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	<title>Mendel Psychological Associates&#039; blog &#187; advice</title>
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	<link>http://www.drmendel.com/blog</link>
	<description>Musings of a psychologist off the clock</description>
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		<title>Supportive therapy groups for teenagers with diabetes</title>
		<link>http://www.drmendel.com/blog/2009/11/16/supportive-therapive-groups-for-teenagers-with-diabetes/</link>
		<comments>http://www.drmendel.com/blog/2009/11/16/supportive-therapive-groups-for-teenagers-with-diabetes/#comments</comments>
		<pubDate>Tue, 17 Nov 2009 01:03:37 +0000</pubDate>
		<dc:creator>Dr. Mendel</dc:creator>
				<category><![CDATA[Therapy]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[diabetes]]></category>
		<category><![CDATA[Family]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/?p=155</guid>
		<description><![CDATA[<p>For over 20 years, I have been leading various groups: groups for kids whose parents have divorced, social support groups for kids with Aspergers Disorder, groups for kids who have lost a parent, groups for kids with ADHD and conduct disorders. One of the few things I have been doing even longer than leading groups [...]]]></description>
			<content:encoded><![CDATA[<p>For over 20 years, I have been leading various groups: groups for kids whose parents have divorced, social support groups for kids with Aspergers Disorder, groups for kids who have lost a parent, groups for kids with ADHD and conduct disorders. One of the few things I have been doing even longer than leading groups is managing my blood glucose levels. I was diagnosed at age 22, with<a href="http://www.diabetes.org/living-with-diabetes/recently-diagnosed/" target="_blank"> Type 1 Diabetes</a>. Since that time, I have tested my blood sugar levels many times each day and given myself insulin shots or, more recently, used an insulin pump. Now, I have decided to put together these two parts of my life &#8212; group leader and diabetic – and start a therapeutic support group for teenagers with diabetes.<br />
The feedback I have received from my diabetic clients, and from their parents, is that the fact that I have diabetes gives me an insight into their struggles that I would not and could not otherwise have. These children and teenagers often feel that I can understand what they are going through in a way that a non-diabetic simply cannot. I know firsthand the exhaustion and misery that come from high blood sugars, the confusion and inability to express a simple thought that come from extreme low blood sugars. I know all too well how desperately we diabetics wish we could – just for a day, just for a few hours! – stop being diabetic; how wonderful it would feel to be able to take a break from being aware of every bite we eat and its impact on us. At the same time, I know that many diabetics, particularly teenagers, are often all too adept at “pretending” they’re not diabetic. With an adolescent’s belief in his own invulnerability, a teenage diabetic may ignore the warnings he gets from his parents, his doctors and educators, and from his own body, and fail to manage his blood sugar levels adequately. And I know how painful, terrifying, and infuriating that can be for his parents.<br />
For the past few years, I have been helping young diabetics learn to manage this disease and to cope with its psychological impact as well as assisting their families in dealing with this new reality in their lives. But I have been doing so one client at a time. I am so excited to announce that early in 2010, I will be initiating a weekly group for teenage diabetics. The group will be open-ended and non-time limited; that is, <a href="http://www.drmendel.com/blog/2009/07/27/joining-a-social-skills-group/">clients may join </a>at any point and remain in the group as long as they benefit from it. The start date, day of the week, and time of day will be announced in the near future. I look forward to hearing from anyone interested in this group.</p>
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		<title>Parents: Talk to your Kids about Sex!</title>
		<link>http://www.drmendel.com/blog/2009/07/27/parents-talk-to-your-kids-about-sex/</link>
		<comments>http://www.drmendel.com/blog/2009/07/27/parents-talk-to-your-kids-about-sex/#comments</comments>
		<pubDate>Mon, 27 Jul 2009 16:54:07 +0000</pubDate>
		<dc:creator>Dr. Mendel</dc:creator>
				<category><![CDATA[Education]]></category>
		<category><![CDATA[Parenting]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[Aspergers]]></category>
		<category><![CDATA[High-Functioning Autism]]></category>
		<category><![CDATA[sex]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/?p=146</guid>
		<description><![CDATA[<p>I know that this sounds like an utterly uncontroversial bit of encouragement; surely everyone believes that parents should speak to their children about sex – providing them with information, guidance, and moral direction. </p> <p>But here I’d like to bring up a somewhat trickier, more challenging proposition: talking with your son who has Aspergers Disorder or [...]]]></description>
