one of the ten most important psychological theories in North America.

While originally anchored in the need to correctly represent the psychology of women and bring about changes in the practice of psychotherapy, RCT has been increasingly applied more widely. A small sampling of RCT research shows it has been used to better understand

  • organizational dynamics (Fletcher, 1999)
  • counseling theory and practice (Comstock, 2005)
  • diversity and marginalization (Comstock et al, 2008; Frey, 2013)
  • social justice (Gunderson, 2012; Gunderson, Mueller, & Teichert 2013)
  • men (Englar-Carlson, Stevens & Scholtz, 2010; Lombardi, 2011)
  • eating disorders (Tantillo & Sanftner, 2010)
  • addiction (Covington, 2008; Gahleitner & Gunderson, 2009; Gahleitner & Gunderson, 2007)
  • mindfulness (Surrey, 2005; Surrey & Jordan, 2005)
  • relational psychotherapy (Jordan, 2010; Walker & Rosen, 2004)
  • education (Schwartz & Holloway, 2014)
  • mentoring (Gunderson et al, 2015; Spencer, Jordan, & Sazama, 2004)
  • empowerment of girls (Covington, 2008; Jordan, 2016)
  • friendships (Miller & Stiver, 1997)
  • neurobiology of relationship (Banks, 2016)
  • couples (Jordan & Carlson, 2013)
  • resilience in girls (Jordan, 2013)
  • clinical outcome (Oakley et al, 2013)
  • chapter representations in college psychology texts (Engler, 2003; Frager & Fadiman, 2012)
  • summary of research on RCT’s usefulness in the field of counseling (Comstock, 2008; Duffy & Trepal, 2016).

Many more references to RCT can be found in the forthcoming APA 2nd edition of Relational-Cultural Therapy (Jordan, in press).

In terms of power analyses, RCT suggests that power over models severely restrict the development of mutuality. When people exercise power over, they seek to maintain the status quo, the imbalance of power that affords them considerable privilege in a stratified society. “Power with” and “power for” models provide healthier social arrangements in which all people matter, all people contribute to one another and the relationship and all people grow as a result of their interactions. In empowerment, we participate and value the growth of the less powerful person. The goal is mutual benefit and movement toward a greater sense of the power of connection.

Women talking by a campfire

RCT views isolation as one of the core factors in psychological suffering and dysfunction. Re-establishing meaningful connection with others fuels healthy development. As the client experiences empathic responsiveness with the therapist, she feels understood and she also feels less alone. She begins to entertain the possibility of healing and feeling that she matters. Strategies of disconnection begin to shift and the client begins to take small, appropriate risks in bringing vulnerability to relationships. This vulnerability is essential to being open and affected by our relationships with others and hence being able to grow in connection.



Banks, A. (2016). Wired to connect. New York: Tarcher/Penguin.

Comstock, D. L., Hammer, T. R., Strentzsch, J., Cannon, K., Parsons, J., & Salazar II, G. (2008). Relational-Cultural theory: A framework for bridging relational, multicultural and social justice competencies. Journal of Counseling and Development 86(3), 279-287.

Comstock, D. (Ed.). (2005). Diversity and development: Critical contexts that shape our lives and relationships. Belmont, CA: Brooks/Cole.

Covington, S. (2008). Women and addiction: A trauma informed approach. Journal of Psychoactive Drugs, 5(3), 377- 385.

Duffey, T., & Haberstroh, S. (2014). Developmental relational counseling: Applications for counseling men. Journal of Counseling and Development, 92(1), 104-113.

Duffy, T., & Trepal, H. (2016). Introduction to the special section on Relational-Cultural theory. Journal of Counseling and Development. 94, 379-382.

Eisenberger, N., & Lieberman, M. (2004). Why rejection hurts: A common neural alarm system for physical and social pain. Trends in Cognitive Sciences. 8, 294-300.

Englar-Carlson, M., Stevens, M., & Scholtz, R. (2010). Psychotherapy with men. New York: Springer.

Engler, B. (2003). Personality theories: An introduction ( 6th ed) . Boston: Houghton Mifflin.

Fedele, N. (2004). Relationships in groups: Connection, resonance and paradox. In J Jordan, M Walker &L Hartling (Eds.), The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute (pp. 194-219) New York: Guilford Press.

Fletcher, J. (1999). Disappearing acts: Gender, power and relational practice at work. Cambridge, MA: MIT Press.

Frager, R., & Fadiman, J. (Eds.). (2012). Personality and personal growth. New York: Addison Wesley Longman.

Frey, M. (2013). Relational-Cultural therapy: Theory, research and application to counseling competencies. Professional Psychology Research and Practice. 44(3), 177-185.

Gahleitner, S., & Gunderson, C. (Eds.). (2009). Gender, Trauma und Sucht: Neues aus Forschung, Diagnostik und Praxis. Kröning: Asanger Verlag.

Gahleitner, S., & Gunderson, C. (Eds.), (2007). Frauen, Trauma, Sucht: Neue Forschungsergebnisse und Praxiserfahrungen. Kröning: Asanger Verlag.

Gunderson, C. (2012). Human trafficking: The trafficking of women in Northern Germany for the purpose of sexual exploitation. A systemic overview of community based responses and challenges. Münster, Germany: LIT Verlag

Gunderson, C., Müller, A., & Teichert, G. (2013). Zwangsprostitution und Menschenhandel/Sex slavery and human trafficking. Münster, Germany: LIT Verlag

Jordan, J. (in press). Relational-Cultural therapy. (2nd ed.) Washington DC: American Psychological Association.

Jordan, J. (2013). Relational resilience in girls. In S. Goldstein and R. Brooks (Eds.), Handbook of resilience in children (2nd ed.) pp. 73- 86. New York: Springer Science and Business Medico. Jordan, J. (2010). Relational-Cultural Therapy. Washington, DC American Psychological Association.

Jordan, J., Kaplan, A., Miller, J., Stiver, I., & Surrey, J. (1991). Women’s growth in connection. New York: Guilford.

Jordan, J., Walker, M., & Hartling, L. (Eds.). (2004). The complexity of connection. New York: Guilford.

Lombardi, K. ( 2011). The mama’s boy myth. New York: Penguin.

Miller, J. (1976). Toward a new psychology of women. Boston: Beacon Press.

Miller, J., & Stiver, I. (1997). The healing connection: How women form relationships in therapy and in life. Boston: Beacon Press.

Norcross, J. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patient. New York: Oxford University Press.

Oakley, A., Addison, S.C., Piran, N., Johnston, G., Damianakis, M., Curry, J., …(2013). Outcome study of brief relational-cultural therapy in a women’s mental health center. Psychotherapy Research, 23(2), 137-151.

Schwartz, H. (2014). “ I become part of the learning process”: Mentoring episodes and individualized attention in graduate education. Mentoring and Tutoring: Partnership in Learning, 22(1), 3855.

Sparks, E. (1999). Against the odds: Resistance and resilience in African American welfare mothers. Work in Progress, No 81. Wellesley,MA: Stone Center Working Paper Series.

Spencer, R., Jordan, J., & Sazama, J. (2004). Growth –promoting relationships between youth and adults: A focus group study. Families in Society, 7(3), 354-363.

Surrey, J. (2005). Relational psychotherapy, relational mindfulness. In C. Germer, R. Siegel, & P. Fulton (Eds.), Mindfulness and psychotherapy, (pp. 91-110). New York: Guilford Press.

Surrey, J., & Jordan, J. (2013). The wisdom of connection. In C. Germer, R. Siegel (Eds.), Wisdom and compassion in psychotherapy: Deepening mindfulness in clinical practice. (pp. 163-175). New York: Guilford Press.

Tantillo, M., & Sanftner, J. (2010). Measuring perceived mutuality in women with eating disorders: The development of the Connection-disconnection scale. Journal of Nursing Measurement, 18(2), 100- 119.

Walker, M., & Rosen, W. (Eds.). (2004). How connections heal: Stories from Relational-Cultural therapy. New York: Guilford Press.

Reducing Bedtime Anxiety: Steps, Worksheets, and Activities

Worn out from the holidays? Having trouble sleeping?

Bedtime Anxiety

Bedtime Anxiety woman trying to sleep

Excerpted from Coping with Sleep Issues
By Ester Leutenberg and John Liptak, EdD

What keeps you awake when you want to be sleeping?

Bedtime anxiety keeps everyone awake at times. Below is a set of steps that you can use at bedtime to dramatically reduce your feelings of anxiety and begin to effectively cope with them. These steps are designed to help you cope with anxiety from its onset. Think of something you are anxious about, describe it, and then try these six steps to conquer anxiety before bed time.

  • STEP 1 = Reduce physical tension by taking a deep breath and holding it for five seconds. Do this ten more times. How did that feel?
  • STEP 2 = Stay in the present by bringing your thoughts to the here-and-now (as if the future does not exist!). How did that feel?
  • STEP 3 = Start the calming process by forming a mental image of a calm place. Close your eyes and picture yourself in this calm place. Use your senses of smell, touch, taste and hearing to make the image real. How did that feel?
  • STEP 4 = Continue calming your body and achieve a sense of deep relaxation. Start at the bottom of your feet and begin relaxing all of your muscles until you reach the top of your head. How did that feel?
  • STEP 5 = Realistically assess the accuracy and rationality of your thoughts. STOP any negative statements and replace them with positive statements. How did that feel?
  • STEP 6 = Repeat several positive affirmations that will help you to stay in the present moment. Affirmations might include statements such as “My thinking is peace-filled.”

Click here for a printable version of Bedtime Steps to Reduce Bedtime Anxiety

The truth is that there is no actual stress or anxiety in the world; it’s your thoughts that create these false beliefs. You can’t package stress, touch it, or see it. There are only people engaged in stressful thinking. ~Wayne Dyer

Activities to Reduce Bedtime Anxiety

There are many ways to reduce anxiety before it spirals into a heightened, debilitating state. These distractions allow you to get out of your own head and focus on things outside of yourself.

  • Physical Exercise Early in the Day (jogging, walking, etc.)
  • Enjoyable, Nourishing Activities (hobbies, family activities, etc.)
  • Creative Expression (garden, scrapbook, journal, etc.)
  • Relaxing Activities (Yoga, meditation, etc.)

Click here for a printable version of Activities to Reduce Bedtime Anxiety.

Man with sleep problems rubbing eyeMy Negative Thoughts and Feelings

Consider all of the negative thoughts and feelings you are experiencing today. How do you think the above negative thoughts and feelings will affect your sleep?

Emotional Pain

Negative thoughts and emotional pain get in the way of a solid bedtime sleep. To relieve emotional pain, you need to deal with it!

Explore the various reasons that you are experiencing your emotional pain. (Example: feeling guilty about something you did or did not do.) What is on your mind?

  • Step 1: Acknowledge your feelings.
  • Step 2: Accept what happened.
  • Step 3: Feel it.
  • Step 4: Don’t mask it.
  • Step 5: Learn from it
  • Step 6: Overcome it.

Use these six steps when you are emotionally troubled.

Click here for a printable version of Emotional Pain.

Creative Arts Can Help with Bedtime Anxiety!

Woman paintingThe creative arts can help you in this process! Create a poem, write a song, create a short story, or draw something that describes what you’re feeling and going through. Remember, this is for you and only you to read or see. Don’t worry about rhymes or meter, sentence structure, or how professional your art is. Do it for yourself, and yourself alone. Try going through this process a few hours before going to sleep.

Click here for a printable version of Creative Arts.

Regretful Feelings: True or Not True?

It’s often hard to know whether feelings about incidents one regrets are based on truth, or what one believes to be true. Evaluate your level of responsibility for what really happened.

