If you had asked me twenty years ago what psychotherapy was about, I would have responded with abstract concepts: transference, countertransference, projection, identification, good enough mothering, neutrality. I had excellent training in psychoanalytic therapy at a world-renowned institution, and I learned the technical aspects of my profession well. But while I do not regret my professional start, life has taught me something much different about the work that, along with my family and dear friends, gives my life meaning.

First of all, everyone suffers - some much more than others, certainly. During our life, we all face losses - family, friends, our youth, our dreams, our looks, our livelihoods. There is no shame in suffering; it is part of being human. You can be certain you are not the only person on your block who is awake at 2:30 in the morning worried about losing something important to them. Of course therapists suffer, too. Therapists see therapists for therapy, who see other therapists, who see other therapists, and so on. At the end of this therapy chain is not one person who is supremely happy or confident, but rather, someone who, at times, has problems like the rest of us, and perhaps rues the fact that there is no one more senior he or she can talk to.

Second, while there are important psychological differences among us (between men and women, people with different diagnoses, etc.), and the daily challenges we face due to prejudice, bigotry, or discrimination differ, for the most part we are more similar than dissimilar. Fundamentally, we all want to be seen, heard, appreciated, and we protect ourselves as best we can if this does not occur. In many of the essays on this site I talk about the ways we protect ourselves, and what happens when our defenses fail. We all strive for voice, for agency, and not to feel helpless. Life presents many hurdles, some of which are too high to clear by ourselves, and when we stumble we are left with anxiety or despair. Often, we are uncomfortable making our fear or desperation known - we are similar in this respect as well.

I learned this not in any class, or supervision, but from life experience, though my personal pain and happiness. Sadly, my own three-year early therapy fit easily into the "pain" category. I learned much from it, mostly about disrespect and the misuse of power, and, over time, this has been exceptionally helpful to me in my work. Trying to raise three teen-age step children when I was still in my twenties (a difficult task at any age) also taught me a great deal, especially about voicelessness--their's and mine. Watching my own daughter grow up (see "What is a Wookah?") rubbed out many of the remaining abstractions of psychoanalytic psychology. As a toddler, she boldly stood up to Freud and in a clear and compelling voice, argued him down. This was a mixed blessing of course because in order to fight the managed care bully, the field desperately needed an intellectual base. Long term therapy was suddenly defined as ten sessions, and I was constantly arguing with insurance company gatekeepers. Was there still a career left for me in the field that I loved?

Of course, there was more joy. I watched my wife pursue a second, singing career with exceptional verve and, yes, voice. She is more satisfied with life than anyone I know, and I have learned a great deal from her. But I also watched my mother (also a singer) die of lymphoma, and my father suffer as a result. I know that grief is the worst that life has to offer, for which there is no remedy save time and an ear. Of course this leaves me feeling anxious about the future. The threat of death nips constantly at our heels. My beloved Golden Retriever, Watson, who is now grumbling because he wants to go out, is 11 years old and nearing the end of his life.

All of these experiences, together with years of working with clients, taught me as much about psychotherapy as my technical training.

So, if you asked me now what psychotherapy is all about, I would say it involves finding the vulnerable self common to all of us, nurturing it, allowing it to grow free of shame and guilt, providing comfort, security, and an attachment. Of course there is technique, but the best of it is mixed with and indistinguishable from humanness: listen more than you talk; make sure you fully understand everything you hear, wonder about it in the context of a unique personal history. This is the very backbone of psychotherapy. Seminars on the technical aspects of psychotherapy are stimulating and intellectually satisfying. But it is the outcome that truly matters. If your therapist does therapy well, and you awaken at 2:30 in the morning, you feel he or she is with you.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Psychotherapy: Truth or Revisionist History?

Selenium may help relieve depression. Low levels of Selenium are associated with heart disease, HIV, miscarriage and female and male infertility. Learn about the usage, dosage, side-effects of Selenium.

Also Known As:selenite, selenomethionine

• Overview
• Uses
• Dietary Sources
• Available Forms
• How to Take It
• Precautions
• Possible Interactions
• Supporting Research

Overview

Selenium is an essential mineral found in trace amounts in the human body. It works as an antioxidant, especially when combined with vitamin E, by scavenging damaging particles in the body known as free radicals. These particles occur naturally in the body but can damage cell membranes, interact with genetic material, and possibly contribute to the aging process as well as the development of a number of conditions including heart disease and cancer. Antioxidants such as selenium can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Selenium is needed for the proper functioning of the immune system and for the production of prostaglandins (substances that affect blood pressure and inflammation in the body). Low levels of selenium may worsen atherosclerosis (plaque buildup in arteries which can lead to heart attack and/or stroke) and can lead to premature aging. Selenium deficiencies have also been linked with certain types of cancer.

