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Behavioral Therapy Effective for Health Anxiety

Cognitive behavioral therapy is effective in reducing excessive health anxiety compared with standard care, with similar costs at two years, according to a study published online Oct. 18 in The Lancet.

Peter Tyrer, F.Med.Sci., from Imperial College in London, and colleagues randomly assigned 444 people (16 to 75 years old) with excessive health anxiety to adapted cognitive behavior therapy or standard care.

At one year, the researchers found that the cognitive behavior therapy group had a significant improvement in health anxiety symptoms, with significantly more achieving normal levels of health anxiety (13.9 versus 7.3 percent; odds ratio, 2.15). Similar differences were sustained at two years, with reductions in generalized anxiety and depression, but no differences were seen in social functioning or health-related quality of life. There were with no significant differences in total cost at two years.

"This form of adapted cognitive behavior therapy for health anxiety led to sustained symptomatic benefit over two years, with no significant effect on total costs," Tyrer and colleagues conclude.

Two study authors developed cognitive behavioral treatment for health anxiety and one is the author of a book describing it in practice.

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Medications for Major Depression

The first medication used to treat depression was "discovered" while researchers were studying another medical disorder. Iproniazid was originally developed as a treatment for tuberculosis in the 1950's. Once it became clear that antidepressant medications were possible, medical science focused attention towards researching and developing depression-specific medications (as well as many other medications useful for treating mental illness)

Modern antidepressant medications are thought to have their effect based on their ability to alter the balance of neurochemicals and neurochemical receptors at the synapse level within the brain. Selective serotonin reuptake inhibitors (SSRIs) and their newer antidepressant cousins, the serotonin norepinephrine reuptake inhibitors (SNRIs), are today considered first choice medication treatment for the treatment of Major Depression. Other medications, including the older tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are used as second-line choices.

Antidepressants are medications and like all medications, they should be used only as prescribed by a physician. Medications can be dangerous and even lethal when taken in a haphazard manner. For example, specific antidepressants are considered unsafe for pregnant or nursing women. You should only obtain medication from a reputable drugstore and only as indicated on a prescription notice from your doctor. Any concerns about the safety of particular medications should be discussed with your doctor.

Even though antidepressants impact a person's levels of neurotransmitters within hours, they usually take several weeks to exert a noticeable effect on mood. This is because antidepressant drugs are thought to cause new receptors to grow within the synapses, and this growth process takes a few weeks. As a result, the effects of antidepressant medications are not instantly apparent, but may take several weeks to build up to levels that impact someone's mood. When treatment effects occur, they occur gradually. Patients often fail to notice the positive effect that the medication is having, but generally family and friends will notice. It is important to keep taking an antidepressant as prescribed for several weeks before making a decision about whether or not it is effective. Up to six weeks may be required to know if a drug will work.

You may have to try several different antidepressant medications before finding one that works well. Even within a family of similar antidepressant medications, some people do better with one than with others. Decisions about when it is time to try new medications are best made when the patient, physician, and the psychotherapist (if one is present) work together as a team. Depressed patients often discount or ignore positive changes brought about by antidepressant medication. Health care professionals can counter this tendency to ignore positive change by offering their more objective observations, while patients can contribute their own impression regarding positive effects and troubling side-effects.

Many people are concerned about having to take antidepressants for the rest of their lives. Typically, individuals begin taking antidepressants when their depression is at its worst. The medication, combined with psychotherapy, will allow most people to get to a point where they can gradually decrease or discontinue their use of antidepressants and maintain well-being by using skills learned in psychotherapy. However, for those individuals whose depression returns when they stop using medication, long-term use of antidepressants may be essential.

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The Causes and Prevention of Intellectual Disability

There are many causes of intellectual disabilities. Some are preventable; others are not. These causes can be grouped into four categories:
1. Medical conditions; 
2. Brain injury;
3. Genetic conditions;
4. Psychiatric conditions.