			<content:encoded><![CDATA[<p>I know that this sounds like an utterly uncontroversial bit of encouragement; surely everyone believes that parents should speak to their children about sex – providing them with information, guidance, and moral direction. </p>
<p>But here I’d like to bring up a somewhat trickier, more challenging proposition: talking with your son who has Aspergers Disorder or High-Functioning Autism (HFA) about sex.  I suspect that many parents think that there’s far less urgency to talk with these boys about sex.  Consistent with their general social deficits and lack of peer interaction, boys on the Autism Spectrum begin to date much later than do their non-Autistic peers and sexual activity starts significantly later. </p>
<p>I believe, however, that it as least as important to speak with these boys about sex.  Because of the rigidity in their thinking, their confusion about “gray areas” and subtle nuances of interpersonal interactions, I have found that kids and teenagers with Aspergers or HFA are often extremely confused about various aspects of sexuality and harbor significant distortions in their understanding.  I believe that this tendency is maintained and amplified by their social isolation: they do not have the sort of friendships and peer interactions in the context of which they could bounce their thoughts off of others.</p>
<p>These points were brought home to me very dramatically over the past few months when pre-teens and teens in my middle school and high school groups brought up sexual topics for discussion in group.  In the context of the ensuing discussion I saw the extent of their confusion which, in a couple of examples, was a source of considerable distress.  One boy recalled a time when he was playing with a female friend of the family and, to his shock and horror, found himself getting an erection.  This signified to him that there must be something terribly wrong with him and rarely has a day gone by since then when he has not mentally “beat himself up” over this.  Another time, the topic of pornography came up.  A boy commented that babies see pornography all the time.  I asked him what he meant by that and he replied “breast-feeding.”  To him, a breast, since it represents an erotic image for him is, <em>ipso facto</em>, pornographic.  Another boy picked up on this point, commenting that while people think that there’s more pornography in the United States, really there’s much more in Europe, since they have lots of nude and topless beaches there.  Again, to this boy, nudity equaled pornography.</p>
<p>I encourage all parents – and especially those with children who have Aspergers or High-Functioning Autism – to open a dialogue with their children about sex.  You will be helping them immeasurably if they can gain assistance in understanding this part of life which is so confusing for all adolescents, and that much more confusing for them.</p>
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		<title>Psychologists are bringing creative arts therapies into the mainstream</title>
		<link>http://www.drmendel.com/blog/2009/03/27/psychologists-are-bringing-creative-arts-therapies-into-the-mainstream/</link>
		<comments>http://www.drmendel.com/blog/2009/03/27/psychologists-are-bringing-creative-arts-therapies-into-the-mainstream/#comments</comments>
		<pubDate>Fri, 27 Mar 2009 19:07:00 +0000</pubDate>
		<dc:creator>Kristin Vitko</dc:creator>
				<category><![CDATA[Education]]></category>
		<category><![CDATA[Therapy]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[Arts Therapy]]></category>
		<category><![CDATA[Aspergers]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/?p=101</guid>
		<description><![CDATA[<p>I encourage yoo to read this <a href="http://www.apa.org/monitor/feb05/express.html">wonderful article </a>published on the American Psychological Association&#8217;s web site and magazine.</p> <p>Experts:</p> <p>An autistic teenager learns to communicate with other people by playing the drums as part of a group. A family in therapy makes a drawing together, allowing the therapist to observe their interactions and the [...]]]></description>
			<content:encoded><![CDATA[<p>I encourage yoo to read this <a href="http://www.apa.org/monitor/feb05/express.html">wonderful article </a>published on the American Psychological Association&#8217;s web site and magazine.</p>
<p>Experts:</p>
<blockquote><p>An autistic teenager learns to communicate with other people by playing the drums as part of a group. A family in therapy makes a drawing together, allowing the therapist to observe their interactions and the finished picture. Members of a breast cancer support group use dance and movement to express their feelings about being ill. A group of abuse survivors write a poem together and then read it aloud.<br />
Each of these is an example of creative arts therapy at work.</p></blockquote>
<blockquote><p>Creative arts therapies&#8211;sometimes also called expressive therapies&#8211;use media like dance, drama, music, poetry and visual arts to help clients express themselves.</p></blockquote>