  • What situation do you regret feel guilt, sad, embarrassed, ashamed, angry, or afraid?
  • Who else was involved?
  • How much control did you have over the situation?
  • Were you really responsible?
  • What could you have done differently?
  • How can you forgive yourself and let it go?

Click here for a printable version of Regretful Feelings: True or Not True?

Distractions from Dwelling on Mistakes

All people make mistakes! It’s time to move on from the emotional pain of having made a mistake. Distract yourself from thinking about the mistake by forgetting it and letting it go.

  • What recreation-time experiences that bring you pleasure?
  • What activities do you like to do that bring you a sense of deep relaxation?
  • What activities do you enjoy that bring you a sense of accomplishment?
  • What activities do you enjoy so much that you actually lose awareness of time?
  • What activities do you feel passionate about, activities that bring you meaning and a sense of purpose when helping others?

When lying in bed trying to go to sleep, distract yourself from negative thoughts by thinking about these activities.

Click here for a printable version of Distractions from Dwelling on Mistakes.


The word affirmation comes from the Latin affirmare, originally meaning “to make steady, or to strengthen.” Affirmations help purify our thoughts and restructure the dynamic of our brains so that we truly begin to think anything is possible. Which affirmations resonate with you? Write them down and keep them in places that you look at it often, on your night stand, mirror, refrigerator, dashboard, etc.

  • I will not struggle. I am peace filled.
  • I forgive myself!
  • I am setting myself free.
  • I choose peace of mind.
  • I am living in the present.
  • I connect with the calm of this present moment.
  • Tomorrow I will enjoy each and every moment.
  • I am relaxing, clearing my mind, and going to sleep.

Repeat one affirmation of your choice as you are going to sleep.

Click here for a printable version of Affirmations.

Spiritual Moments – Developing Spirituality in Children

Spiritual Moments

Excerpted from Nurturing Spiritual Development in Children by Understanding Our Own Spirituality

By Ester R.A. Leutenberg and Deborah L. Schein, PhD


Nurturing Spiritual Development in Children by Understanding Our Own Spirituality

Caregivers should be aware of the importance of spirituality and to realize that spiritual development can be nurtured at very young ages.

In this blog the term caregiver refers to biological, adoptive, step or foster parents; family members; child-care educators; day-care workers and nannies; and other people who are in the position of being responsible for the care of young children.

A caregiver can begin instilling spirituality even before a child is born. Singing and other sounds are felt as vibrations and possibly as sounds by a fetus in the womb. During this time frame, an infant is most vulnerable to the environment. A baby absorbs and adapts to time, place, region, and local norms and culture. The spiritual embryonic phase begins here and continues throughout one’s lifetime.

Spiritual development is vital for all caregivers. There are aspects of spiritual development that are common to all people. The intent of the authors is to provide opportunities to evoke and strengthen each caregiver’s spiritual development, and ultimately, influence the spiritual development of the children to whom the adults are giving care. Readers will find information about various aspects of spiritual development. Caregivers are encouraged to spend time in reflection and journal writing. This will provide opportunities to evoke and strengthen the spiritual development that will enhance the spiritual development of the children the adults are nurturing.

Truisms – Young Children and Spiritual Development

  • Spirituality is an innate human trait.
  • This innate trait must be nurtured in order to flourish.
  • All children require love and attachment at the beginning of life to awaken this innate spirituality, so that it can be nurtured and developed.
  • All children need interesting and beautiful spaces in which to experience life. This space can be as big as a park, and as small as a corner of a room.
  • Young children are extremely competent learners because they have absorbent minds with exceptional ability to learn culture, language, and nuances from the environment and the people in that environment.
  • Spiritual development plays an important role in promoting learning and growth for all children, and is inter-related with all other domains of development.
  • Children will develop spirituality far more easily when the adults in their lives are spiritually grounded.

Important definitions to keep in mind:

Complex disposition is reflected in how one acts toward others by caring, kindness, empathy, and reverence.
Basic disposition is the internal feeling triggered by moments of wonderment, awe, joy, or inner peace.

Spiritual Moments Happen Every Day

Spiritual Moments at Machu PichuI was co-writing a book about spirituality and on the way to a restaurant with friends, I asked the husband if he was religious, spiritual, spiritual and religious, or none of them. He gave me a confused look, and said, “What is spirituality?” I told him that it is different for everyone. I said, “For me, when I look at the mountains beyond my backyard, I have a sense of wonderment, of being a small part of the universe. It swells my heart.” His response was, “I have no idea what you are talking about.” We enjoyed our dinner, saying no more about it.

Driving home, he said he had been thinking. When he was at Machu Picchu, atop the Andes Mountains in Peru, he recalled an unbelievable feeling of awe. He reflected at that time upon his wonderment of the world. In the twenty-five minutes it took us to drive home, he told a half a dozen other stories like that. His wife’s mouth was wide open. She, in fifty years of marriage, had never heard these stories. That one question opened him up to reflect and to recognize his spiritual moments and to consider his own spirituality.

~ Ester R.A. Leutenberg

Spiritual Moments in Time

Spiritual moments in time are quiet, calm moments with extended time for children to play and explore – these moments are most felt when children live their lives within a set routine and within environments that provide order. Such environments invite children to predict, know, and feel secure within a day, a week, or more.

Think about moments that have given you feelings of peace and contentment; moments when you felt as if time was simply stretched out before you and you had no need to hurry.

  • What are you doing in these reflective moments?
  • What ties these reflective moments together?

Click here to for a printable worksheet.  

Spiritual Moments in Space

Spiritual moments in space describe young children’s play environments that are aesthetically pleasing and a beautiful space where real objects, real experiences, and rich language are intentionally provided. This type of environment is often filled with moments of wonder, awe, joy, and inner peace that can fill each child’s basic disposition.

  • What would you consider to be a beautiful learning space. What qualities would that space need?

Click here to for a printable worksheet.

Spiritual Moments in Relationships

Children with pet dogMost children enjoy interactive relationships that are not stagnant, but that change in ways that stimulate their senses, intellect, and inner person. Such moments can help children to strengthen their will to self-regulate, be mindful, and take on responsibilities such as caring for a plant or garden, a pet, or helping to keep a room clean and organized.

We all have special people in our lives.

  • Think about the special people who were important to you as a young child. What made them so important to you?
  • Who are the special people in your life now and what makes them so important to you?
  • Describe how the qualities of the important people in your life, from your childhood to now, are the same or how they have changed.

Click here to for a printable worksheet.

Spiritual Moments in and with Nature

Many research studies have been conducted on nature’s impact on human development. Kindness, respect, empathy, harmony, and being welcoming to others, are just a few of the benefits children engage in as they experience the natural world. As they explore the outdoors with nature, nature is also brought indoors for close-up exploration. Spiritual life begins with a sense of wonder, and one of the first windows leading to wonder is the natural world. In general, nature is an amazing source for wonder, awe, joy, inner-peace, and relationships. It eventually provides an environment for the emergence of big questions.

Go for a walk outdoors and look for moments that touch you spiritually.

  • Why do you think this is happening?
  • Try to put words to your feelings.

Click here to for a printable worksheet.

Spiritual moments under a large treeSpiritual Moments with Big Questions

Big questions are capable of taking one beyond oneself. When one engages in big questions, one is able to feel one’s own place within the universe. If one believes in transcendence, then a big question can take the person to that place. If one does not, the big question can provide feelings of humility, smallness, and a feeling of a place within the vastness of the universe.

Young children are capable of big questions, also. You can see the question in a child’s body posture, eyes, and expression. Through exploration of the world a myriad of questions come alive for a child. It is through big questions that a child is capable of seeing that the world exists way beyond oneself.

We all have big questions about life and how we see ourselves in the big picture!

People often have big questions involving these aspects of life:

  • Spiritual Moments
  • Caregiver Love
  • Self-Awareness
  • Mindfulness and Mindsight
  • Disposition
  • Wonder
  • Kindness
  • Openness and Imagination
  • Gratitude
  • Breath and Presence
  • The Big Picture: Spiritual Development

Although children may not be able to completely articulate their big questions, they hold curiosities and questions about how life works.

Examples might be:

  • Where does the sunlight come from?
  • Why does light go away at night?
  • Where do my shadows come from?
  • Who creates a rainbow?
  • An example of a big question from an adult might be:
  • What happens to a person when the person dies?

A Big Question can lead you to explore spirituality from a personal perspective.

  • What is one of YOUR big questions about life in general
  • that in some way involves one or more of the items listed on the prior page?
  • Why is this big question important to you?

Click here to for a printable worksheet.

The Relationship of Rituals and Spiritual Moments

Spiritual Moments boy prayingA ritual is a ceremony or regular occurrence consisting of a series of actions performed according to a prescribed order and a set time. Some common rituals are saying good morning to someone when waking up, or singing a song to a child before going to bed. One’s life is filled with rituals that strengthen one’s spirituality.

  • What are some rituals that were shared with you as a child?
  • At the time, how did you feel about those rituals?
  • How did it make you feel to participate in those rituals?
  • How do rituals strengthen your spirituality?
  • What are some of the rituals you share with a child in your life?

Click here to for a printable worksheet.

Spiritual Moments: Thought-Provoking Quotations

Spiritual moments happen every day. All you need to do is to know how and when to recognize them.

~ Ester R.A. Leutenberg

Spiritual moments are created in relationships with others, in awareness and appreciation of self, in and with nature, and in dialogue with big questions capable of taking one beyond oneself.

~ Deborah L. Schein

Click here to for a printable worksheet.

Spiritual Moments

Ideas, Activities, and Moments for All Caregivers to Share with Children

Spiritual moments can sometimes happen by chance. More often, though, they need to be created by establishing nourishing connections. Here are some ways to provide spiritual moments for the children you know, and for yourself as well. Such moments can strengthen the spiritual development of everyone. • Answer questions in a patient, thoughtful way.

  • Ask the child to tell you a story. Then, ask questions about it.
  • Breathe slowly with a young child, putting each of your hands on each other’s heart.
  • Clean up toys together.
  • Create time in the day to simply be with the child.
  • Dance together.
  • Discuss the importance of friendship.
  • Encourage quiet time.
  • Enjoy reading with a child.
  • Find a caterpillar and wonder together where it came from and what it will become.
  • Find a spider’s web and talk about it.
  • Keep play spaces decluttered and organized, but expect them to get messed up.
  • Laugh together.
  • Limit saying No when you can – offer Yes or Yes, but, and don’t be afraid to say no when it is truly needed.
  • Look at the brown on a banana and together, wonder why it’s there.
  • Notice and discuss the wag of a dog’s tail.
  • Offer children time to play alone or with other children without any interruptions.
    • Do not interfere.
    • Do not show the child what to do.
    • Do not suggest to the child to do something different than what the child has chosen to do.
    • Do not talk.
  • Pay attention to the environment, make it beautiful and inviting.
  • Play together.
  • See a shooting star, watch the moon, clouds, sunrise, or sunset.
  • Show appreciation and respect when a child repeats something over and over again.
  • Sing together.
  • Stop and smell the roses.
  • Support a child’s right to have open time to play.
  • Take time to answer children’s questions.
  • Talk about things for which to be grateful.
  • Together, look at the shadows cast by the sun.
  • Walk together.
  • Watch and discuss a worm squiggling on the ground.
  • When hearing a siren, say aloud, “We are wishing good thoughts to the person in the ambulance.”

Click here to for a printable worksheet.

Coping Styles: More and Less Skillful Defense Mechanisms and Means

Coping Styles

The following material is excerpted from

Mindfulness for Emerging Adults: Finding balance, belonging, focus, and meaning in the digital age.