The leading causes are Autism, Down syndrome, Fragile X syndrome, and fetal alcohol syndrome or FAS. Among these, the only preventable cause is fetal alcohol syndrome.

Medical conditions that lead to intellectual disabilities fall into three groups. These are: 1) prenatal exposure to alcohol and other drugs; 2) exposure to certain toxins; and 3) some types of infections. Prenatal exposure to alcohol and drugs is entirely preventable. Even drinking three drinks a day during pregnancy can cause fetal alcohol syndrome (FAS). FAS is a leading cause of intellectual disabilities. It is not clear how much alcohol is safe. Therefore, most doctors recommend pregnant women do not drink. Other drugs also harm a developing fetus. This includes nicotine, cocaine, and heroin. A pregnant woman should tell her doctor if she uses alcohol or drugs. Her doctor may be able to help her reduce the risks to her unborn child.

Pre- and post-natal exposure to toxins can cause intellectual disabilities. Of particular concern are lead, mercury, and radiation. Avoiding exposure to these toxins reduces the risk of developing an intellectual disability. Large fish such as shark, mackerel, and swordfish contain higher amounts of mercury. Low mercury fish include shrimp, salmon, and Pollack. Lead based paints are present in pre-1970s homes and in the soil surrounding older homes. Families can find lead abatement programs through their county and state public services. High radiation exposure is associated with intellectual disabilities. Fortunately, modern radiation equipment has drastically reduced the amount of radiation exposure. However, it is uncertain what a safe level of exposure is. For this reason, women who may be pregnant should speak up before receiving any radiation procedures.

Certain types of infections can also lead to intellectual disabilities. Pregnant women can take simple steps to reduce these risks. Pregnant women should avoid any contact with cat feces. Cats can carry a parasite that causes Toxoplasma infection. This infection is known to cause intellectual disabilities. Pregnant women should not handle cat liter boxes. They should not garden in places where cats may have defecated.

Several sexually transmitted diseases can lead to intellectual disabilities if a fetus or infant is exposed to these diseases. These include Hepatitis B, syphilis, and herpes simplex II. Pregnant women should practice safe sex and use condoms to reduce the risk of exposure. Children should receive immunizations for infections known to cause intellectual disabilities. These immunizations and protocols are constantly evolving. Parents should ask their child's doctor for recommendations. 

Brain injury is another cause of intellectual disability. Many brain injuries are preventable. Children should always ride in an approved child safety seat. The seat must be installed and used correctly. Follow the manufacturer's instructions for installation and use. If a family cannot afford a safety seat, there are agencies that can provide them. Ask your healthcare provider for information. Children should always wear helmets when riding bikes, skateboards, etc.

Brain injury also occurs when infants are shaken or dropped. This unfortunate situation often occurs when caregivers are frustrated. Caring for infants can be extremely stressful. It is natural to feel frustrated. Ask your healthcare provider to refer you to someone who can teach you better ways to cope stress.

There are many genetic causes of intellectual disability. The two most common are Down syndrome and fragile X syndrome. Genetic causes of intellectual disability cannot be considered preventable.

Lastly, certain psychiatric conditions are associated with intellectual disabilities. The most common disorder is called autism spectrum disorder (ASD). Like genetic abnormalities, there is no known way to predict or prevent ASD.

More complete and detailed information can be found in our Intellectual Disabilities Topic Center.

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My Family is Ruining my Relationship With my Boyfriend

I'm 26 almost 27 years of age, a single mother of a 5 year old boy and I've been struggling through my life.

I was in an abusive relationship with a drug addict when I got pregnant and I left him and have been raising my son on my own with my parents help. The only problem is my parents are controlling of me and always have been. If I discipline my son they will make comments under their breath like, "God you're such a bitch" or get mad at me. 