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		<title>Use Your Imagination to Defeat Your Fears</title>
		<link>http://www.drmendel.com/blog/2008/11/21/use-your-imagination-to-defeat-your-fears/</link>
		<comments>http://www.drmendel.com/blog/2008/11/21/use-your-imagination-to-defeat-your-fears/#comments</comments>
		<pubDate>Sat, 22 Nov 2008 03:43:22 +0000</pubDate>
		<dc:creator>Dr. Mendel</dc:creator>
				<category><![CDATA[Therapy]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[children]]></category>
		<category><![CDATA[fears]]></category>
		<category><![CDATA[imagination]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/2008/11/21/use-your-imagination-to-defeat-your-fears/</guid>
		<description><![CDATA[<p>Over the years, I&#8217;ve worked with a lot of kids struggling with fears, phobias, and anxieties. Recently, I saw a nine year old boy who was having a lot of trouble getting to sleep because of night-time fears and bad dreams. This boy had one of the most vivid and creative imaginations I have ever [...]]]></description>
			<content:encoded><![CDATA[<p>Over the years, I&#8217;ve worked with a lot of kids struggling with fears, phobias, and anxieties.  Recently, I saw a nine year old boy who was having a lot of trouble getting to sleep because of night-time fears and bad dreams.  This boy had one of the most vivid and creative imaginations I have ever come across.  He uses his creativity to positive effect in lots of areas of his life, but when it came to sleep and night-time, the vivid images his mind came up with were so terrifying to him that he was unable to get to sleep.  This situation was worsened and complicated by the fact that when he became scared, he went into his mother&#8217;s bed where he felt safe and was comforted to the point that he was able to sleep.  Fortunately, his mother and father, who were recently divorced, were both fully on board in helping their son develop the skills and strategies he needed to be able to soothe himself to sleep.</p>
<p><img src="http://www.drmendel.com/blog/wp-content/uploads/2008/11/112208-0343-useyourimag1.png" alt="" align="left" />My approach in working with this boy involved two main steps:</p>
<ol style="margin-left: 38pt">
<li>First, he needed to understand that the problem was &#8220;in his head.&#8221;  That is, the things he feared and that were interfering with his sleep were not entities that he actually needed to be fearful of, but simply products of his vivid imagination.  Fortunately, this boy knew this full well.</li>
<li>Second – and this is the key step – <strong>if imagination can cause the problem, imagination can cure the problem.</strong> I set this boy to work coming up with imaginary creatures that would be on his side and able to battle and defeat the monsters bringing him such distress.  He created an intricate sequence of &#8220;blobs&#8221; able to outnumber and overwhelm the monsters of his bedtime.</li>
</ol>
<p>The results were immediate: This boy and both parents reported that he was consistently sleeping in his own bed.  Quickly, the frequency of his fears declined and he was able to dispel them rapidly when they did come on, with the help of his faithful &#8220;blobs.&#8221;  To me, this approach was enormously gratifying for several reasons.  The boy was able to defeat his imaginary monsters by himself rather than only through the presence of another person.  This, I believe, will help him in many ways in his life, by strengthening his sense of competence and self-sufficiency.  His belief that he was safe only in the presence of his mother, or of a protective adult, gave way to a view that he could be and feel safe even when he was by himself.  Finally, rather than attempting to subdue or disparage his imagination – one of his great strengths – he was able to use his potent imagination and creativity to overcome this problem.</p>
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		<title>How to Say No</title>
		<link>http://www.drmendel.com/blog/2008/10/25/how-to-say-no/</link>
		<comments>http://www.drmendel.com/blog/2008/10/25/how-to-say-no/#comments</comments>
		<pubDate>Sat, 25 Oct 2008 23:59:32 +0000</pubDate>
		<dc:creator>Dr. Mendel</dc:creator>
				<category><![CDATA[Aspergers]]></category>
		<category><![CDATA[High-Functioning Autism]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[Life]]></category>
		<category><![CDATA[Parenting]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/?p=53</guid>
		<description><![CDATA[<p>As you all know, I work with lots of kids with Aspergers Syndrome or High Functioning Autism. This advice applies particularly to these children, but I think it&#8217;s probably relevant for many if not most kids. </p> <p>I have had several experiences in which the children in my groups become annoyed at me, insisting that [...]]]></description>
			<content:encoded><![CDATA[<p>As you all know, I work with lots of kids with Aspergers Syndrome or High Functioning Autism.  This advice applies particularly to these children, but I think it&#8217;s probably relevant for many if not most kids.