Many of the benefits of selenium are related to its role in the production of the enzyme glutathione peroxidase. This enzyme is responsible for detoxification in the body. Chronic exposure to environmental toxins, including chemotherapy drugs, radiation and other toxic medicines, increases the requirement for selenium.

Cigarette smokers have lower levels of selenium. There are several reasons for this. Tobacco decreases absorption of selenium in the digestive tract. In addition, many smokers have poor dietary habits and eat fewer foods containing selenium. Alcohol also lowers selenium levels.

Uses

Heart Disease
Low blood levels of selenium can contribute to heart failure. Selenium deficiencies have been shown to worsen atherosclerosis (plaque build up in arteries which can lead to heart attack and/or stroke). It is not known, however, whether selenium supplementation can prevent development or progression of atherosclerosis. Plus, some researchers are concerned that selenium supplements may minimize the benefits of cholesterol lowering drugs.

Cancer
Several animal and human studies have suggested that selenium may protect against the development of colon cancer. Higher cancer rates have been observed in areas where the level of selenium in the soil is low. At least one study has also found that selenium may reduce the risk of death from colon cancer.

Similarly, population based trials suggest that people who eat a diet rich in antioxidants, including selenium, may reduce their risk of prostate cancer. The National Institutes of Health (NIH) is currently sponsoring a large clinical trial, with projections of over 32,000 male participants, to evaluate whether use of selenium and vitamin E helps prevent prostate cancer.

In another study, over 1,300 people with skin cancer were randomly assigned to receive either selenium 200 mcg per day or placebo for at least three years. The researchers found that people who were not taking selenium were more likely to develop lung, prostate, or colon cancers than those who did take the supplement. Plus, an animal study found that selenomethionine (an active breakdown product of selenium) may reduce the spread of melanoma cells in mice. The authors of this study suggest that selenomethionine may prove to be an appropriate addition to the standard treatment for melanoma.

More research is needed to evaluate the use of selenium in preventing and treating the types of cancers discussed in this section. Any potential relationship between selenium supplements and other types of cancer, such as breast and cervical, have not been thoroughly evaluated in studies. Use of selenium supplements in conjunction with other antioxidants (including vitamin C, vitamin E, beta-carotene, and coenzyme Q10) and essential fatty acids, may reduce cancer spread and lessen death rate in women with breast cancer. However, this benefit cannot be attributed to selenium alone.

Immune Function
Numerous studies suggest that selenium is necessary for proper immune function. Selenium along with other minerals can help build up white blood cells, enhancing the body's ability to fight illness and infection.

In a study of 725 elderly men and women, for example, those who received zinc and selenium supplements demonstrated a better immune response to the influenza vaccine than those who received placebo. These results suggest that selenium and zinc supplements may boost immunity in older people and improve their resistance to infections.

In addition, an animal study found that selenium deficiencies may cause the flu virus to mutate into more dangerous forms, leading to harmful lung inflammation.

Asthma
Evidence suggests that people with asthma tend to have low blood levels of selenium. In a study of 24 people with asthma, those who received selenium supplements for 14 weeks demonstrated a significant improvement in symptoms compared to those who received placebo. More studies are needed, however, to determine whether selenium supplementation is safe and effective for people with this respiratory condition.

HIV
Selenium plays a key role in the proper functioning of the immune system and studies have shown that levels of this nutrient decline consistently as HIV progresses. Preliminary evidence suggests that selenium supplementation may improve certain symptoms of this condition.

For example, severe weight loss is a serious problem for people with HIV. In a well-designed study of people with HIV, those who took a daily supplement containing selenium, glutamine, beta-carotene, N-acetylcysteine, and vitamins C and E for 12 weeks gained significantly more weight than those who took placebo. Given the number of nutrients included in this supplement, however, it is unclear whether it was the selenium alone or the combination of all nutrients that ultimately prevented the weight loss in the study participants.

Burns
When skin is burned, a substantial percentage of micronutrients, such as copper, selenium, and zinc may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many clinicians suggest that a multivitamin including selenium may aid in the recovery process.

Selenium for Depression
Some reports indicate that selenium affects mood. In one study of people with low levels of selenium, those who consumed a diet high in selenium reported fewer feelings of depression after 5 weeks.

Male Infertility
Selenium and other antioxidants play an essential role in the formation of certain proteins found in sperm. Deficiencies of selenium, therefore, can have a detrimental effect on sperm motility. In a study of 69 infertile Scottish men, those given selenium or selenium in combination with vitamins A, C, and E for three months demonstrated significant improvement in sperm motility compared to men given placebo pills. Sperm count was unaffected.