Apparently I've even been referred to as Hitler but I'm trying to be more strict lately because my son had zero discipline in his life before and it's starting to really show.
There's no way a 5 year old should be demanding things of adults and throwing fits when he doesn't get his way. But when I do put him for a time out, someone will go to him and say "Come here buddy, talk to me" instead of letting him finish out the time out. What's worse is in my relationship, I found a really great guy who's been helping me become a better person all around. I love him with all my heart and now I'm afraid I'm going to lose him.

My parents have been badgering me about how late we hang out. He comes here always so that I'm not away from my son and I can still be mom. But my parents constantly over our shoulders, and finding faults with everything he does is starting to wear on him and he's at his limit with it now. I can see that I'm losing him, if I could move out I would in a heartbeat.

I'm finding myself resenting my family, I'm getting incredibly depressed to the point where I vomit because I'm so upset. I can't function and I'm trying to pull out every possible solution to keep my relationship going and improving my home life. I've failed at every relationship before this one because I gave up too easily, I found faults with the guys instead of looking at myself.

I'm afraid if I lose my boyfriend now that this is it for me. I'll not find this again and I will give up.
I just need some direction, I need some help.

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Resentment-Controlling Wife/Passive-Agressive Husband

How long have you been together? 12 years
What is your age range? 34-40 no children together, husband has 2 previous marriages
 
Please share your story:

After several years of strained relations within my marriage, I think we may have a case of a controlling wife and passive-aggressive husband dynamic.

I am the primary breadwinner and have handle to finances and general running of the household. I know I can be a overbearing person as I like things a certain way and I tend to take charge, but, at the same time, I feel I am reasonable and have compromised a great deal in the course of the relationship.

It seems that my husband has subtle ways to sabotage our relationship and fiances. For instance, we are on a budget. He will take money out of the joint account and act like he thought we had extra money for him to gamble with. Other times he will evoke the silent treatment if I try to have a conversation that he perceives as unpleasant. If I try to talk to him about normal relationship and household matters it is impossible to come to a real solution as he will just agree and do nothing or go silent.

Lately, things have gotten much worse when I have expressed the likelihood that I do not want children. I have some medical issues that came about and brought the issue to the forefront. The medical issue was always something we both postponed for myriad reasons but seemed we would "eventually get to a better position" to do it. Granted, I did not disclose this early on in the relationship but it was because I was not sure about the condition until now.

He is not happy and saying we are not compatible about anything because of this medical issue. He is even now trying to blame me for the strained relationship he has with his adult daughters because "he sold his soul" to be with me. The bottom line is that he has resentment towards me, and, hence, the passive aggressive behavior has escalated. He thinks he wants out of the relationship but he will not make the move. I admit, I am stubborn and will not make the move either. I do not feel I should be made to be uncomfortable (giving up the home) because he is acting out.

He refuses the counseling I have suggested. I have presented books and other tools we could use to improve the relationship and he resists. For my own sake, I am going on my own therapist.

I am not sure of how to get a handle on the situation or if the relationship can be saved? He has moved out of the bedroom and decidedly is giving me the silent treatment, again, for the umpteenth time. I am not sure if its for present or past transgressions on my part as it is hard to keep count.

I haven't talked to anyone about this as I am embarrassed and no one would believe me anyway because he is the quintessential "mr nice guy."
Any insight on the situation besides the obvious "divorce solution" will be helpful.

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Adult Son Interferes with Our Relationship

My boyfriend and I have been together for 2 years. Two months ago we started to live together. He was living with his 23 year old son at the time. Also, they both work together in a business that is open for lunch and again in the evenings. The son has continued living in the house they both lived in before he and I moved in together.

The evening that my boyfriend moved in with me, his son called to say "Dad, you've replaced me with her." It was supposed to be a special night for us. But, he tends to call even in the middle of the night and his dad never gets upset about being woken up over nothing. I think it is rude.