By Donna Torney MA, LMHC, RYT

The identity project: Encouraging mature coping styles

Early psychoanalytic thinkers defined common defense mechanisms, more frequently known as coping styles, that help individuals regulate emotions and reach goals. These defense mechanisms are often categorized as unhealthy, immature, and mature. The Harvard Men’s Study found a strong correlation between the use of mature defense mechanisms and triumphing over adversity in adult life. Buddhists and yogis may use the terms skillful or unskillful means, or mindfully healthy and unexamined unhealthy coping behaviors. Here’s a partial list of defenses and coping styles classified as less skillful means and more skillful means along with an example of how they may show up in emerging adult life. As you read through the coping styles, can you remember using some of the less skillful coping styles? Is there a defense mechanism you still use that keeps you feeling isolated?

Coping Styles Young Man AloneLess skillful means

When the less skillful defense mechanisms are in use, we usually feel as though we have no control over our environment. These coping mechanisms are often semi-consciously employed. In an attempt to gain control, we might resort to these defenses. Unfortunately, they often create more chaos.

Less Skillful Defense Mechanism Example
Aggression/Anger An overly stressed and frustrated individual responds by punching a wall or person.
Denial Ignoring the consequences of a dangerous behavior like unprotected sex, or binge drinking.
Displacement Taking out frustrations from work on a family member.
Somatization Mental stress and anxiety are ignored, but manifest as physical symptoms.
Dissociation Mentally removing oneself from a stressful situation losing connection with people or physical surroundings.
Wishful thinking/fantasy Adopting an unrealistic view of a situation rather than facing disappointment.

More skillful means

As we gain more life experience, we often learn more skillful coping mechanisms that help us feel more in control and capable of achieving independence and connectedness. At times we need mentors to help us move toward more skillful coping styles. A person who is using denial and ignoring the consequences of heavy drinking might start to consider the more skillful means of moderation. Someone who is ignoring mental stress but experiencing physical symptoms might identify with a friend who takes daily walks to manage stress and can start building his own awareness of the connection between mind and body.

More Skillful Defense Mechanism Example
Moderation A young adult who is struggling with spending too much time playing video games with friends decides to set a weekly time limit.
Patience/Acceptance Instead of bringing frustrations from work into the home, a roommate decides to talk to her trainer at work.
Identification Instead of letting unmanaged stress cause physical symptoms, a person in recovery identifies with the story of an ex-heroin addict who takes up running.
Sublimation/Altruism Rather than feeling sad about not having a significant other, two single friends sign up to volunteer at a local charity.
Humor Realizing that final exams are causing stress and low mood, a group of friends decides to watch a comedy on Netflix.
Anticipation Foregoing a weekly dinner out to save for an upcoming vacation.
Suppression Instead of lashing out and becoming consumed with a recent break-up a young musician waits until after an important performance to process the difficult emotions.

Click here for printable version of the charts above.

Coping Styles Friends TogetherNormalizing the circling back process and filling in developmental gaps

Many emerging adults are looking for help in finding intimate, meaningful relationships with friends and romantic partners. However, coping styles often lag behind chronological age. Most emerging adults don’t spend a lot of time consciously thinking about their coping styles. In fact, in traditional psychoanalytic theory defense mechanisms are thought to be subconscious.

We are at a critical point of human evolution and cultural identity. We can look at the industrial revolution and imagine what it was like to be a young adult raised on a farm trying to make the transition to a more urban way of life. We can look at the Sixties and imagine what it was like for an emerging adult trying to make good decisions during a time of radical social change. We are again facing a sea change. The current knowledge-based, digital age is radically changing the way we live and think about ourselves in the world, not to mention the way we take care of our basic needs. There are many benefits to this new way of life, but as with any big cultural change, wise application of innovation can make the difference between a thoughtless, joyless existence and a life well-lived. Building balance, belonging, focus, and meaning early in life and facing direct experience with clarity will lead to healthy decision-making and healthy identity development for the individual and society. Speaking with elders and looking back at past innovation and our adaptation to innovation will help us make wise choices with the newest wave of technology.

Voice of an Emerging Adult
Jake: Focusing and belonging

I thought I was doing a good job taking care of myself but my boss’s comments at the end of my review were kind of a wakeup call. This time when I walk into her office I hope she notices that my clothes don’t smell and I took a shower. I thought she was judging when she first brought it up, but I could tell she was just worried that I wasn’t taking care of the basics, like scheduling in time to do laundry and eat. It’s just so hard to focus lately.

The fights with Becca are getting worse. I have a stomachache almost all the time lately. I’m so jealous of any guy she talks to. Last night our fight was so bad that I hurt my fist by punching a wall. I hope I can still play at the show tonight.

I don’t know what my problem is. I’ve been on my own since I was nineteen. I’m twenty-seven now. I always thought of myself as being super independent. So why am I so obsessive and crazy about my girlfriend? Sure, Becca and I are splitting expenses and it would be hard to live on my own. But at this point I’m ready to couch surf again. I know how to get by on almost nothing. That’s how I was able to quit my job and tour with the band last year.

It’s been a good thing to stop drinking and stay away from drugs. Last week my co-worker had me try some deep breathing exercises. They helped a little. We also talked about how much I used to like to mountain bike. I realized I’m hardly ever outside anymore. I’m trying to think of a way to get back into enjoying time on my own.

I’m still having a hard time sticking to my goals. Part of me wants to apply to the community college for sound engineering. Part of me just wants to take off and do another tour, even though we hardly break– even financially when we are on the road and the basics – like healthy food – take a hit.

Jake is typical of the many emerging adults looking for help in finding intimate, meaningful relationships with friends and romantic partners. However, Jake’s coping style was lagging behind his chronological age. Most emerging adults don’t spend a lot of time consciously thinking about their coping styles, in fact in traditional psychoanalytic theory, defense mechanisms are thought to be subconscious. The contemplative exercises in Center Points will help emerging adults become more conscious of unhealthy coping styles and move toward more skillful means of managing stress.

Voice of a Mentor
Words from Jake’s grandfather:

Imagine what it was like to be young 65 years ago. It’s hard for me to watch Jake struggle. But when I was his age I was already a manager at the paper mill, was married, and Jake’s dad was on the way! It wasn’t easy but I can remember feeling proud. We had a good group of neighbors – some stayed our neighbors for fifty years! We didn’t get our first television until 1960. It seems every time Jake visits me he has a new gadget! Sometimes I get frustrated with Jake. Those tattoos! And I thought his dad was wild! I consider myself a modern thinker. Hell, I have a tattoo from the Navy. It was just  our way of bonding. Even an old guy like me can see all the changes. I read the papers. I can see how hard it is for Jake’s generation. I can also see how my wife may have been frustrated with being a housewife, raising three kids without access to a car every day. But it seems like Jake and his friends have fewer opportunities. We could buy a house on one income and easily pay it off on my manager’s salary. Not so for Jake and his friends.

A flexible identity

Identity formation is a life-long process. A healthy, flexible identity can serve as a resting place, a place where we can practice direct experience with pleasure, or at least with less discomfort. There are aspects of Buddhism and yoga that foster healthy human development. Combining these aspects with newer theories in Western psychology such as positive psychology and modern neuroscience make these ancient practices accessible and practical for use in everyday young adult living.

The rules of finding intimacy have changed drastically due to online dating and digital overload. The idea that someone looks good on paper but is completely different in person is a real challenge for young adults. Furthermore, in the digital age, emerging adults are bombarded with images, many unrealistic, about what a healthy, happy relationship should look like.

Voices of Emerging Adults
Tracey – Balancing outside expectations with personal goals, and formulating a genuine identity.

I thought once Peter and I got engaged and I had a good first job that I would feel more confident. But lately I’ve been so anxious. That’s why I decided to call Donna. I stayed home from work last Monday because I was overwhelmed with the wedding plans. I am trying to manage what my parents expect and what I really want. I just can’t keep letting my emotions get the best of me!

I’ve also been kind of hiding from my friends. I don’t understand why I can’t let go of other people’s standards and just live my own life. I have a great job and I just got a small raise. I’m just about the only one of my friends who can pay for an apartment and pay for my student loans. Why can’t I just relax?

Donna told me that I was sitting as still as a statue in our first session. The deep breathing has helped me relax a little and sleep better. I’ve stopped missing work but now I’m having doubts about Peter, which is really freaking me out!

I know everyone thinks we are the perfect couple. From the outside, everything looks ideal. We’ve been dating since sophomore year, and we are great friends. I really am a relationship person. I can’t deal with the thought of going back to online dating. Plus almost all my friends are getting married now.

Donna asked me to do a couple of exercises to help me think about my strengths, and things I value. I realized that I never work on my art anymore! I used to love going to museums and taking art classes. In fact I was hoping I could add more design work into my job description.

It’s just that Peter doesn’t like art that much, and I really don’t like doing things by myself. Like I said, I’m a very social person. I guess I really have been using this relationship to hide from my anxiety about being alone. Ugh! I can see now that the anxiety won’t go away if I keep running away from it and trying to make everyone happy.

Craving/grasping and aversion/avoidance:

Mindfulness for Emerging AdultsEmerging adults’ anxiety often increases at the same rate as the emerging craving to be able to express one’s true self. When a young adult has reached a point of discomfort then he or she is more willing to explore coping styles. Without an honest exploration of true identity and personal values we are all susceptible to getting caught up in what Buddhists and yogis identify as the suffering of clinging to ideas at one extreme, and the unhappiness of avoidance of experience on the other.

Every generation of emerging adults has faced its own particular flavor of clinging and avoidance. For those reaching adulthood in the digital age clinging might show up as unhappily and hypervigilantly checking Facebook for status updates, or clinging to media-driven ideas of work, friendship, and family. Avoidance can manifest as a rigid and anxious stance against new ideas that might prevent exploring reasonable opportunities.

Click here for Breathing for Balance exercise.

Click here for Mood Mapping exercise.

Understanding PTSD as we Honor Veterans

Saturday, November 11 is Veteran’s Day. As we pause in our busy schedules to thank those who have served our country, we must remember that many returning from deployment come back suffering from Post-Traumatic Stress Disorder or PTSD. Let’s take a few moments to review our understanding of this often devastating condition. The following information was excerpted from Veterans: Surviving and Thriving after Trauma by Ester R.A. Leutenberg & Carol Butler, MS Ed, RN, C.

Exposure to combat, witnessing death and destruction, and other trauma can lead to common reactions that resolve soon. When reactions persist over time they become PTSD symptoms. Many veterans have an array of post-traumatic stress symptoms. These symptoms may not rise to the level of a formal diagnosis. Nevertheless, they may significantly hinder the joy and quality of daily living and need to be addressed. They can include:

  • Anxiety, the fight or flight reaction, freezing with fear, being jumpy and watchful
  • Sadness or depression, crying, lack of interest or enjoyment, self-isolation, fatigue
  • Guilt and shame: The serviceperson feels they could have done more; they feel guilty because they survived when others did not
  • Irritable and angry about being treated unfairly, low levels of patience, overreacting
  • Behavior changes, increased substance use, reckless driving, self-neglect

Symptoms of PTSD for the person who experienced or witnessed an event involving actual or threatened death or serious injury and responded with intense fear, helplessness or horror, include the following:

  • Re-experiencing or reliving the event with the same terror, images, thoughts, perceptions; dissociative flashbacks, nightmares, illusions, hallucinations
  • Intense psychological distress reaction to triggers which are internal or external cues that resemble an aspect of the trauma
  • Avoiding reminders – people, places, things such as crowds, cars if their convoy was attacked, fireworks, keeping too busy, and not addressing related thoughts and feelings, and not talking about traumatic experiences
  • Numbness, feeling shut-down, detached or estranged from others, not feeling affection or joy, inability to recall aspects of the trauma, diminished interest in formerly significant activities, harboring a sense of foreshortened future, not expecting a normal life-span
  • Hyper-arousal, easily startled, poor sleep patterns; irritability or anger outbursts, hyper-vigilance, (on guard)
  • Feeling lost, alone, distrustful, awkward, and afraid most of the time

Veterans are at greater risk if they had earlier trauma such as child abuse, mental illness, a family history of emotional problems, poor support system, limited education, or other recent life changes.