Miscarriage and Female Infertility
Women who have miscarried tend to have lower levels of selenium than women who carry a pregnancy to full term. Whether selenium supplementation helps prevent miscarriage, however, is not clear. One study of only 12 women who either had trouble conceiving or had a history of miscarriage found that those who took selenium along with magnesium were more likely to carry their pregnancy to full term. Further research is needed. In the meantime, check your prenatal vitamin for selenium and magnesium content and talk to your doctor about the proper amounts

Diabetes
Animal studies suggest that selenium, particularly in combination with vitamin E, may lower blood sugar levels over time and reduce the risk of complications (such as kidney and blood vessel diseases) associated with diabetes. Studies in people are needed before conclusions can be drawn.

Inflammatory Bowel Disease (IBD) People with inflammatory bowel disease (including Crohn's disease and ulcerative colitis) often have reduced levels of selenium, as well as other vitamins and minerals, in their bodies. In the case of IBD, this can be from decreased nutrional intake and absorption in the intestines, excessive diarrhea, and/or surgical resection of parts of the digestive tract. For this reason, a multivitamin including selenium may be recommended by health care professionals for people with this health condition.

Liver Disease: Low selenium levels may be associated with an increased risk for liver cancer in people with hepatitis B and/or C. Furthermore, low selenium levels may worsen the toxic effects of alcohol on the liver. It is not clear, however, whether selenium supplementation can help prevent or treat liver damage.

Disorders of the Pancreas: Studies have found that antioxidant therapy including selenium may significantly reduce pain in people with pancreatitis (inflammation of the pancreas).

Thyroid Problems: Selenium deficiency can affect metabolism of thyroid hormones. Selenium supplementation in a small group of elderly individuals improved thyroid function.

Skin Problems: Selenium supplementation may help improve symptoms in individuals with various skin conditions such as acne, psoriasis, and eczema.

Rheumatoid Arthritis: Low levels of selenium in the blood may be associated with increased risk of rheumatoid arthritis. It is not known, however, whether supplementation with selenium alone will improve arthritis. Some experts believe, however, that the combination of selenium and vitamin E helps relieve symptoms.

Other Preliminary studies also indicate that selenium supplementation may be useful in the prevention and treatment of eye disorders (such as age-related macular degeneration) and lupus. Further studies are needed to confirm these findings, however.

Selenium Dietary Sources

Brewer's yeast and wheat germ, liver, butter, fish (mackeral, tuna, halibut, flounder, herring, smelts) and shellfish (oysters, scallops and lobster), garlic, whole grains, sunflower seeds, and Brazil nuts are all good sources of selenium.

The amount of selenium contained in different foods depends upon the level of selenium in the soil. Selenium deficiencies are common in parts of China and the U.S. where selenium levels in the soil are low.

Selenium is destroyed when foods are refined or processed. Therefore, eating a variety of whole, unprocessed foods is the best way to obtain this nutrient. This means eating foods in their original state, not canned, frozen, or commercially prepared.

Available Forms of Selenium

Selenium may be taken as part of a vitamin-mineral supplement, a nutritional antioxidant formula, or as an individual supplement. Most supplements contain selenomethionine.

How to Take Selenium

For best results, selenium should be taken with vitamin E.

The minimum daily recommended dietary allowances for selenium are listed below.

Pediatric

Neonates to 6 months: 10 mcg Infants 6 months to 1 year: 15 mcg Children 1 to 6 years: 20 mcg Children 7 to 10 years: 30 mcg Males 11 to 14 years: 40 mcg Females 11 to 14 years: 45 mcg The usual therapeutic dosage for children is considered to be 30 to 150 mcg, or 1.5 mcg per pound (0.7 mcg per kilogram) of body weight.

Adult

Males 15 to 18 years: 50 mcg Males over 19 years: 70 mcg Females 15 to 18 years: 50 mcg Females over 19 years: 55 mcg Pregnant females: 65 mcg Lactating females: 75 mcg Usual therapeutic dosage for adults is considered to be 50 to 200 mcg/day; but as dosages as high as 400 mcg/day may be recommended by a healthcare provider.

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

High doses of selenium (more than 1,000 mcg a day) over time may produce fatigue, arthritis, hair or fingernail loss, garlicky breath or body odor, gastrointestinal disorders, or irritability.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use selenium supplements without first talking to your healthcare provider.

Cisplatin, Doxorubicin, and Bleomycin Selenium may reduce toxic side effects associated with cisplatin and doxorubicin, two forms of chemotherapy used to treat cancer. On the other hand, a test tube study suggested that selenium may inhibit the anti-cancer effects of bleomycin.

Cholesterol-lowering Medications Researchers recently discovered an unexpected adverse interaction between antioxidant supplements and a popular combination of cholesterol-lowering medications known as simvastatin and niacin -- this interaction may have important implications for patients with heart disease. Together, simvastatin and niacin have been shown to lower LDL ("bad") cholesterol and raise HDL ("good") cholesterol in people with heart disease. When taken with antioxidants (including selenium), however, these medications may not be as effective in raising HDL cholesterol.