Now that my boyfriend finally put some distance between him and his son by moving in with me, I thought we were finally going in the right direction. Instead, I am very disappointed that he leaves our house at 7:30 AM every morning and says he's going to work...which really means he's hanging out at his son's house until they car-pool together to work at 11:00 AM.

I feel that my boyfriend is getting all of his emotional intimacy from his son. I feel neglected. How can I let him know that his intense closeness to his son is ruining our relationship? If he got together at his son's house once a week I could handle it but every day is just over the top. The constant phone calls between him and his son, when we are together, are also annoying and it makes me feel like an outsider.


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How to Let Criticism and Stressful Comments Roll off Your Back

How often have you heard the advice, "Just let it roll off your back"? Pretty often, if you've read much of my work here at Caring, because I seem to say it a lot as a de-stressing tactic, whether in quoting an outside expert in caregiving or psychology, or when offering my own ten cents. I said it just last week in my post about how to cope with relatives who heap extra stress on caregiving.
In the comments on that post, someone asked for help on just how to do that. Good question!
How do you let criticisms roll off your back? How do you ignore busybodies who create chaos, not help? How do you make yourself impervious to the stress?
Try these self-psyching ideas:
  1. Ask yourself, frankly, if there's any truth in the comment.
    Better to get this part out of the way first: Deep in your heart, do you know it's true that, say, you can't continue dealing with Mom's incontinence without help? Or that your partner might benefit from a different doctor or therapy?
    Most, but not all, criticisms are unproductive. But sometimes we're annoyed by truths we don't want to hear -- and that's important to be able to recognize.
  2. Try to parse out what it is about the annoying comments that's so annoying.
    Even when comments are unproductive, asking yourself why, exactly, you're so bugged can reveal a useful nugget to work with. For example:
    • Is your sister lack of action rather than her words that really gets your goat? That cues you that this isnt about you, but her, and should make it easier to ignore (or point out).
    • Is it that she's your older sister and her criticisms make you feel like a fifth grader again? Then you know it's really about your own insecurities, and you can draw power from remembering that you're a fully functioning, competent grown-up now.
    • Is it that the comments are so relentless? Then you can tune them out by picturing the speaker like the grownup voices as heard by the kids in the old Charlie Brown cartoons: "Myah-myah-myah-myah."
  3. Run through a quick self-praise list.
    After taking a deep breath, remind yourself of an inventory of all you're doing right: I'm looking after Dad. Dad is happy and safe. My husband loves me. I have three great kids. I have dear friends. I always balance my checkbook. Last week the doctor praised me for how well I've been helping Dad manage his blood sugar.
    Sounds corny, but actually articulating your strengths, blessings, and skills is like putting up an invisible shield against the slings and arrows of outside offenses.
  4. Smile and keep moving.
    The best way to skip past hurts is to not stop and dwell on them. Arch your brows, frown, or smile, whichever suits you -- and then move your mind and body onto something else. Sound hard? It gets easier with practice.
  5. Turn the tables.
    I love this tactic, from a wise reader of that same post: "Play dumb, like their 'wisdom' is an offer to volunteer," she suggests: 'Oh, wow, thanks so much for your help! Those are some great suggestions! You know what?... I'll take you up on that! You can stay with Mom a couple hours this Friday, so I can go to a doctor appointment! That will give me some much-needed help - thanks SO much! You're a lifesaver! Boy, I didn't know what I was going to do about Mom during that appointment until you volunteered! Thanks a million!' Then hope they either put up or shut up."

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Fixing Your Family Feud


If you're in the middle of a family feud — whether it involves money or not — ask yourself: Is it worth losing a loved one over?


  • Choose to forgive. Holding onto a grudge will only eat you up inside and cause huge family rifts. The only thing worse than not speaking to a family member for three years is not speaking to them for three years and one day. 

  • Sometimes relationships need a hero. That means someone has to step up and be the bigger person to close the gap. Someone has to make the first move, the first compromise, to heal the relationship. Swallow your pride and be that person. Think about what the future holds if you do not mend this. 