PTSD often leads to self-medicating through substance abuse, employment and relationship problems, hopelessness, depression, despair, shame, aggression and suicidal ideation.

People may not seek help due to the perceived stigma of mental illness, long waits for treatment, denial, or cultural factors such as being stoic versus false a perception of weakness if asking for help.

When family members suggest getting help veterans are urged to follow through to respect their loved one’s concerns.

Denial is a common response yet tough people suffer symptoms, not always combat-related. Victims of abuse, accidents, and natural disasters are at also at risk.

Physical reactions may involve chronic pain, heart palpitations, trouble breathing, profuse perspiring, stomach upsets, and other bodily reactions to anything that reminds the person of the stressful military experience.

How do we open a discussion with a Veteran about the possibility that they may be experiencing PTSD? The following are tips from the U.S. Department of Veterans Affairs, and were retrieved on Nov. 7 from

  • Be respectful and calm during conversations.
  • Be patient ‒ it usually takes more than one conversation before most people accept the idea of seeking care.
  • Don’t argue or attempt to talk a Veteran out of their feelings, thoughts, and/or emotions
  • Allow the Veteran in your life to decide whether or not they want to talk about what they have experienced or what they are currently dealing with. If they don’t, that’s okay. Let them know the door is always open and you’re willing to listenwithout offering advice or suggestions.
  • Do not take the Veteran’s social withdrawal or isolation personally. Be willing to invite them and accept that they may not want to participate. Let them know they are welcome to change their mind.
  • Avoid giving advice unless the Veteran specifically asks for it.
  • Minimize distraction during conversations with the Veteran by turning off phones, TV, radio, etc. Be willing to limit conversations to 10 to 20 minutes at a time, if necessary. Think small steps.
Joseph Ambrose, an 86-year-old World War I veteran, attends the dedication day parade for the Vietnam Veterans Memorial. He is holding the flag that covered the casket of his son, who was killed in the Korean War.

Joseph Ambrose, an 86-year-old World War I veteran, attends the dedication day parade for the Vietnam Veterans Memorial. He is holding the flag that covered the casket of his son, who was killed in the Korean War.

Help your Veteran to feel more comfortable and be aware of potential triggers that may aggravate a Veteran’s heightened alertness, such as loud noises on TV, fireworks, a car back-firing, etc.

  • Remind yourself that it’s not about you. Be patient when a Veteran is struggling with feelings, emotions, stress, and so on.
  • Talk about your feelings and encourage the Veteran to share their feelings about what is going on without forcing the issue.
  • Validate the Veteran’s feelings if they are willing to share them by simply listening, rather than offering advice.
  • Try to build in some enjoyable activities with the Veteran in your life on a regular basis.
  • Encourage sticking to schedules and routines.
  • Don’t force a Veteran into social outings. If they agree to go, plan ahead in case they feel uncomfortable and want to leave.

The U. S. Department of Veterans Affairs also reminds caregivers to take care of themselves. You can’t help your Veteran if you are exhausted.

  • Engage in activities you enjoy that help you tolerate or decrease stress.
  • Educate yourself about mental health problems.
  • Consider getting your own counseling and mental health support.
  • Join a support group or talk to others who are struggling with similar issues.

Thank you to all of those who have served our country in the military: The Marines, Coast Guard, Army, Air Force, Navy, and National Guard. Whether a deployed soldier in Afghanistan or a helper in a flood in Texas or a fire fighter in the West, we owe our appreciation, support, and understanding.

Chronic Sleep Problems Affect 50 To 70 Million Americans

50 to 70 Million Americans Struggle with Chronic Sleep Problems

Excerpted from Coping with Sleep Issues Workbook
By Ester R.A. Leutenberg and John J. Liptak, EdD

Man with sleep problems rubbing eyeMost people, at one time or another, have experienced trouble falling asleep or staying asleep. Inability to sleep occasionally is normal and is often the result of some sort of stress in life. However, when sleep problems become a regular occurrence and begin to affect one’s ability to function in daily life, the person may have developed a sleep disorder.

A lack of adequate sleep may not seem like a big problem, but it can seriously affect one’s performance at school or work, ability to concentrate, ability to control emotions, and ability to handle stress. Lack of sleep is a challenge to one’s own general health and well-being.

Adequate sleep is a great buffer that helps to protect people from everyday stress. Sleep is a vital support for one’s ability to rejuvenate the mind and body.

Any type of sleep deficiency can seriously increase one’s vulnerability to a variety of physical disorders and to a host of negative feelings, emotions, and behaviors such as:

  • anger
  • anxiety
  • frustration
  • irrational thinking
  • irritability
  • sadness

Inadequate sleep can result from two things:

  • A reduction in the amount of sleep one experiences. This occurs when people find that they are not sleeping enough hours each night.
  • A reduction in the quality of sleep one is receiving. This occurs when people find that they are having a hard time falling asleep, often awaken, and then may difficulty going back to sleep. This reduction causes a dramatic break in the sleep cycle.

Click here for a printable handout: What is the Sleep Cycle?

Over the years many folks have written about getting a good night’s sleep. Here are a few. Journal a few lines about each one and how you feel about it. Do you have other favorite quotes about sleep? Jot them down in your journal and write about how you feel about them. It is important to understand your (and your client’s) attitude to sleep problems so you can provide a guide to better sleep that may include anything from easily made changes to routines to participating is a formal sleep study.

Woman with chronic sleep problems

Control what you can control. Don’t lose sleep worrying about things that you don’t have control over, because at the end of the day, you still won’t have control over them.

-Cam Newton

Though sleep is called our best friend, it is a friend who often keeps us waiting.

-Jules Verne

If you have difficulty sleeping or are not getting sleep or sleep of good quality, you need to learn the basics of sleep hygiene, make appropriate changes, and possibly consult a sleep expert.

-Andrew Weil

Sleep is the best meditation.

-The Dalai Lama

My father said there are two kinds of people in the world: givers and takers. The takers may eat better, but the givers sleep better.

-Marlo Thomas

Click here for a printable worksheet on quotes about sleep for your clients.

Possible Causes of Sleep Problems

Some clients feel overwhelmed when they try to analyze why they are having trouble sleeping. There are so many possibilities. This list of suggestions can help them narrow down the choice. For example, this is a list of possible causes of sleep problems.

  • Acid reflux
  • Allergy
  • Anger
  • Anticipation that something might happen
  • Certain medications
  • Anxiety
  • Bedroom cluttered
  • Caregiving responsibilities
  • Disappointments
  • Disease
  • Electronics (tablet, cell phone, games) in bedroom
  • Emotional stress
  • Family issues
  • Fearfulness
  • Friend relationships
  • Frustration
  • Grief
  • Guilt
  • Hot flashes
  • Hurt feelings
  • Indecisive
  • Isolation
  • Jealousy or envy
  • Job issues
  • Medical issues of self or loved one
  • Mental health issues
  • Overwhelmed
  • Partner
  • Phone use in bedroom
  • Physical ailment or pain
  • Regrets
  • Relatives or in-laws
  • Sadness
  • Social life
  • Stimulants
  • Substance abuse
  • Suspicions
  • Time constraints
  • Too warm or cool in the bedroom
  • Trauma
  • Uncomfortable bed and/or pillow

Click here for a printable worksheet version.

Man with chronic sleep problems asleep at the wheelSuggesting small changes that can make a difference is a good start. Some are more difficult to achieve than others. Start with the easier ones and move on from there.

  • Avoid alcohol, nicotine, or caffeine before bedtime
  • Avoid extreme exercises before bedtime
  • Avoid rich and spicy foods before bedtime
  • Be sure the bed, mattress, and temperature are comfortable
  • Do easy stretches before bed
  • Do something mildly stimulating after dinner to avoid falling asleep too early
  • Don’t watch scary television shows before going to sleep
  • Drink enough fluid at night so as not to wake up thirsty, but not so much that you frequently need to go to the bathroom
  • Eat nothing or something light before bedtime
  • Eliminate loud noises
  • Engage in deep breathing exercises
  • Enjoy a pleasant book on tape
  • Get up at the same time each day
  • Go to sleep at the same time each day
  • Have the same sleep routine on weekends
  • If something is on your mind, write it on a paper next to your bed and then fall asleep
  • If you wake up and can’t fall back asleep in 30 minutes, get out of bed until you are tired enough to sleep
  • Consume no caffeine after noon time
  • Keep the bedroom cool
  • Listen to relaxing music
  • Maintain a bedtime routine
  • Make preparations for the next day before going to bed
  • Meditate
  • Nothing in the room but sleep and intimacy
  • Progressive relaxation exercise
  • Read a pleasant book or magazine
  • Save vigorous exercise for during the day
  • Stay away from big meals close to bedtime
  • Take a nap way before bedtime
  • Take a warm bath or shower before bed
  • Take prescribed medications
  • Turn off electronics or technology (other than an alarm clock, turned backwards)
  • Use earplugs to block out noise
  • Use guided imagery
  • Wind down the evening with a favorite hobby, calm music, fun television, or book
  • Write in a journal

Click here for a printable worksheet version.

According to the U.S. Centers for Disease Control, an estimated 50 to 70 million Americans face chronic sleep problems. Sleep deprivation is associated with injuries, chronic conditions such as obesity, mental illnesses, poor quality of life, increased healthcare costs and lost work productivity.

Tired eyeMost adults require seven to nine hours of sleep each night. Getting less than that daily amount can cause a serious sleep deficit over time. While some sleepless nights may be the result of too much caffeine or thinking about something that’s worrying, chronic sleep deprivation is often the result of a sleep disorder such as:

  • Delayed Sleep Phase Disorder is a disorder in which a person’s sleep is delayed by two or more hours beyond the conventional bedtime. This delay in falling asleep causes difficulty in waking up at a desired time.
  • Insomnia is the most common type of sleep disorder. Some of the symptoms of insomnia include difficulty getting to sleep, waking many times during the night, and often waking before it is time to actually get up. Insomnia can affect normal daytime activities. Insomnia is most often caused by stress, anxiety, certain medications, depression and/or inadequate sleep habits.
  • Narcolepsy occurs when people feel excessively sleepy in the daytime. The sleepiness felt with narcolepsy is overwhelming. Some people with narcolepsy have uncontrolled sleepy periods that can occur regardless of what they are doing, while others have constant sleepiness throughout the day. The person has this feeling for a period of time longer than three months, and it is accompanied by a higher than usual percentage of REM sleep.
  • Nightmares are frightening dreams that occur during deep, REM sleep.
  • Periodic Limb Movement Disorder is the movement of hands, arms, feet, and legs during sleep that frequently causes arousals and disturbs the sleep cycles. Whether the person remembers waking or not, the brain often shifts from sleep to wake in a response to the jerking of the limbs causing the sleep cycle to be disrupted and increase excessive daytime sleepiness.
  • Restless Leg Syndrome occurs during wake hours and is often worse in the evenings and before bedtime, which can lead to sleep onset insomnia. This discomfort can come in the form of an urge to move one’s legs and feet to get relief. People find themselves experiencing excessive and rhythmic movements while they are sleeping.
  • Sleep Apnea occurs when soft tissue covers the airway, either partially or completely, causing a cessation of breathing for ten seconds or longer repeatedly through the night. This can cause frequent arousals and disruption of the desired sleep cycle. These disruptions cause those suffering from sleep apnea to be very tired during the day.
  • Sleep Talking is a sleep disorder defined as talking during sleep without being aware of it. Sleep talking can involve complicated dialogues or monologues, complete gibberish, or mumbling. The good news is that for most people it is a rare and short-lived occurrence.
  • Sleep Terror Disorder occurs mostly in children, but can be found in adults. Night terrors are frightful images that appear in a person’s dreams, but are often difficult to remember upon awakening.
  • Sleepwalking is a disorder that causes people to get out of bed and walk while they are sleeping. It usually happens when a person is going from the deep stage of sleep to a lighter stage, or into the wake state. The sleepwalker can’t respond during the event and usually does not remember it.