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Supporting Research

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Barrington JW, Lindsay P, James D, Smith S, Roberts A. Selenium deficiency and miscarriage: A possibly link? Br J Ob Gyn. 1996;103(2):130-132

Batieha AM, Armenian HK, Norkus EP, Morris JS, Spate VE, Cornstock GW. Serum micronutrients and the subsequent risk of cervical cancer in a population-based nested case-control study. Cancer Epidemiol Biomarkers Prev. 1993;2(4):335-339.

Beck MA, Nelson HK, Shi Q, Van Dael P, Schiffrin EJ, Blum S, Barclay D, Levander OA. Selenium deficiency increases the pathology of an influenza virus infection. FASEB J. 2001;15(8):1481-1483.

Benton D, Cook R. The impact of selenium supplementation on mood. Biol Psychiatry. 1991;29(11):1092-1098.

Berger M, Spertini F, Shenkin A, et al. Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial. AmJ Clin Nutr. 1998;68:365-371.

Boucher F, Coudray C, Tirard V, et al. Oral selenium supplementation in rats reduces cardiac toxicity of adriamycin during ischemia and reperfusion. Nutr. 1995;11(5 Suppl):708-711.

Brawley OW, Panes H. Prostate cancer prevention trials in the USA. Eur J Cancer. 2000;36(10):1312-1315.

Brown AC. Lupus erythematosus and nutrition: a review of the literature. [Review]. J Ren Nutr. 2000;10(4):170-183.

Cai J, Nelson KC, Wu M, Sternberg P Jr, Jones DP. Oxidative damage and protection of the RPE. Prog Retin Eye Res. 2000;19(2):205-221.

Cheung MC, Zhao XQ, Chait A, Albers JJ, Brown BG. Antioxidant supplements block the response of HDL to simvastatin-niacin therapy in patients with coronary heart disease and low HDL. Arterioscler Thromb Vasc Biol. 2001;21(8):1320-1326.

Clark LC, Combs GF Jr, Turnbull BW, et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. JAMA. 1996;276:1957 - 1963.

Combs GF Jr, Clark LC, Turnbull BW. Reduction of cancer risk with an oral supplement of selenium. Biomed Environ Sci. 1997;10(2-3):227-234.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Dimitrov NV, Hay MB, Siew S, et al. Abrogation of adriamycin-induced cardiotoxicity by selenium in rabbits. Am J Pathol. 1987;126:376-383.

Douillet C, Tabib A, Bost M, Accominotti M, Borson-Chazot F, Ciavatti M. Selenium in diabetes: effects of selenium on nephropathy in type 1 streptozotocin-induced diabetic rats. J Trace Elem Exp Med. 1999; 12:379-392.

Dworkin BM. Selenium deficiency in HIV infection and the acquired immunodeficiency syndrome (AIDS). Chem Biol Interact. 1994;91:181 - 186.

Finley JW, Davis CD, Feng Y. Selenium from high selenium broccoli protects rats from colon cancer. J Nutr. 2000;130:2384-2389.

Fleshner NE, Klotz LH. Diet, androgens, oxidative stress and prostate cancer susceptibility. Cancer Metastasis Rev. 1999;17:325-330.

Fleshner NE, Kucuk O. Antioxidant dietary supplements: Rationale and current status as chemopreventive agents for prostate cancer. Urol. 2001;57(4 Suppl 1):90-94.

Gabbe SG, ed. Obstretrics--Normal and Problem Pregnancies. 3rd ed. New York, NY: Churchill Livingston; 1996.

Garland M, Willet WC, Manson, JE, Hunter DJ. Antioxidant micronutrients and breast cancer. J Am Coll Nutr. 1993;12(4):400-411.

Garland M, Morris JS, Stampfer MJ, et al. Prospective study of toenail selenium levels and cancer among women. J Natl Cancer Inst. 1995;8:497 - 505.

Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer R-JM. Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr. 2000;54:514-521.

Ghadirian P, Maisonneuve P, Perret C, Kennedy G, Boyle P, Krewski D et. al. A case-control study of toenail selenium and cancer of the breast, colon, and prostate. Cancer Detect Prev. 2000;24(4):305-313.

Girodon F. Impact of trace elements and vitamin supplementation on immunity and infections in institutionalized elderly patients. Arch Int Med. 1999;159:748-754.

Hasselmark L, Malmgren R, Zetterstrom O, Onge G. Selenium supplementation in intrinsic asthma. Allergy. 1993;48:30-36.

Helzisouer KJ, Huang HY, Alberg AJ, Hoffman S, Burke A, Norkus EP, et al. Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer. J Nat Cancer Inst. 2000;92(24):2018-2023.