  • Think of how this feud is affecting the rest of the family. Are there other family members or children caught in the middle? Think of the unnecessary stress you may be putting on others. Dr. Phil tells two feuding siblings to consider their 84-year-old mother. "Let me tell you something. At 84 years old, she deserves the peace of knowing that her family is unified and intact," he says. 

  • No matter how flat you make a pancake, it still has two sides. Step into the other person's shoes and try to see their side of the story. Try to understand the other person and why they acted in a hurtful way. Try not to judge them. Conversely, examine your role in the feud. Did you do or saying something hurtful? Did you promise something and then back out of your agreement? Keep in mind the other person probably has some valid points that you need to weigh and consider.

  • Ask yourself, if your family member died suddenly, what would be left unsaid? In a perfect world, if you could write the script of your life, what would your relationship with that person be like? Start creating that relationship now.

  • Reach out to your family member and ask them to talk to you. Start with an apology for whatever part you may have played in the feud. Take responsibility for your actions. Explain why this relationship is important to you and affirm your love for the other person.

  • Dig further into what may have caused this rift. If it's about money, ask yourself if that is the real issue. Examine your feelings about the person you're fighting with and get to the bottom of when it all began.

  • Consider hiring a financial expert if you and a loved one are at odds over finances. If you can't see eye to eye, perhaps a third party can help come up with a plan that will lead to a solution.

  • Create some boundaries where you can begin to heal the relationship, but you're not allowed to bring up the source of the feud. Take 90 days to focus on reconnecting, and rebuilding the relationship. If you're siblings, just be siblings for 90 days and keep the subject of the feud off the table. After 90 days, examine the issue. You'll have found some middle ground and the value of the relationship will be more important by then. 
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    10 Tips to Help You Deal With Family Drama

    As an attorney-mediator who helps resolve messy sibling and intergenerational family money and property conflicts, my work can be challenging. Even so, I faced an even harder task -- and was called upon to "walk the walk" of my approach to resolving family financial conflicts -- when one of my own siblings faced a difficult crisis. All of the ingredients for explosive family disputes were there, including issues of fault, shared obligations, and duties of generosity. The resolution process brought us to the precipice of all varieties of emotional cliffs, hard feelings, and festering resentments. Yet, while the final outcome is not fully in place, it looks like we are emerging with our love and concern for each other intact. No one has cut off communication, no lawsuits have been filed, and we are happily planning our next family get-together.
    Reflecting on this drama, I've compiled ten tips for managing extended-family financial conflicts. They parallel the advice I give to clients and the strategies I invoke as a mediator, and I hope they'll be useful to you if you face a similar situation.

    1. Gather Information First, Offer Advice Second

    Family troubles can bring out the best and the worst in loving relatives. In my family culture, offering advice before it's asked for is the norm, but never before did I realize how unhelpful this can be. We started receiving e-mails with explicit plans for solving the problems before anyone had learned any of the details, and definitely before anyone asked for advice. Suggestions can be useful if offered at the right time, but even then, they should be just that: suggestions, not imperious dictates.
    Gathering information isn't just about assembling facts; it's also about understanding each person's perspective. Listening to a rambling narrative can be frustrating, but it also can be a window into the speaker's thinking -- rational or not. Many folks tell their story in a distorted manner, but we need to hear that personal version in order to learn what suggestions would be useful.

    2. Give It Time, as It Takes Time

    Most of my family lives east of California, so they were usually ready to start talking before I was awake. Fortunately, they were considerate enough to wait until I was ready to talk, and talk we did. Some weeks it seemed that every morning commenced with two hours of counseling, exploring, evaluating, and strategizing.
    Time is what these situations take, especially if the issues are complicated. Some folks need repeated explanations in order to process the issues. It's about paying attention to everyone, especially those who are in trouble. Of course, there will be moments when it's totally appropriate to say, "Get to the point" -- or to ask to reschedule a conversation because you have work to do or a family member or pet to attend to. But if you can make the time to let the full stories emerge, tensions will reduce dramatically and solutions will more readily appear.