Clients suffering from serious sleep disorders might be helped by a visit to a sleep center. Contact the American Academy of Sleep Medicine at to find an expert near you.

Coping with Sleep Issues Workbook and Card DeckA book such as Coping with Sleep Issues Workbook from where most of this material has been excerpted can be of invaluable help to you and your clients. It can be found at



Excerpted from Mindfulness for Emerging Adults: Finding balance, belonging, focus, and meaning in the digital age

By Donna Torney MA, LMHC, RYT

Mindfulness has become a household word in popular culture causing some of us to see it as just another fad. But emerging adults can trust in mindfulness practices thanks to the large body of scientific evidence proving the benefits of this once esoteric idea. Recent studies have shown that mindfulness practices can help us manage stress and anxiety, better communicate with friends and co-workers, and build our ability to give and receive love and compassion.

Emerging Adult in a moment of MindfulnessMost researchers define mindfulness to include these two main components:

  1. Mindfulness is the practice of bringing yourself back to the present moment, over and over. Our minds are wired to have a sometimes anxiety-provoking bias toward planning for the future or remembering the past. Mindfulness practices tame this bias.
  2. Mindfulness is reacting to the present moment without judgment. Mindfulness practices help us build the capacity to notice, without self-criticism, when we lose sight of the present moment.

One emerging adult I work with describes mindfulness as the ability to be with one’s current set of circumstances without freaking out. She tells me that mini-mindfulness breaks at her workplace help her notice when she is having an automatic negative reaction to a situation, something that was getting in the way of her success at work. By employing mindfulness she found that she was better able to stay open to present moment experience in a way that helps her feel less threatened by new people and places. This skill, in turn, helps her with making conscious choices about her future and building more successful connections with peers.

Starting in the mid-20th century, in a time when millions of people were healing from the aftermath of two world wars, theories that elaborate on optimum human development began to emerge. These theories expanded on child development to acknowledge that adults continue to grow and evolve psychosocially way beyond the point of reaching full physical maturity. But this perpetual maturing only happens if we are willing to continue learning from life experiences and adapt in healthy ways – a process that demands mindfulness.

Erikson’s stages of psychosocial development

Young man emerging adult on campusErik Erikson’s classic model of psychosocial development has been used as a frame for exploring human growth beyond childhood by many prominent social scientists. Erikson’s model measures timeless developmental struggles and serves as a good frame when thinking about using contemplative exercises to foster positive adult maturity. Erikson went well beyond Freud’s focus on unconscious drives, seeking to legitimize theories of human altruistic potential.

Most scholars of human development see Erickson’s stages as flexible, to be expanded or contracted based on current cultural norms. They are not necessarily completed fully and sequentially. As balance is gained in one area of psychosocial development, it will affect the next area. This is good news! Life presents many twists and turns and often we must abandon straight-forward developmental maturity in order to survive. The beauty of Erikson’s model is that it acknowledges that individuals can circle back and revisit certain developmental processes.

Summary – Erikson’s stages of psychosocial development
Life stage Conflict Resolution or value attained Manifestation in adult life Example
Infancy (0-1 year) Learning basic trust vs. mistrust Hope Appreciation of human interdependence I accept help and trust that it is available.
Early childhood (1-3 years) Autonomy vs. shame and doubt Will Acceptance of the life cycle and impermanence I can manage disappointment
Play age (3-6 years) Initiative vs. guilt Purpose Humor, resiliency, compassion I don’t take myself too seriously; I take time to enjoy life.
School age (6-12 years) Industry vs. inferiority Competence Humility, accepting unfulfilled hopes I have both strengths and weaknesses.
Adolescence (12-19 years) Identity vs. role confusion Fidelity Merging of complex thought and emotions I take both emotions and logic into account.
Early adulthood (20-25 years) Intimacy vs. isolation Love Acceptance of the complexity of long-term relationships, openness, loving-kindness I am willing to work to maintain important relationships.
Adulthood (26-64 years) Generativity vs. stagnation Care Caring for others, empathy and concern My life has more meaning when Icare for my community.
Elderhood (65+ years) Ego integrity vs. despair Wisdom A sense of identity and integrity that tempers physical limitations I feel content and I accept the aging process.


A printable version of this chart can be found here.

The famous Harvard-Grant Study of Adult Development uses many of Erikson’s ideas. The Grant study followed a cohort of men who entered Harvard in the late 1930s, along with other less privileged young men. For over seventy-five years, this study has measured everything from blood pressure, to alcohol intake, to coping styles, and more recently, to brain activity. The study compares these measurements with the participant’s satisfaction and success in work and in relationships. Researchers involved with this longitudinal study are still collecting data and refining its findings on test subjects who are now in their eighth decade of life.

Most scholars of human development see Erickson’s stages as flexible, to be expanded or contracted based on current cultural norms. They are not necessarily completed fully and sequentially. As balance is gained in one area of psychosocial development, it will affect the next area. This is good news! Life presents many twists and turns and often we must abandon straight-forward developmental maturity in order to survive. The beauty of Erikson’s model is that it acknowledges that individuals can circle back and revisit certain developmental processes.

Mindfulness for Emerging Adults Book Release

Because of the current elongated road to adulthood, (see “Are We There Yet”) there is often a blending; some might say a clash, of the adolescent and emerging adult developmental milestones of finding identity and finding intimacy. George Vaillant, long-time director of the Harvard-Grant study, states that we must first master identity before finding true intimacy. Vaillant defines mastery of identity as achieving economic, social, and ideological independence from one’s parents.

Mindfulness for Emerging Adults: Finding balance, belonging, focus, and meaning in the digital age By Donna Torney MA, LMHC, RYT is a new Whole Person Associates book. Now available for order at

Using Poetry to Explore Thoughts and Feelings

Creating a Healthy Balanced Life WorkbookPoetry exercises excerpted from Creating a Healthy Balanced Life

By Sandra K. Negley, MTRS, CTRS and Ester Leutenberg

Looking for an interesting way to lead your clients as they explore their thoughts and feelings? Something different and introspective? Try poetry.

Poetic Thoughts and Feelings – exploring through poetry

One creative way to explore thoughts and feelings is through the writing of poetry. Don’t worry, this does not mean a person has to be a great poet or writer to have fun with this unique and ancient art form. The key is to be open, enjoy, explore, and look soulfully at one’s deeper thoughts and feelings. Writing poetry can assist a person to focus thoughts, stop circular thinking, and begin to look at life from a different perspective. A variety of creative writing techniques will work with most people and most ages; here are four styles to initiate participants’ creative thinking.

Technique #1

Haiku is a unique ancient Japanese style of writing that uses 17 syllables divided into 3 lines of 5, 7 and 5 syllables.

River inspiring poetryExample:

River flows gently

Water moves sand and rock

Forgiveness begins


Technique #2

Five-line poetry while similar to Haiku is less restrictive and for some allows a more creative exploration.

Title of Topic (1-word) Describe Topic (2 words) Action Occurring (3-words) Feelings—how it makes you feel (4-words) Summary (1-word)



Honesty, acceptance

Evolving through time

Creating more fulfilled experiences



Technique #3

Pass Around Poem

A fun exercise in poetry writing can come from a less threatening approach that lends itself to creative and critical thought. This opens the door for participants to have interesting and inquisitive discussions on the coincidences in life.

Poetry book and notebookInstructions: Distribute one poetry book, a pen, and one piece of paper to each participant. Instruct participants that when you say, “start” they will follow this process:

  1. Close your eyes
  2. Open the book
  3. Place one finger on a spot in the book
  4. Open your eyes
  5. Write a line of poetry from where your finger landed (one line)
  6. Give participants an example

The facilitator gives participants 30 seconds and then says “pass.” Participants will pass their book to the right and repeat the process. The number of lines of the poem will be determined by the number of participants. (Keep in mind some people may need more time than others, waiting can be unsettling and/or break the magic with boredom. Consider facilitating with smaller groups.)


Technique #4

An I Am Poem can be used as an introspective exercise for participants to increase self-awareness while also connecting with other members of the group. The I Am Poem is a creative way to also teach and explore current issues, science, art, and conceptual thoughts. There are two ways to approach this form of writing:

Form One — Instruct the participants that to write this poem only requires one instruction; each line of the poem must start with “I am . . .” The poem can be as long as they choose and reflect as much about themselves as they would like to share. The poem may include such things as gender, ethnicity, interests, family traditions, mottos, memories, or future goals. Encourage participants to be creative in defining who they are and how they express themselves. Remind them that it does not have to rhyme.

Example Format:

I am a woman

I am multidimensional

I am strong and industrious

I am vulnerable and emotional

I am an advocate for individuals with disabilities

I am a listener

I am a mother, grandmother, teacher, friend

I am a woman


Form Two — This poem follows a more directed and structured format. Begin with the I am statement — two characteristics of the person. This statement can be repeated throughout the poem as a line opener and then repeated as the last line of the poem. The writer can have as many stanzas to their poem as they choose. As the facilitator, you can prepare a format for participants or you can list a variety of suggestions and let participants develop their own format.

Example Format:

I am (characteristics of the person)

I wonder (something the person or thing could think or be curious about)

I hear

I see

I dream

I am (If you wish repeat first line of the poem, every 4-5 statements)

I fear

I love

I understand

I hope

I am (end poem with this line)

Additional Suggestions

I care                     I feel                      I want                     I touch

I pretend               I respect                I cry                       I laugh

I worry                   I unfold                  I release               I forgive

I say                        I hope                    I honor

Thrive Behavioral Coping Skills for Teens

Teens ~ Out-of-the-Box Coping SkillsExcerpted from Teens ~ Out-of-the-Box Coping Skills

By Ester R.A. Leutenberg & Carol Butler, MS ED, RN, C

It’s already August. Teens, whether they have been working, getting ready to go away to college, or just hanging about the house, are bored. They grunt in response to questions, don’t want to go anywhere with the family (pa-leeease, Mom!), have their noses in social media of all kinds at all times, and are, in general, no fun to be around.  They need to find some way to cope with the last of summer. We need them to find a way to cope.

Assuming that they already have a firm foundation in the coping skills we teach to our teens, let’s take it a step further and take a look at how teens can thrive by becoming part of a larger cause. We can guide participants to interact with their community by engaging in activities they are passionate about.

I’ve come to believe that each of us has a personal calling that’s unique as a fingerprint – and that the best way to succeed is to discover what you love and then find a way to offer it to others in the form of service, working hard, and also allowing the energy of the universe to lead you.

-Oprah Winfrey

Poems About the Earth

Clean it Up

Clean up the earth,
so it could be a sparkling clean place for us all!
Clean up the earth,
so we can see the gorgeous blue and green on our planet.
The blue and green will shine in our eyes if we clean it up.
So clean it up,
so that we don’t see any garbage ~
any time or any day.
Clean it up
and live in a world of happiness.
The world we live in can be cleaned up and we can be happy!