Howard JM, Davies S, Hunnisett A. Red cell magnesium and glutathione peroxidase in infertile women: effects of oral supplementation with magnesium and selenium. Magnes Res. 1994;7(1):49-57.

Hu YJ, Chen Y, Zhang YQ et al. The protective role of selenium on the toxicity of cisplatin-contained chemotherapy regimen in cancer patients. Biol Trace Elem Res. 1997;56:331-341.

Juhlin L, Edqvist LE, Ekman LG, Ljunghall K, Olsson M. Blood glutathione-peroxidase levels in skin diseases: effect of selenium and vitamin E treatment. Acta Derm Venereol. 1982;62(3):211-214.

Kadrabova J, Mad'aric A, Kovacikova Z, Podivinsky F, Ginter E, Gazdik F. Selenium status is decreased in patients with intrinsic asthma. Biol Trace Elem Res. 1996;52(3):241-248.

Kappus H, Reinhold C. Inhibition of bleomycin-induced toxic effects by antioxidants in human malignant melanoma cells. Adv Exp Med Biol. 1990;264:345-348.

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Navarro-Alarcon M, Lopez-Martinez MC. Essentiality of selenium in the human body: relationship with different diseases. Sci Total Environ. 2000;249:347-371.

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Olivieri O, Girelli D, Stanzial AM, Rossi L, Bassi A, Corrocher R. Selenium, zinc, and thyroid hormones in healthy subjects: low T3/T4 ratio in the elderly is related to impaired selenium status. Biol Trace Elem Res. 1996;51(1):31-41.

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Psathakis D, Wedemeyer N, Oevermann E, Krug F, Siegers CP, Bruch HP. Blood selenium and glutathione peroxidase status in patients with colorectal cancer. Dis Colon Rectum. 1998;41:328-335.

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Scott R, MacPherson A, Yates RW, et al. The effect of oral selenium supplementation on human sperm motility. Br J Urol. 1998;82:76-80.

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Sundstrom H, Korpela H, Sajanti E, et al. Supplementation with selenium, vitamin E and their combination in gynaecological cancer during cytotoxic chemotherapy. Carcinog. 1989;10:273-278.

van 't Veer P, Strain JJ, Fernandez-Crehuet J, Martin BC, Thamm M, Kardinaal AF, et al. Tissue antioxidants and postmenopausal breast cancer: the European Community Multicentre Sudy on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC). Cancer Epidemiol Biomarkers Prev. 1996 Jun;5(6):441-7.

Vermeulen NP, Baldew GS, Los G, et al. Reduction of cisplatin nephrotoxicity by sodium selenite. Lack of interaction at the pharmacokinetic level of both compounds. Drug Metab Dispos. 1993; 21:30-36.

Wasowicz W. Selenium concentration and glutathione peroxidase activity in blood of children with cancer. J Trace Elem Electrolytes Health Dis. 1994;8:53 - 57.

Witte KK, Clark AL, Cleland JG. Chronic heart failure and micronutrients. J Am Coll Cardiol. [Review]. 2001;37(7):1765-1774.

Yan L, Yee JA, Li D, McGuire MH, Graef GL. Dietary supplementation of selenomethionine reduces metastasis of melanoma cells in mice. Anticancer Res. 1999;19(2A):1337-1342.

Yang GQ, Xia YM. Studies on human dietary requirements and safe range of dietary intakes of selenium in China and their application in the prevention of related endemic diseases. Biomed Environ Sci. 1995;8:187 - 201.

Yoshizawa K, Willett WC, Morris SJ, et al. Studies of prediagnostic selenium level in toenails and the risk of advanced prostate cancer. J Natl Cancer Inst. 1998;90:1219 - 1224.

Yu MW, Horng IS, Hsu KH, Chiang YC, Liaw YF, Chen CJ. Plasma selenium levels and risk of hepatocellular carcinoma among men with chronic hepatitis viral infection. Am J Epidemiol. 1999;150(4):367-374.

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor, pharmacist, nurse, or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.

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Chapter 89 of the book Self-Help Stuff That Works

by Adam Khan:

WITH CONFIDENCE YOU'RE MORE attractive and likable, and you feel better than when you lack confidence. You've experienced the truth of that statement many times in your life. But isn't confidence something you either have or don't, something you're either born with or not? Can you deliberately become confident?

I'm confident you can.

You see, if we just use a synonym for confident, the way becomes obvious. One of its synonyms is "certain." And it is true that you feel confident wherever you have a lot of certainty. Think about it. For a teenage boy who wants to talk to a girl he likes, he may feel very awkward and not confident at all. But if he knew a lot about computers, and she was having a problem with a computer and asked his help, he could help her and feel confident doing so. Why? Because he would know what he was talking about. People feel confident when they are certain.

Therefore, wherever you would like to feel confident, develop more certainty about it. And I don't mean an attitude of certainty, I mean to develop real honest-to-goodness, actual certainty.