</p>
<p>I have had several experiences in which the children in my groups become annoyed at me, insisting that I&#8217;ve <img align="left" src="http://www.drmendel.com/blog/wp-content/uploads/2008/10/102508-2359-howtosayno12.png" alt=""/>promised to do something for them or give them something.  I have felt at least equally confident that I had not said anything of the sort.  For example, in my groups, I provide pizza as part of a celebration whenever a child graduates from group.  I have provided pizza for the group on a few other occasions as well (which I think was a mistake, but what can I say?).  Well, at various times, kids have asked me if I could get them pizza the following week.  To my utter surprise, when the next week rolled around, they were dismayed and upset to learn that I wasn&#8217;t going to buy them pizza.  Several of the kids stated emphatically that I had &#8220;promised to buy [them] pizza.&#8221;  Looking back on the previous week, I think I had said something like &#8220;we&#8217;re not going to talk about that now; we need to listen to Jimmy&#8217;s sharing.&#8221;
</p>
<blockquote><p>A vague, non-committal response, will be heard as whatever the child hopes it to be
</p>
</blockquote>
<p>I&#8217;ve come to realize that a vague, non-committal response, will be heard as whatever the child hopes it to be.  If I do not provide a firm &#8220;No,&#8221; my answer will quickly evolve into a promise that I am then bound to break.  It struck me that I&#8217;d heard similar, flabbergasted complaints from parents over the years, that their children mishear things and insist that they said something that they had not.  My advice to all such parents – advice I need to follow myself – is to make your answers very clear.  <strong>Kids with Aspergers are often virtually obsessed with clarity, precision and specificity</strong>.  They don&#8217;t do so well with vagueness and open-ended circumstances.
</p>
<p>I think that there are truly only three categories of answer:
</p>
<ol style="margin-left: 40pt">
<li>If your child asks you for something and you can provide it, by all means reply &#8220;Yes.&#8221;  Be aware, however, that this is a commitment and a promise and should be kept in all but the direst of exceptional circumstances.
</li>
<li>When the answer is no, simply say &#8220;No&#8221; (and, of course, don&#8217;t proceed to provide that item or do that favor).
</li>
<li>Sometimes the answer is not definite.  You may not be sure whether you can provide the item requested, or you simply may not want to discuss the request at that point, or you may just need to take more time to consider it.  In that case, I recommend saying something like this: &#8220;The answer right now is No, but I&#8217;ll think about it more later on and we can discuss it more after you get home from school.&#8221;  No guarantees, but I think that it would be hard for any child to construe this answer as a promise to do something.