-By Allie ~ 9 years old from
Ms. Siegelman’s Third Grade Class
Nassakeag Elementary School – Long Island, NY

In the Future, My World …

I will live in a country of my own making.
In the future,
Environmental destruction will be the norm.
No longer can it be said that
My peers and I care about this Earth.

-Excerpt from The Lost Generation by Jonathan Reed

Before the session begins, place a small globe or a picture of the earth in a covered box.

  • At the start of the session, have a volunteer take the picture out of the box and show it to the group.
  • Ask the participants what is represented (our world).
  • Ask what it means to live in one’s own little world. (Caring only about oneself and one’s close associates.)
  • Point out that teens might have a wider view of the world – school, community, etc.


Distribute the handout of Earth Poems. (Click here for printable handout.)

  • Have a volunteer read Jonathan Reed’s poem aloud.
  • Ask the participants what it means to them. Discuss.
  • Have another volunteer read it again, this time from the last line to the first. (Not each word, each line.)
  • Ask the participants what it means now.
  • Why did the poet want us to hear it both ways?
  • Which way do the participants want to see going forward?
  • Can we achieve this?
  • Ask participants for suggestions on how we can achieve a world where environmental destruction will be rare and folks will care for and cherish the earth.


Point out the list of causes on their handout. Ask what other causes might be added to the list.

Animal advocacy Health issues School
Children’s needs Homeless assistance The arts
Community Literacy Veterans
Cultural rights and equality Political issues Violence prevention
Faith-based organizations Safety


  • Ask them to choose a cause and write a poem about it. As they see from the examples, the lines do not have to rhyme, nor does the rhythm need to sound like that of Robert Louis Stevenson. Write their thoughts about an issue important to them and that causes them concern.
  • Have volunteers read their poems aloud. It might help to write one of your own and read it first to break the ice.
  • Discuss what ways there are to use their various abilities to support their chosen cause.
  • Debate the pros and cons of peaceful demonstrations.
  • Identify other ways a message might be conveyed.
  • Discuss how to raise funds to support a cause.
  • Identify the benefits received from volunteering.
  • Help each participant create and share a plan to follow through on advocacy or humanitarian efforts they care about.
  • Discuss the value of volunteering for a charity, faith-based or public service organization? Does it negate your contribution if you benefit as well as your cause?

Enrichment Activities

 Initiate discussion about these questions; possible responses are in italics.
  • How can teens use their artistic or literary skills to promote their causes?
Posters, postings, and pictures on social media, letters to editors, petitions, etc.
  • I what other ways can a message be spread about a particular need?
Songs, movies, television programs, documentaries, stage plays, etc. about the topic.
  • What are the pros and cons of parades and peaceful demonstrations?
Pros – publicity, educate the community. Cons – may be difficult to organize.
  • What are some ways to raise funds?
Sales (baked goods, rummage, etc.), services (cut lawns, wash cars, etc.). Donate the proceeds.
  • What is the value of volunteering for a charity, faith-based or public service organization?
 A natural high from helping others, make like-minded friends, work experience for a resume.
Prompt teens to make plans to follow through on one or more of their ideas. 

Post Traumatic Stress – Grief and Survival Guilt

Grief and Survival Guilt

As veterans make the transition from deployment to civilian life, from military housing to home, from loneliness to being in the heart of their family they often experience grief and survival guilt. Survival Guilt JournalingIf you are doing this exercise with a group, ask them to share what the phrase “shock and awe” means to them both as a military term and as a generic phrase. If you are doing this exercise alone, journal about what the phrase means to you. Remember, journaling is for your eyes only. Don’t worry about your writing style. Just jot down your thoughts as they come to you.

The death of a comrade in arms or the death of anyone close to you often leads to feelings of being overwhelmed, of not having the strength to go on, of feelings of guilt…why am I here and he/she isn’t.

Read the following with your own feelings in mind.

Excerpted from Veterans: Surviving and Thriving after Trauma

By Ester R. A. Leutenberg and Carol Butler, MS Ed, RN, C

Shock and Awe

Shock and Awe is a military doctrine of rapid dominance; the use of overwhelming power and spectacular force to paralyze the enemy’s perception of the battlefield and destroy their will to fight.

  • Shock, disbelief and denial are usually the first reactions to death.
  • Awe involves fear and dread, natural reactions to loss, especially sudden death.
  • You may grieve the loss of your former identity, the loss of innocence after combat, the loss of a dream if you change careers due to emotional or financial problems, and so on.

The grief process is individualized. Stages have been theorized, but people do not go through all the same stages and no specific time frames exist.

Elizabeth Kubler-Ross named five stages of grief:

  1. Denial, a defense mechanism that buffers immediate shock.
  2. Anger, we resent the pain and loss, and then are guilty about being angry.
  3. Bargaining, If only I had been better toward them; or if they are still alive, we tell our Higher Power, if they are saved I promise …
  4. Depression, sadness, about practical concerns and the loss.
  5. Acceptance, new normal, easier after a long illness or advanced age; harder to accept when a soldier dies in the prime of life.

GriefWork ~ Healing from LossGriefWork ~ Healing from Loss lists three markers along the Healing Pathway:

  1. Shock ‒ The reality of the loss has not sunk in.
  2. Disorganization ‒ The reality of the loss is real.
  3. Reorganization ‒ Rebuilding a satisfying life ‒ a New Normal.

Survival Guilt compounds grief among many veterans.

  • Some ask, why wasn’t it me who got hurt or killed.
  • Some take responsibility or blame, it’s my fault.
  • Some think, the dead person deserved to live and I deserved to die.

Survival Guilt can be mitigated if you accept the following statements to be true:

  • Admit to your feelings
  • Realize that survival guilt is common, but not comfortable
  • Seek others who understand, veterans, support groups, family
  • Mourn the loss, possibly having a ceremony or some other way to commemorate the person’s life
  • Act and live as they would have advised; make a contribution, hold a fundraiser, give blood, time, and energy to the causes they believed in

Warning Signals

Some symptoms are dangerous and require professional help. Make note of those symptoms of depression or complicated grief that apply to you.

  1. Thoughts of harming or killing yourself or others.
  2. Inability to trust yourself or others.
  3. Persistent belief that you deserve(d) to die.
  4. Inability to function months after the death; cannot perform at work or school; unable to care for children or household responsibilities.
  5. Severe depression and hopelessness about the future; feeling worthless.
  6. Inability to eat or sleep or take care of personal health and hygiene.
  7. Feelings of extreme guilt, rage or bitterness.
  8. Substance abuse, including taking higher than recommended doses of prescribed medications.
  9. Extreme physical reactions like nausea, aches and pains, lowered immunity.
  10. Very slow thinking, speech, and body movements.
  11. Seeing or hearing things that are not there.
  12. False beliefs that the person still lives; searching for them, or thinking you recognize them in familiar places.
  13. Envy toward others who are not suffering, or not caring about others.

Veterans front cover*Here are two exercises from Veterans: Surviving and Thriving after Trauma that may help those working through grief and survivors guilt:

Carry the Torch

Shock and Awe – Journaling Suggestions

May is Mental Health Awareness Month

Mental Health Awareness

Excerpted from Managing Moods Workbook, by Ester R.A. Leutenberg and John Liptak, PhD

Managing Moods WorkbookMay is Mental Health Awareness Month. It is important that facilitators keep an open mind about mental health issues and the stigma attached to people experiencing these issues. Rather than thinking of people as having a mental disorder or being mentally ill,  Erasing the Stigma of Mental Health Issues through Awareness helps facilitators to diminish the stigma that surrounds people suffering from these issues. Stigmas occur when people are unduly labeled, which sets the stage for discrimination and humiliation.

People who stigmatize and /or stereotype others bring about unfair treatment. This unfair treatment can be very obvious. For example, people make negative comments or laugh. On the other hand, this unfair treatment can be very subtle. For example, people assume that a person with mental health issues is dangerous or violent.

Stigmas affect a large percentage of people throughout the world. Some of the more common stigmas are associated with physical disabilities, mental health conditions, age, body type, gender, sexual orientation, nationality, family, ethnicity, race, religion, financial status, social sub-cultures and conduct. Stigmas set people apart from society and produce feelings of shame and isolation. People who are stigmatized are often considered socially unacceptable and they suffer prejudice, rejection, avoidance and discrimination.

Mental Health Awareness – An Introduction to Stigmas for your Clients

Intense Anxiety - Mental Health AwarenessA stigma is extreme social disapproval of some type of personal characteristic or a belief that is not considered socially acceptable. Fear of judgment and ridicule about mental illness often compels individuals and their families to hide away from society rather than face criticism, shunning, labeling and stereotyping. Instead of seeking treatment, they struggle in silence. Here are some ways you can combat the stereotypes and stigmas that are associated with mental illness.

  • You and your loved ones have choices. You can decide who is to know about your mental illness and what to tell them. You need not feel ashamed or embarrassed.
  • You are not alone. Remember that many other people are coping with a similar situation.
  • Seek help and remember that treatment from medical professionals can help you to have productive careers and live satisfying lives.
  • Be proactive and surround yourself with supportive people – people you can trust. Social isolation is a negative side effect of the stigma linked to mental illness. Isolating yourself and discontinuing enjoyable activities will not help.

Mental Health Awareness Month – Printable Exercises

DE-STIGMA-TIZE with the Facts About Mental Health Issues

Myth: Mental health issues are rare.
Fact: Mental health issues are not rare and affect nearly everyone either directly or indirectly.

Myth: People with mental health issues are unable to lead productive lives.
Fact: Most people with a mental health issue respond to treatment, learn to cope with and manage their problems, and go on to lead productive and fulfilling lives.

Myth: People who have mental health conditions will not get better.
Fact: Once diagnosed, mental health issues are treatable. While they are not always cured, they can be managed effectively. Most people with mental health conditions live productive and positive lives while receiving treatments for their mental health issues. As is the case with any illness, individuals with severe or persistent mental health conditions who respond poorly to available treatments may require more support and may not function as highly as others.

Myth: People with serious mental health issues are violent and unpredictable.
Fact: While some people who suffer from serious mental health issues do commit antisocial acts, mental health issues do not equal criminality or violence – despite the media’s tendency to emphasize a suspected link. People with mental health issues are no more likely to commit violence than anyone in the general public, but they are more likely to be victimized and are more likely to inflict violent behaviors on themselves.

Myth: Mental health issues happen because of bad parenting or personal weakness.
Fact: The main risk factors for mental health issues are not bad parenting or personal weakness but rather genetics, severe and prolonged stress (such as physical or sexual abuse), or other environmental influences (such as birth trauma or head injury).

Myth: Treatments for mental health issues are not usually effective.
Fact: The effectiveness of any treatment depends on a number of factors including the type of mental health issue and the particular needs of the individual. A combination of psychiatric medication and psychotherapy, or social interventions is the most effective way to treat mental health issues.

Myth: Mental health conditions are caused by everyday stressors.
Fact: It may seem that stress is responsible for mental health conditions; however, there is no one clear cause of mental health issues. Rather, it is a result of complex interactions between psychological, biological, genetic, and social factors. Stress, stigma, and lack of support can make it worse on the individual.

Myth: Mental health issues are always hereditary.
Fact: Some mental health issues include a genetic component, which results in a predisposition or vulnerability toward the mental health problems among children and siblings, but environment also plays a key role in the development of certain conditions. If someone in one’s family has a mental health condition, that person will be a higher risk.