If, for example, you have to get up and speak to a group next week and you don't feel confident about it, start working to develop some degree of certainty: Talk to the people you need to talk to and find out who will be there and what they are expecting, and then prepare thoroughly. The more you prepare, rehearse, talk about what you will say to your friends, make notes, do research, the more certain you will be and the more confident you will feel.

As another example, a shy person might feel a lack of confidence meeting new people. When she's introduced, she feels like running away. This is very common. Why? Because a new person is - by definition - unknown. Our shy person is not certain about anything except the person's name (and if she is too distracted by her nervousness, she'll quickly lose her certainty about that too).

But surprisingly, even with a person you've never met before, you can know with certainty quite a bit about him. And our shy person can increase her certainty and therefore her confidence when dealing with people by:

1. Learning more about the human nature we all have in common.
2. Learning more about manners (so you're certain about what should be done when).
3. Learning strategies for getting to know someone.

You can learn human nature and manners and strategies so well you have a high degree of certainty about those things. This would add up to more confidence around people - even people you've never met before. A good book to start with is Dale Carnegie's How to Win Friends and Influence People.

But there are many ways to gain certainty about people, and each one increases your feeling of confidence a little more. Confidence is not on or off; there are many shades of gray from No Confidence to Absolute Confidence. Any actions you take to increase your level of certainty slides you over a little more toward Absolute Confidence.

Increase your certainty about how to act.

Would you like to learn more about the fine art of positive thinking? Would you like to behold the power of positive thinking? How about the power of anti-negative thinking? Check this out:
Positive Thinking: The Next Generation

How can you take the insights from cognitive science and
make your life have less negative emotion in it? Here's
another article on the same subject but with a different angle:
Argue With Yourself and Win!

next: Attitudes and Kin

Detailed overviewed of ADHD medications plus education and psychotherapy for ADHD.

ADHD Medications

As with children, if adults take a medication for ADHD (attention deficit hyperactivity disorder), they often start with a stimulant medication. The stimulant medications affect the regulation of two neurotransmitters, norepinephrine and dopamine. The newest medication approved for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled studies in both children and adults and has been found to be effective.¹

Antidepressants are considered a second choice for treatment of adults with ADHD. The older antidepressants, the tricyclics, are sometimes used because they, like the stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®), an antidepressant with an indirect effect on the neurotransmitter dopamine, has been useful in clinical trials on the treatment of ADHD in both children and adults. It has the added attraction of being useful in reducing cigarette smoking.

In prescribing for an adult, special considerations are made. The adult may need less of the medication for his weight. A medication may have a longer "half-life" in an adult. The adult may take other medications for physical problems such as diabetes or high blood pressure. Often the ADHD adult is also taking a medication for anxiety or depression. All of these variables must be taken into account before a medication is prescribed.

Education and Psychotherapy for ADHD

Although medication for ADHD gives needed support, the individual must succeed on his own. To help in this struggle, both "psychoeducation" and individual psychotherapy can be helpful. A professional coach can help the ADHD adult learn how to organize his life by using "props"—a large calendar posted where it will be seen in the morning, date books, lists, reminder notes, and have a special place for keys, bills, and the paperwork of everyday life. Tasks can be organized into sections, so that completion of each part can give a sense of accomplishment. Above all, ADHD adults should learn as much as they can about their disorder.

Psychotherapy can be a useful adjunct to medication and education. First, just remembering to keep an appointment with the therapist is a step toward keeping to a routine. Therapy can help change a long-standing poor self-image by examining the experiences that produced it. The therapist can encourage the ADHD patient to adjust to changes brought into his life by treatment—the perceived loss of impulsivity and love of risk-taking, the new sensation of thinking before acting. As the patient begins to have small successes in his new ability to bring organization out of the complexities of his or her life, he or she can begin to appreciate the characteristics of ADHD that are positive—boundless energy, warmth, and enthusiasm.

Sources: Excerpts from NIMH and Neuroscience Inc.

Notes:

1. Attention Deficit Disorder in Adults. Harvard Mental Health Letter, 2002:19;5:3-6.

next: The ADHD Diet

Get a copy of the IDEA 2004 regulations, read a manual - Special Education Rights and Responsibilities - and view webcast on IDEA 2004.

** Attention! **

The Department of Education published the Final IDEA 2004 Regs in html and pdf formats. You might also find it helpful to view a webcast on IDEA 2004 and 2006.

THIS IS IT! This manual has been my BIBLE for the last 5 years. I take it to every IEP meeting and found it an invaluable source of information when I was fighting to obtain special education services for my son. You will find references to California State and Federal special education laws in this manual. Even if you do not live in California, I think you will find this manual very helpful as it will give you ideas what to ask for, what other states are providing in the way of special ed and will give you some valuable ideas as to what area's you should do more research in as to specific laws pertaining to your state. This manual was revised in 1995 and is currently being updated again. I'll get the updated version to you as soon as it becomes available.