    3. Allow for Idiosyncratic Modes of Information Processing

    As a lawyer, I tend to focus on the substantive questions: who should pay what, who should do what, when should something be done. If someone misunderstands something, I simply repeat the story until he or she does understand. But in fact, we each have our own way of processing reality, and when we are under stress -- even those of us who are not 90 years old -- our capacities are limited. Those who are older, disabled in any way, or feeling accused or blamed often are limited in their ability to take in new information and organize their thoughts.
    Experts on cognitive abilities describe capacity by taking into account not just someone's physiological state but also his or her emotional state and mode of communication. My mother may do an excellent job at describing a book she's read, but she finds it much harder to process a financial crisis, and she may need to hear the story in person rather than over the phone or by e-mail. For some, the only way to really take in new and complex information is in a private conversation, not in a group discussion.
    Managing the decision-making process requires a customized information-delivery system approach, with due attention to the limitations of each participant. As frustrating as it can be, you'll need to repeat some stories before the anxious and concerned listener is able to comprehend the news. But if the goal is to reach consensus and rational decision making with all family members participating, this time-consuming process cannot be avoided.

    4. Manage Your Judgments Productively

    One of my favorite writers on human relationships, David Richo, reminds us that part of being human is forming judgments -- so it's unrealistic to try to avoid having any, as if we could suddenly morph into a Buddha-like openness and tolerance of all souls. This is especially so when it comes to family members -- the histories are too deep, the recollections and resentments too powerful. But, again quoting Richo, it may be possible to manage one's judgments in a productive way: When it comes to the key conversations, don't ask "Why?" Instead, ask, "How can I help?"
    The key is to find the right time and place for your judgments. This is tricky, because complaining to a third person can inflame the dynamics. Usually it makes most sense to talk with someone who isn't engaged in the core discussion -- a friend rather than another relative, or a professional such as a therapist. Other times it requires a gentle deferral of a request for help: It's better to say, "I can't be helpful to you today" and leave it at that, rather than dumping your judgments on the needy one just when they are at their most vulnerable.
    A skill we're taught as mediators is translating judgment into a question. Instead of proclaiming that the decision to quit a job seems stupid and self-destructive, it's better to express concern in a question: "It's hard for me to understand what motivated you to quit your job at this delicate time in your family's finances; could you explain it so that I have a better understanding of what motivated your decision?" Then be open to accept the response and not criticize it -- or next time you won't get any answers to your questions!

    5. Engage the Extended Family

    Inevitably, in every family mediation process, the issue of the in-laws surfaces. Whether it's a spouse or an unmarried partner, chances are there is a chorus of "outsiders" who have opinions and want to be included in the conversations. Rarely is it effective to lock them out as nonfamily members; at the same time, one must balance the need for including these voices with an equally valid concern for maintaining the integrity of the inner family circle. This can be particularly difficult when there are hard feelings against a particular spouse.
    The answer is found in a managed series of communication strategies. I usually start with an "inner circle" meeting as a preliminary strategy session, or with a series of separate phone conversations. We discuss the role of the spouses and craft an approach that includes them. Remember, in many families the spouse has been hearing the embattled family member's complaints for years and may feel the need to stand up for him or her. Or siblings may prefer to let their spouses take the hard positions, distancing themselves in discussions but privately pleased to hear their significant other taking a stand.
    Try to avoid creating a situation that pits a family member against his or her own spouse or partner or suggests that a family resolution depends on the rejection of a spouse's perspective. Instead, make it clear that there is a core team that has priority in exchanging information and making decisions, but the periphery will not be ignored in designing and implementing the overall solution.