Click here for a printable version DE-STIGMA-TIZE with the Facts About Mental Health Awareness Issues

Communicating With Your Healthcare Provider

Excerpted  from Optimal Well-Being for Senior Adults II
By Ester R.A. Leutenberg and Kathy A. Khalsa, CPC, OTR/L

Communication with my healthcare provider.

The following is a guide for senior citizens as they prepare to meet with their primary care health care professional. Feel free to distribute it to your clients/participants, or print it out for yourself.

Scheduling enough time with your healthcare provider is sometime difficult. If you have several intricate questions about your health tell the patient representative when you make your appointment that you have issues to discuss with your physician and will need extra time. You are not required to tell the person on the other end of the phone what these issues are. However, if you are speaking with a physician’s assistant or nurse you might want to let them know what your issues are so the doctor can be prepared with the information needed to answer you in full.

Optimal Well-Being For Senior Adults II - Healthcare ProviderHere is a list of things you will need to know for your appointment:

  • What is your primary health care provider’s name?
  • Medications
    • What are they, including over-the-counter supplements?
    • Are you taking them as prescribed? If not, why not?
    • If you aren’t taking them as prescribed, how and when are you taking them?
  • Your chief problem today is:
  • This problem is affecting my daily life in these ways:
  • My questions are:
  • I have been feeling differently since I last saw you in the following ways:
    • Feeling more anxious
    • Feeling more disorganized
    • Being more forgetful
    • Having trouble expressing yourself

Your provider is required to ask you if you feel safe in your daily environment. Be sure to be honest with him or her when you answer this question. You don’t have to be physically abused to feel unsafe. If someone or something is bullying you or scaring you in any way, your doctor can be your first line of defense. Doctors have complete information regarding resources in your community to help you. You are paying for her or his time and interest. Don’t feel your concerns are unimportant.  If you aren’t being heard by your physician, go to family, friends, minister, or social services for help finding a doctor who will listen to your concerns.  . If you are having difficulty with family member(s) arrange to go to the appointment without them. Contact the Salvation Army, local churches, or Social Services if you need help getting to your appointment without your family member taking you there. There are folks who will gladly step up and help, but you have to ask!

Consider bringing a family member or friend to your appointment. You have a right to have them with you when you talk with your physician.  Two folks at the same meeting will hear different things.  It will help to remember what was said after the appointment is over. Go for a post-appointment coffee and write down what you discussed and what solutions were suggested.

Click here to download a printable form to take with you to your appointment.

Signs and Symptoms of Intense Anxiety

Intense Anxiety

By Ester R.A. Leutenberg and John J. Liptak, EdD
Excerpted from Managing Intense Anxiety Workbook

Managing Intense Anxiety WorkbookAnxiety is an inevitable part of everyday life for most people. Some anxiety is actually an appropriate emotional response to a variety of situations that people encounter. It manifests itself in the life of most people in many different ways. Some of the most common types of everyday, “normal” anxiety:

  • Situational Anxiety – Feelings of apprehension and dread related to a specific situation such as starting a new job, moving to a new community, or learning about a new illness.
  • Anticipatory Anxiety – Feelings of apprehension and dread when one confronts something that has been frightening in the past, or that has resulted in a negative experience such as speaking in front of a large group of people.

Anxiety Disturbances – These can be distinguished from the everyday, “normal” anxiety because they are more intense (panic attacks), last longer (often months or years instead of going away after an anxiety-producing situation), and interfere with a person’s ability to function effectively in daily life (i.e., inability to function in a job).

Different types of disturbances related to thinking and behavior are conveyed and expressed in different forms:

  • Panic Disorder: People have feelings of extreme terror that strike suddenly and often without any warning. People with panic disorder often experience sweating, chest pain, and/or heart palpitations. They feel as if they are out of control during one of their attacks of fear, and they attempt to avoid places where panic attacks have occurred in the past.
  • Social Anxiety Disorder: People have feelings of overwhelming worry and experience extreme self-consciousness in everyday social situations. These worries include the fear that others will judge them harshly, they will do something that may be embarrassing, and the fear of being ridiculed by other people. People with this disorder often are very anxious being around people and have a difficult time talking to others. They will stay away from places where there are other people and have a hard time making and keeping friends.
  • Generalized Anxiety Disorder: People exhibit excessive, extreme, and/or unrealistic worry and tension, even if there is nothing (or very little) to be worried and/or tense about. People with this disorder may be worried about just getting through the day and doing everyday tasks. They often have trouble falling and staying asleep, inability to relax, and trouble concentrating.
  • Specific Phobias: People experience intense, unwarranted fears about an object or a situation. The fear involved in a phobia is usually inappropriate for the object or the situation and may cause people to avoid specific everyday situations in order to avoid the object or the situation. Some common phobias include snakes, speaking in public, clowns, fear of situations where escape from bad things is perceived as difficult. This represents an intense fear resulting from real or imagined exposure to a wide range of situations.
  • Substance-Induced Anxiety Disorder: People experience anxiety caused by substance utilization or withdrawal.
  • Anxiety Disorder Due to Another Medical Condition: People have anxiety attacks that can be directly attributed to an existing medical condition (often diagnosed with cancer), and it often parallels the course of the illness.

Intense AnxietyWhen to Worry?

Symptoms related to intense anxiety can be very complex and difficult to cope with. The good news is that people can develop the skills needed to manage the symptoms and progress forward to begin enjoying life more. Undergoing the stress that accompanies many of the mental health issues can be a very frightening way to live. People who experience intense anxiety and stress over time are at risk of developing a serious mental or physical illness and need to seek a medical professional.

Suicide Warning!

People who experience intense anxiety may feel suicidal, have suicidal thoughts, and make plans for committing suicide. Sometimes they think that the only way to escape the physical, psychological, and emotional pain is to attempt suicide. Remember to take any talk about suicide or suicidal acts very seriously.

Signs of Suicidal Thoughts

  • Calling or visiting people to say goodbye
  • Engaging in reckless actions
  • Expressing feeling of being trapped with no way out
  • Expressing severe hopelessness about the future
  • Giving away possessions
  • Increasing use of harmful substances
  • Talking about killing or harming oneself
  • Making a plan for dying by suicide
  • Purchasing a weapon
  • Putting legal affairs in order
  • Withdrawing from family, friends, and activities of interest in the past

Serious Mental Illness

If there is a serious mental illness present, much more must be done than complete the assessments, activities, and exercises contained in this workbook. Serious mental illness must be taken seriously and professionals can take an active role in finding help immediately. All disturbances related to intense anxiety need to be thoroughly evaluated by a medical professional, and then treated with an appropriate combination of medication, and group and/or individual therapy.

*To download four PDF exercises from Managing Intense Anxiety Workbook, click here.

Reach out with your heart

Reach out with your heart

By: Donald A. Tubesing, PhD, and Nancy Loving Tubesing, EdD
Excerpted from Seeking Your Healthy Balance

Reaching out can be a risky business. When you commit yourself to loving your neighbor in general, you never know when a particular neighbor is going to pop up with a need you can fill. It takes an attitude of openness and curiosity to leave your personal circle of security and step across invisible boundaries into the unknown.

Community crowd walking up stairs It’s not too hard to offer your services to an elderly neighbor whose lawn needs mowing… or help out a charity you enjoy…Think the last time you were with a group of people. Which people did you include in your reach-out circle? Which did you ignore or interact with only superficially? For most of us the second group is by far the larger.

The neat, clean lines we’re tempted to draw between the people who belong in our neighborhood and receive our care, and those who don’t belong and are therefore excluded from our care-giving, tend to disappear in times of crisis when our connections as part of the human family suddenly, unexpectedly, draw us closely together in intimate contact with strangers.

Reach out with care and concern

People need people. Reaching out with care and concern for another heals both the receiver and the giver! Break beyond your boundaries and give yourself to others. They need you. You can make a difference in your world by reaching out with your attitudes, with your heart, with your hands, and with thanksgiving.

The most valuable skill for reaching out to others is the art of listening with your heart. This gift of listening deeply and carefully to the concerns and feelings of others is called empathy.

Empathy literally means to “feel in” to stand in another’s shoes for a moment. Everyone needs empathy. Click here for a group of assessments that will help you open up to others.

Reach out - Woman hugging childAnother important skill is the ability to reach out and literally touch someone. Most of us learned to keep our hands to ourselves as we were growing up…In this society we keep our distance. Why not get used to giving people hugs. It’s not that hard. Some people may be surprised at first, but if you practice it often enough, your neighbors will soon figure out you’re for real. Touch is a powerful way to reach out.

Positive caring demonstrated by physical contact lets high energy flow between people, filling each person with vigor and vitality. You can hardly touch without being touched in return. You have a marvelous health-giving resource at the end of your arms and many touch-hungry neighbors waiting for physical strokes. Initiate a health-enhancing exchange. Make sure that touch is a part of every contact you make.

At this time of year in particular we reach out with thanks-giving. A little appreciation goes a long, long way. Studies have shown that gratitude is a more powerful motivator than money. Most of us will really put ourselves out just to hear someone say, “Thank you.”

If you want to improve your thanks-giving style, you could try one or more of these suggestions:

  • Form a mutual-admiration group. If some people in your life don’t like to give and receive appreciation, find some who do and spend time with them.
  • Select small, unique gifts that carry a personal message from your heart. Surprise people with them. Gifts you create – poems, notes, wall hangings – speak most clearly.
  • Once again, get into the habit of thanks-giving. Say it directly! “Thanks for listening to me.” “You’re always so positive. Thanks.” “Knowing you care keeps me going. Thanks.”

To be truly healthy we must reach out beyond ourselves. When we share each other’s burdens and joys we become channels of healing. No matter how timid or tired or selfish or crazy or young or old we are, we all have something important to offer each other. Train yourself to notice others’ needs and then be ready to share your gifts when they are appropriate.

Click here for exercises to assess your reaching out skills.

Steps to Effective Communication

Stop, Look and Listen!

Steps to Effective Communication

The ability to express oEffective Communicationurselves clearly and to understand what others are trying to say to us is the key to success in all areas of our lives. Most of us have not been trained in the principles of effective communication. We do not always listen to what is being said. Instead we are busy formulating and justifying our own point of view. We also become derailed by bringing up the past, especially old hurts and resentments.

Effective communication has two parts: How to really hear – and really understand – what others are saying, and and how to express feelings and thoughts without dragging in past conflicts and emotions.

It takes commitment and practice to improve communication with your care-receiver, medical team, family members, etc. You can begin by noticing when you are on automatic and then remembering what you learned about crossing a street safely: Stop, Look, and Listen.


A. Stop what you are doing. Be present, eliminate distractions, stop talking, etc.

B. Look at the speaker. Give full attention; notice body-language.

C. Listen to what is being said. Allow the speaker time to finish, don’t jump to conclusions.

D. Double check. Be certain you have all the facts, ask for more information if needed.

Once you have done all the above, it is your turn and time to express your thoughts and feelings.

Your Turn to Speak

A. “Be” Attitudes

Be focused Address the issue at hand. Do not bring strong emotions and issues from the past into the discussion.
Be specific. Do not assume the listener knows what you are thinking. Offer clarifications if necessary.
Be calm If the speaker is distraught, be calm. If you are in an emotional state where you are unable to discuss an issue, agree to continue the discussion later.
Be polite Do not use inflammatory words. Avoid insults and accusations. They will lead to heated argument and make the problem worse.

B. When pointing out an existing problem

  • Identify the issue without blaming or shaming. Avoid personal attacks.
  • Use “I” statements. “I feel __________when you _______________.
  • Offer solutions as preferences. “I would prefer it if you/we _____________________.

C. Make allowances if the other person has hearing or vision loss, or is confused.

D. Revisit the issue if you cannot reach a consensus. Accept the fact that there are some problems for which there is no solution.