</li>
</ol>
<p>A couple more quick points about this approach: if you say &#8220;No, probably,&#8221; and later change your mind and say &#8220;Yes,&#8221; your child has gotten a pleasant surprise, which is a heck of a lot better than a broken promise or the perception of a broken promise.  Most importantly, if you give a firm &#8220;No,&#8221; stick to it.  Saying &#8220;No&#8221; to a child&#8217;s request (or demand) and then giving in to placate him or her or reduce his or her whining or nagging sets a truly bad example and sets you up for your future &#8220;No&#8217;s&#8221; to be ignored and battled.  If you choose to say &#8220;No,&#8221; stick with it, hard as this may be to do.  </p>
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		<title>Balancing the Two Essential Aspects of Parenting</title>
		<link>http://www.drmendel.com/blog/2008/09/28/balancing-the-two-essential-aspects-of-parenting/</link>
		<comments>http://www.drmendel.com/blog/2008/09/28/balancing-the-two-essential-aspects-of-parenting/#comments</comments>
		<pubDate>Sun, 28 Sep 2008 15:50:49 +0000</pubDate>
		<dc:creator>Dr. Mendel</dc:creator>
				<category><![CDATA[Divorce]]></category>
		<category><![CDATA[Parenting]]></category>
		<category><![CDATA[advice]]></category>
		<category><![CDATA[children]]></category>
		<category><![CDATA[Life]]></category>

		<guid isPermaLink="false">http://www.drmendel.com/blog/2008/09/28/balancing-the-two-essential-aspects-of-parenting/</guid>
		<description><![CDATA[<p>I believe that there are two essential components of parenting:</p> providing warmth, comfort, nurturance and affection; and providing structure, rules, discipline and a sense of responsibility and accountability. <p>The necessity of both components – and a reasonable balance between the two – is certainly not unique to post-divorce families; similar issues and similar complications arise [...]]]></description>
			<content:encoded><![CDATA[<p>I believe that there are two essential components of parenting:</p>
<ol>
<li><strong>providing warmth, comfort, nurturance and affection; and </strong></li>
<li><strong>providing structure, rules, discipline and a sense of responsibility and accountability</strong>.</li>
</ol>
<p>The necessity of both components – and a reasonable balance between the two – is certainly not unique to post-divorce families; similar issues and similar complications arise in most families.  I have seen intact families manage the issue in a variety of ways.  In many families, one parent is the primary source of affection and comfort and the other provides most of the structure and discipline.  I can&#8217;t tell you how many times a parent during an initial intake interview states that &#8220;I&#8217;m the disciplinarian in the family.&#8221;  My personal preference is for each parent to participate extensively in both aspects of parenting.  I think it is good for a child to see both mom and dad as sources of warmth and nurturance on the one hand and responsibility and accountability on the other.  But I have seen many, many families in which a division of the roles works quite well.</p>
<blockquote><p>I should emphasize that I view each of the two parental roles as absolutely essential and of equal importance.  Neither should be viewed as secondary to the other.</p></blockquote>
<h3>Post-Divorce Families</h3>
<p>The situation becomes far more complicated after a parental separation.  Obviously, from this point forward, the child or children are with only one of their parents at a time.  If a parent has heretofore functioned almost exclusively as a disciplinarian or primarily as a loving &#8220;buddy&#8221; to his or her child, he or she is likely to be ill-prepared to provide the other essential aspects of parenting.  Functioning alone as a parent, he or she cannot rely on the other parent to provide the complementary duties.</p>
<p>Often, in post-divorce families, each parent views the other as inadequate in one or the other area of parenting.  This may stem from the earlier patterns during their marriage in which each parent emphasized either discipline &amp; structure or warmth and affection.  During the marriage, the child could still be provided with all the necessary components of good parenting.  After the divorce, he or she alternates, getting more comfort from and play with one parent and more structure and sense of responsibility from the other.</p>
<p>While this is likely to be confusing and distressing to the child, unfortunately the situation often worsens as time goes on.  I have found that a sort of &#8220;dance&#8221; goes on between the parents, with each trying to balance out perceived deficits on the part of the other parent.  For example, a mother who has traditionally provided the bulk of the rules and discipline may see the father as impossibly lax, as a &#8220;good-time parent,&#8221; a &#8220;buddy&#8221; to their child incapable of providing adequate structure and discipline.  As a result, she may escalate her own level of rules and discipline to ensure that their child is learning appropriate lessons.  The father, meanwhile, may see the mother as cold and &#8220;no fun,&#8221; ridiculously extreme in her rules and overly strict in their enforcement.  He responds by becoming even more lenient, focusing almost exclusively on providing fun and entertainment to their child.  The parents become increasingly polarized, so that one household turns into a place of strict rules and rigidity in their application, while the other becomes a playhouse, in which appropriate bedtimes and regularity in schedule is sacrificed in favor of constant fun and entertainment.</p>
<blockquote><p>The main message is for each parent to strive for balance in his or her household.  Each parent needs to remind him- or herself that both structure &amp; discipline and warmth and affection are absolutely essential.</p></blockquote>
<p>Neither is more important than the other.  If you are a divorced parent, take an honest look at your ability to provide both aspects of parenting.  Are you better at one than the other?  If so, work on strengthening the area of relative weakness.  You will feel better as a parent and, most importantly, your child will benefit enormously from receiving the full range of appropriate parenting from you.</p>
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