    6. Communicate Honestly, but With Restraint

    Another lesson we learn as mediators is how to reframe statements, conveying the central import of the message but taking out the sting of the delivery. Instead of saying, "I can't bear seeing how irresponsible you've been in how you've managed your life," it's better to say, "As I'm sure you can understand, the difficulties you've endured are hard for me to watch, given that I care about what happens to you." One of the major tasks of a mediator is to listen to the complaints of each party, reframe the statements in ways that the others can hear, and facilitate a conversation that is constructive and solution oriented.
    Honesty means not telling a lie, but it doesn't require telling the entire story, either -- and it certainly doesn't preclude a healthy dose of diplomacy. Over and over again I had to practice this lesson, as I went back and forth in the discussions with my own family. I certainly didn't do a perfect job -- at times I revealed too much at the wrong time or included a detail that was unnecessarily provocative. But I always tried to find the right balance.
    Managing the conversation is a form of power that has to be used judiciously. Resentments can flare up if someone feels you're withholding the full story, and it's not helpful to mask the truth just because you think it's going to be hard to deliver the message. That's why I always tried to explain why I wasn't conveying certain information, so that everyone felt I was being appropriate and not abusing my role. Sometimes it's necessary to set boundaries of confidentiality even within a mediation, especially if one of the parties turns to the mediator as a coach to air concerns that they aren't ready to disclose to the other parties. Indeed, allowing such internal confidentiality is part of the typical "contract" for mediation, and it's a healthy practice that can be used productively in resolving family financial conflicts.

    7. Pay Attention to the Mode of Communication

    I sometimes encourage clients to send old-fashioned handwritten letters to convey sensitive information, for three reasons. First, written expressions convey the personal nature of the missive, which is helpful in tapping the emotional core of the family connection. Second, a letter slows down the communication -- the receiver has to wait at least a few moments before rushing over to the computer to send a response. And third, a letter stays on the desk rather than remaining hidden in the recipient's hard drive, thus minimizing the likelihood of it being ignored over time.
    Interestingly, a recent study has shown that if someone sending an e-mail has a photo of a person pasted on to their computer screen -- any person at all, not necessarily the intended recipient -- the tone of their e-mail is less adversarial. Indeed, although one of the reasons folks like e-mail is because they can assert their positions without being interrupted -- not even by a negative facial expression -- such "freedom" to speak without interruption can be highly destructive when it leads to exaggerated emotions and unchecked pontification.
    Phone calls often are better for delivering sensitive messages: They allow for an interaction and an informality that can be helpful, and they can't be "forwarded" to an army of supporters minutes after the conversation. But generally, an in-person discussion is the best for resolving family conflicts, even when the geography of far-flung families makes this difficult.
    The key is to be mindful about the communication process. Here are a few guidelines to keep the process from derailing:
    • Pay attention to the mode of communicating, and have an open discussion with everyone as to their preferences.
    • Whenever possible, schedule the conversations in advance rather than striking up a sensitive exchange just when your sibling is sitting down for dinner or dealing with a sick child.
    • Also try to develop a specific agenda for each meeting in advance, so that no one is surprised by the topics and everyone has a chance to be prepared.
    • If in-person meetings don't work, conference calls can be effective, since they require advance scheduling and can include all the concerned parties.
    • If you're using e-mail to carry on extensive conversations, be careful about forwarding and copying e-mails to others -- especially if the e-mail chain includes sensitive discussions that you didn't intend to share.
    • If you need to engage in e-mail discussions of complicated issues, consider using an application such as Google documents that allows you to retain the correspondence and comment constructively on each other's statements.