The manual, Special Education Rights and Responsibilities is now online! Be prepared for your next meeting with the school! KNOW YOUR RIGHTS!!!

1. Chapter One: Basic Rights and Responsibilities
2. Chapter Two: Information on Evaluations/Assessments
3. Chapter Three: Information on Eligibility Criteria
4. Chapter Four: Information on IEP Process
5. Chapter Five: Related Services
6. Chapter Six: Due Process Hearing
7. Chapter Seven: Least Restrictive Environment
8. Chapter Eight: Discipline of Students with Disabilities
9. Chapter Nine: Inter-Agency Responsibility
10. Chapter Ten: Vocational Education
11. Chapter Eleven: Information on Rights of Multicultural Children
12. Chapter Twelve: Preschool Education Services
13. Chapter Thirteen: Early Intervention Services

Here is additional information about the 504 plan so that parents can better be prepared in gaining services for the children.

Writing Legally Correct and Effective IEPs and TIEPs.

I wouldn't get caught dead in IEP meeting without knowing what my rights were and some idea what kind of services I could get. Click here if you want to know how to write a good IEP (Individualized Education Plan).

This site has a lot of great information regarding special education issues. www.wrightslaw.com.

next: Advocating for Your ADHD Child
~ adhd library articles
~ all add/adhd articles

As a parent of a child with ADHD, the best way to deal with guilt is to educate yourself about ADHD and your child's legal rights.

"There is nothing wrong with this child. He is just lazy and doesn't apply himself."

"If you would simply apply some discipline to this child, you wouldn't have these problems."

"ADHD is crap. It's just an excuse for poor parenting."

"Drugging your child is just a cop out, so you don't have to parent him."

Sound familiar? Got those bags packed for that guilt trip you always seem to be leaving on? Well you're not the only one and it's time we all stopped blaming ourselves for our children's ADHD diagnosis, and it's time we stopped listening to what others are saying and learn to trust our instincts and believe in the decisions we've made for our child.

Comments like this come from all sorts of people. Family members, teachers, friends, and even strangers. When remarks like this come from professionals, it often leaves us second guessing ourselves and the choices we've made for our children. When these remarks come from family members, they seem to cut straight to the core, hitting us right in the heart.

I've been hearing comments like these for over 11 years now and I've heard them from everyone. From the child's father, family members and his teachers. While I don't always hear the words, I see plenty of disapproving stares and glares from strangers when my child acts out in public places.

One thing I've come to realize is that you are never going to stop the comments. Every year brings new teachers and other staff members. If you're a single parent, boyfriends will come and go, all leaving their two cents worth. And family members seem to feel it's their God-given right to express their opinions to you.

I learned this the hard way recently when after 6 years of diagnosis, treatment and hardships with my son, I really felt my family understood. I really thought they knew how hard it was to raise this child and how hard it was fighting to get him the services he needed from the schools to make him a successful student. Then on Easter Sunday, the well-meaning male members of my family announced to me that I am raising a "mama's boy" and that "I am my child's biggest disability, not this ADHD crap."

So what is the answer to dealing with the guilt? What can you do to ease the pain?

I have found that the best possible way to deal with the guilt is to educate yourself. If you educate yourself, then you're making the best possible decisions you can for yourself and your child. If you are doing the BEST that you can, then What's to feel guilty about? Guilt thrives on doubt. So replace doubt with confidence by educating yourself about attention deficit disorder and by knowing your rights!

1. Learn what your rights, and your child's rights, are when it comes to special education. There are federal laws in place that protect your child's right to a free and appropriate education. Get a copy of these rules and regulations from your nearest CHADD office or local Protection and Advocacy Agency. Check the internet for the updates and changes to IDEA.

2. Network with other parents and share experiences and exchange ideas. Get support and understanding from parents who are going through some of the same things you are. Check with your local CHADD office, church or clergymen, or start your own support group. The internet has become one of the biggest and most convenient sources for information and support. HealthyPlace.com also offers support through chat groups and bulletin boards and best of all, it's convenient and open 24-hours a day.

3. Another helpful resource are listserv's. Through a listserv, parents get together and carry on discussions, ask for help, exchange information and support each other via email. Listservs have a way of becoming small communities, where soon you feel like you know the people you are communicating with.

Information is everywhere you look. Libraries, bookstores, newspapers and magazines. Use it to your advantage and learn all you can about the latest treatment on ADHD and special education. Knowledge is power! And with power, you gain control.