15 Reminders of Effective Communication Principles

  1. Check to see if your care-receiver has on glasses and hearing aids.
  2. Look at your care-receiver when he or she is speaking. Be aware of non-verbal communication
  3. Answer all of your care-receiver’s questions. Don’t rush.
  4. Imagine yourself in your care-receivers world. How would you feel in his or her situation?
  5. Speak to your care-receiver as one adult to another. Use a respectful tone.
  6. Acknowledge your care-receiver’s objections and concerns.
  7. Allow your care-receiver time to absorb what you’re saying. Clarify or state in a different way if necessary. Offer options.
  8. Mirror back what you think you’ve heard your care-receiver say. Ask questions.
  9. Stay calm. Don’t take anything personally.
  10. Give your care-receiver time to think things over. Don’t press for an immediate answer.
  11. Think of this as a time to get to know your care-receiver better. Listen for concerns and fears. What would give him or her comfort? With whom would he or she like to talk?
  12. Take a break if your care-receiver is tired or either of you becomes upset. Return to the conversation at an appropriate time.
  13. Make sure you have heard your care-receiver’s decision correctly and are interpreting it as intended.
  14. Request help from other family members if necessary and/or appropriate.
  15. Remember, you are not alone. There are two of you in the equation. Keep communications open.

*Book excerpts taken from The Complete Caregiver Support Guide.

Leisure lacking in the “No Vacation Nation”

The Importance of Leisure

The United States Is Called the “No Vacation Nation”.

Are Americans allergic to leisure time? 57% left unused vacation on the table. Reasons given:

  • Too much work to do
  • Afraid of being replaced
  • Don’t want to come back to huge pile of work
  • Can’t afford to do anything out of the ordinary
  • No backup at work
Paid Vacation Chart

Chart retrieved from CNN/Money

In recognition of National Mental Health month, we offer this article from The Wellness Lifestyle Workbook on the importance of leisure followed by an exercises for “Leisure Exploration” and “Overcoming Barriers to Leisure Participation.” We invite you to use the article and the worksheets for yourself and for your clients.

The Importance of Leisure

By Ester R.A. Leutenberg and John J. Liptak, EdD.

Working Leisure LackingLeisure can be defined as a period of time that we have outside of work and essential household and relationship activities. The typical American employee spends about eight to ten hours a day working, five days a week. This totals at least forty to fifty hours per week. Most of us also spend a lot of time for compulsory activities such as eating, sleeping and essential chores. With the time left over, it is important for us to engage in leisure-time activities that will allow us to balance work, find enjoyment, and expend mental, physical, social and creative energy.

Leisure-time activities are usually more fun than work. We usually do not engage in leisure activities that we do not like to do. We often forget that it’s all right to have fun. Many of us are workaholics who feel guilty when we take time for ourselves to enjoy fun activities. We do not want to take time away from our family, friends or obligations. But we can creatively incorporate time with family and friends and engage in leisure activities at the same time.

leisureThe skills you gain from leisure-time activities can easily be transferred to occupations. People are typically good at what they enjoy, are more motivated to participate in these activities, and will spend more time at them. Leisure-time activities can be valuable exploratory experiences in which individuals can develop both personal and work-related skills that might be useful in many different types of jobs. Similarly, leisure-time activities also provide an opportunity to expand and perfect skills you already have.

Most people work a lot of hours and work very hard. Although a certain amount of work is very good for us, it does not mean that twice as much work means that you get twice as much done. In fact, research indicates that the law of diminishing returns takes over and that you actually gain less and less for each extra hour that you work. In Japan, they have a term, Karoshi, which means sudden death from overwork. Leisure can help you to remain balanced.

Ernie Zelenski, in his book The Joy of Not Working, suggests that when people are able to enjoy leisure time to the fullest, their lives will be enhanced to immeasurable levels. Some of the benefits people enjoy from satisfying leisure include:

  • A higher quality of life
  • Personal growth
  • Improved healthy
  • Higher self-esteem
  • Less stress
  • A more relaxed lifestyle
  • Excitement and adventure
  • A balance lifestyle
  • A sense of self-worth
  • An increase in quality of family life

Click here for “Leisure Exploration” and “Overcoming Barriers to Leisure Participation”, worksheets from The Wellness Lifestyle Workbook.


Stress in the Workplace

Sources of Stress

People experience stress in the workplace in three primary ways. When these sources of stress are ignored, they can lead to accidents in the workplace, injuries, and even more stress. Stress from one of these sources can be difficult to overcome, but stress from more than one of these sources can be debilitating.

  1. Stress generated from within a person: Stress can be self-imposed through low self-esteem, anger, feelings of hopelessness, feelings of helplessness, anxiety, excessive negativity, the need to be in total control, perfectionistic tendencies, jealousy and hostility. For example, people who are perfectionistic often bring stress upon themselves by being too careful and worrying about tasks being perfect.
  2. Stress in the WorkplaceStress generated from the environment: Stress can be felt from the result of the work environment including overly demanding supervisors, low pay, poor working conditions, noisy work environments, too many commitments required for the work being done, long hours, lack of technology for employees to accomplish the work, lack of a safe place to work, whining co-workers, and complaining customers. Any of these external stressors can negatively affect the job performance of an employee. For example, a person who must work with an abrasive supervisor will feel uncomfortable most of the work day.
  3. Stress from a poor job fit: Sometimes stress is felt by employees who do not have a good fit between their interests and skills and the demands of their jobs. Many people find that a good job fit is critical in being productive and being able to cope with stress. For example, a person who is not satisfied working a repetitive job may find a lot less stress in a job that is creative and flexible.One of the reasons that many employees are unable to cope with the stress of the workplace is that they live by a set of outdated myths.
  • The best employees work the longest hours. In fact, working smarter rather than harder is more productive.
  • I need stress to meet deadlines. In fact, people who manage their time well and who are not pushed to deadlines are more productive and do a better job.
  • You will not get ahead in the workplace if you are not worrying about your work 24/7. In fact, your capacity to do well occurs when you are stress-free, not stressed about work.
  • The business is at fault. In fact, blaming the system does not help people to be less stressed and more productive. People who take responsibility for themselves and their work are the least stressed and more productive employees in any business.

Coping-with-Stress-in-the-WorkplaceAbove are just a few of the rationalizations that people tell themselves about work, stress, and productivity in the workplace. In order to deal with all of the various types of stress in the workplace, it will help to understand workplace stress and acquire tools and techniques for managing it. The Coping with Stress in the Workplace workbook provides assessments and self-guided activities to help participants learn useful skills for coping with the various forms of stress in the workplace.

-From the Introduction of Coping with Stress in the Workplace, by Ester R.A. Leutenberg & John J. Liptak, Ed.D.

Caregivers and Caregiving

About Caregivers:

Complete Caregiver Support GuideFormer First Lady Rosalynn Carter stated,

“There are four kinds of people in this world: those who have been caregivers, those who currently are caregivers, those who will be caregivers, and those who will need caregivers.”

This includes virtually everyone!

A Brief History of Caregiving

In past generations, it was customary for people to have large families. Members of an extended family often lived within a few miles of each other. Few women had jobs outside the home, so the elderly and infirm were cared for within the family. Both the primary caregiver and care-receiver had the support of nearby relatives, friends and community.

Circumstances are different today. Families are typically smaller and are often scattered across the country and around the globe. A much larger percentage of women work outside the home. People live longer, often with chronic illnesses. These factors make caregiving much more complicated than it was in the past.

The early stage of caregiving is often handled by family members or by friends who live near the person needing help. They begin by simply doing what they can and often, as time passes, assume the caregiver role without realizing it – caregiving isn’t a job that many people choose to sign up for.

The tasks caregivers perform can vary widely, from transporting a child with disabilities to school each day, to doing someone else’s laundry, to helping with medications, to dealing with insurance companies. Caregiving can be temporary, as when someone is recovering from an accident, or long-term, as when caring for a person in need of significant ongoing support.


Illustration by Amy L. Brodsky, LISW-S

In an attempt to define family caregiving, the National Family Caregivers Association (NFCA) developed a list called “Caregiving Is.” The text below was inspired by that list.

Caregiving is as diverse as the individuals needing it. It can be 24-hour care for persons who cannot manage daily tasks of living or are suffering a significant level of cognitive loss. It can be preparing for an uncertain future because a spouse has a progressively disabling disease, even though that person is still able to function quite well. It can be temporary, last several years or last a lifetime.

Caregiving means being a person’s healthcare advocate. It requires learning to work with doctors and other health care professionals and to navigate government healthcare programs. It can also be learning what it means\ to die with dignity and making sure that the care-receiver’s wishes will be honored.

Caregiving is stressful work. Most people have had no training or education regarding the many aspects of caregiving when they begin helping their care-receiver. They discover that caregiving is assuming tasks they never dreamed of undertaking. It can be learning about medications, wheelchairs, lifts and gadgets that help struggling fingers button a shirt. It can involve doctor visits, calls to 911 and long days and nights in a hospital waiting or emergency room.

Caregiving challenges people to go beyond their comfort zone. It is having conversations on topics most people hope they will never need to address. It is grappling with questions that often have no easy answers. It is loving, giving and sharing. It is accepting, adapting and being willing to keep on going.

Caregiving forces individuals to deal with change. They are often required to re-evaluate finances, living conditions and/or their personal work situation. They will need to make compromises and readjust again and again as the circumstances change.

Caregiving is an endless search for balance. It is seeking the middle ground between doing too much for the care-receiver and doing too little. It is trying to find time for personal needs – and hopefully, even wants – while providing for another’s needs. It is recognizing that one cannot do it alone – one can and should ask for help, respite care and time off for a vacation to recharge through activities that help maintain a sense of self.

Caregiving is a strain on relationships. Even the best of relationships can be challenged by the stress of caregiving. The demands on one’s time and energy may leave family members or friends feeling neglected. Moving a parent into a family home – or moving into the parents’ home – can be a source of contention between couples, and between parents and their children. Finances and other emotionally charged issues can also cause tension between adult children of an ailing parent.

Caregiving can be a lonely world. While the tasks and experiences of caregiving may be similar in nature, surprisingly they are not what unites family caregivers. According to the National Family Caregivers Association, the common bond of caregiving is the emotional impact.

Those caring for others often feel lonely, isolated, and unacknowledged for all their work and sacrifice. They can experience anger and resentment toward family members and others who carry on as usual, while they of necessity give up much of their normal life. They grieve the losses in their own lives as well as and the loss of the person their care-receiver once was as they watch him or her decline. They often experience depression, sadness, pain, the need for normalcy and regret for what they might have done had circumstances been different. They also may feel guilty because they sometimes wish it were over.

Caregivers can find comfort in learning that such feelings are perfectly normal and in finding ways to cope with them in support groups and within these pages. They can also find hope in the possibility of connecting on a deep level with their care-receiver and creating closer bonds with family members. In fact, discovering positive meaning in the tasks of caregiving is crucial for the emotional health of everyone involved.

Caregiving can also be moments of joy and fulfillment.

  • Happiness when seeing one’s child with a developmental disability learn a new skill.
  • Joy when a spouse’s face lights up, expressing thanks for being his or her partner on a difficult path.
  • Closeness during nighttime conversations about love, life, death, and what’s most important.
  • Satisfaction in the knowledge that one has provided something for the care-receiver that has
  • made life better.
  • New recognition of one’s inner strength and determination.
  • Gratitude for simple things, for each new day.

-from The Complete Caregiver Support Guide, by Ester R.A. Leutenberg and Carroll Morris, with Kathy Khalsa, OTR/L