    8. Engage Professionals Wisely

    Sometimes it's prudent to bring in an outside professional -- an attorney, therapist, or mediator -- to help resolve difficult impasses or simply to structure the family process. Our family situation didn't need outside help, but I regularly monitored the situation to be sure.
    This strategy usually involves deciding what sort of professional expertise you're looking for and the specific assignment you're giving to that person. Often families will turn to an accountant, financial planner, or social worker to help with a technical task, such as an estate tax return or a care-taking plan for an elder relative. They may not want to face the reality that what they actually need, as a family, is mediation or counseling services, but over time, these deeper needs surface. Occasionally the hired professional will be able to assist in this other role, simply by dint of personality or concern, but generally it's better to be up front about what's needed and to hire the appropriate professional for the job.

    9. Keep Your Eye on the Long-Term Goals

    It isn't easy to keep your long-term goals in mind in the middle of a nasty argument with siblings or a discussion about the financial future of a parent or child. But it's essential to do just that, and not get sidetracked by every immediate challenge. Family members are likely to be around for decades -- or for generations. Long-standing conflicts shape family cultures and patterns of interaction; ignoring concerns can set a pattern of disregard that's highly destructive over time. Cruel responses or judgmental proclamations can create wounds that take decades, if ever, to heal.

    10. Take Care of Yourself

    Few of us qualify as saints, so it's important to recognize that even the most loving caretaker needs some nurturing to keep going. Whether you are one of a team of caring relatives or are the primary family mediator, don't neglect your own needs. Some days that means postponing a phone call so you can focus on your own family or job -- but be sure to ask explicitly rather than to simply fail to reply. Requests for cross-country travel to attend a family meeting need to be carefully considered in light of your own family needs and financial and time constraints.
    I found myself needing to be regularly "refueled" as I was helping my own family this year. For instance, one day I spent at a local Buddhist retreat center, attending a class on compassion and judgment and caretaking -- skills I definitely needed for family challenges. I tried to make sure that our phone calls happened first thing in the morning so they didn't unduly interrupt my workday obligations. I confided in my partner and a group of close friends about the challenges we were facing so that I'd be sure to have my own support system in place.

    Navigating a family financial crisis isn't easy, and there can be long-term harm to family relationships if the emotional dynamics aren't managed in a thoughtful manner. Even if you aren't the professional mediator, try your best to approach the challenges as if you were -- chances are the outcomes will be far more favorable on both the financial and the emotional levels.

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    She's Lied About Everything

    I met my son's girlfriend almost a year ago. She claimed to be a psychologist in her fellowship year at a major hospital, a 2 time cancer survivor that became pregnant with his child about the time her chemo treatment for bladder cancer ended. She claims to have terminated that pregnancy just before Christmas last year. Since then she's been diagnosed with stomach cancer and as of 6/9/13 given 3-6 weeks to live. Since then she has had her tumor removed via her esophagus and participated in a clinical trial that has virtually eliminated a stage 5 cancer. All of this while maintaining a robust appearance and having no physical signs of treatment or illness.



    Their relationship has been a constant rollercoaster of "illness" and accusations of betrayal. My son is at his wits end and I have gone so far as to have her investigated. I have absolute proof that she lied about her hospital position, she's an LVN, she didn't attend the schools she claimed to, nor did she receive an athletic scholarship as a distance runner.

    I don't care who she really is but I don't know what to do to stop her from destroying my son's life. He attempted to break it off with her last week and she calmly informed him that she is 12.5 wks pregnant again and intends to keep the baby. During that visit my son managed to take photos of all of her prescriptions which there are about 15 and based on one for prenatal plus along with Odansstron filled on 7-24-13 it appears that for once she may be telling the truth. Based on prescribers listed on her various medications she is seeing approx 6 different MD's and is taking everything from Adderall to Zanex. Ocycodone APAP, Hydrocodone with acetaminophen, Monodox, Indomethacin, Monelukast SOD, Hyoscamine, Omeprazole DR, Urelle Tabs and Budesonide.....

    I Loved this young lady. I know my son does still. We have both agonized over her health and I went so far as to send them to HI and Ireland to make her last weeks better for them. I'm still struggling with accepting that she is obviously a very sick girl but now my son's future is in her hands.....


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