As for the pain, it's impossible for a mother to ever stop feeling the pain. I think the best we can ever hope for is to know that we're doing the best we can, and realize, that nobody, not teachers, family members, no one knows our child like we do and nobody will ever love them like we do. And because they are our children, we will love them no matter what. And as along as we are doing the best we can, then deep down, in our hearts, WE KNOW that we are doing the right thing. 

next: Getting Social Security for ADHD Children
~ adhd library articles
~ all add/adhd articles

A description and brief explanation of words related to ADHD, ADHD symptoms, medication for ADHD and others.

ADHD - Attention Deficit Hyperactivity Disorder is a developmental disorder characterized by hyperactivity, impulsiveness and/or inattention.

Adderall - Adderall is a stimulant drug which contains an amphetamine. It is used to improve attention span and decreases impulsivity.

Amphetamines - Drugs used to stimulate the brain; in children, can be used to treat hyperactivity.

Arthralgia - Neuralgic pain in a joint or joints.

Cylert - (pemoline) is a central nervous system stimulant.

Dexedrine - an amphetamine used as a central nervous system stimulant.

Hyperactivity- Having highly or excessively active behavior.

Hyperkinesis - Hyperactivity, especially in children.

Inattention - failure of person to pay attention; disregard; heedlessness; neglect.

Impulsiveness -Inclined to act on impulse rather than thought.

Insomnia - innability to fall sleep, difficulting sleeping.

Methylin - (methylphenidate HCl) is a mild central nervous system (CNS) stimulant.

Neurological - Having to do with brain function.

Pharmacological - The science of drugs, including their composition, uses, and effects.

Placebo - A pill containing no medication that is given to reinforce a individual's expectation they will feel better. This technique is used to test a drugs effectiveness.

Psychotherapy - The treatment of mental and emotional disorders through the use of psychological techniques.

Ritalin - (methylphenidate hydrochloride) a stimulant medication used to treat Attention Deficit Disorder.

Strattera - is the first non-stimulant medication approved for the treatment of ADHD in children, adolescents, and adults.

Section 504 - the law that prohibits discrimination against individuals with disabilities.

Stimulant - a drug that temporarily quickens central nervous system function.

Tics - A habitual spasmodic muscular movement or contraction, usually of the face or extremities.

Urticaria - an itchy skin eruption characterized by weals with pale interiors and well-defined red margins; usually the result of an allergic response to insect bites or food or drugs.

next: Be an Advocate for Your ADHD Child
~ adhd library articles
~ all add/adhd articles

I was born in Southern California to a family with its share of problems and troubles. My two siblings and I endured alcoholism, divorce, poverty, and unworkable thinking habits and communication styles. I became an avid reader in high school of self-help books. I started with Dale Carnegie's How to Win Friends and Influence People. I had always been very shy and socially inept, and I wanted to become more popular (especially with girls). After high school, I took a lot of personal-growth seminars and went to college and continued reading and all the while I tried to apply what I was learning. And you know what? Some of it worked!

I gradually changed many of my habits of thought. I became more confident in myself, less pessimistic, more persistent with my goals. I learned better ways to communicate and formed better relationships because of it. And I learned HOW to experience good moods more often.    

Back in 1990, I started writing a column for a startup newsletter called At Your Best. It was published by Rodale Press, the publishers of Men's Health, Prevention Magazine, and many others. Rodale sold their stylish, 6-page newsletter to businesses FOR THEIR EMPLOYEES. The newsletter had columns on relationships and time-management, and so on. Very practical stuff. And my column was about improving your attitude, getting along better with people, and enjoying work more. In a readers' survey, I was voted their favorite columnist.

The column ran for seven years, until At Your Best was no longer published. I had a huge collection of these articles and decided to publish them as a book and on the web.

I have tested every principle personally. I included in the book and on this web site only those principles that I found both effective AND relatively easy to apply.

One thing I learned from Dale Carnegie way back in high school is to summarize ideas into one short sentence. I do that for every chapter. It is much easier to remember and apply a principle that has been chiseled down into a short sentence. Please remember that. It is very important. As you explore these pages, you'll sometimes learn a new idea. Often you'll gain a new insight. When you do, try to boil it down into something easy to remember, and then remind yourself of it often enough to form a new mental or physical habit.

Enjoy your exploration.

Adam

next: Introduction

Contents in Essays on Psychology and Life Website:

Introduction
Understanding Voicelessness
Essays on Parenting
Essays on Relationships
Essays on Psychotherapy
Recommended Books

Introduction

• Essays on Psychology and Life Homepage
• About Me
• Richard Grossman, Ph.D. Curriculum Vitae

Understanding Voicelessness

• The Four Questions
• Six Questions About 'Voice' and 'Voicelessness'
• Voicelessness: Narcissism
• Voicelessness: Holiday Blues
• Depression and the Subtext of Family Life
• Adult Children of Narcissistic Parents: Is Love Enough?
• Little Voices
• Voicelessness: Depression
• Bill Clinton: A Case of Attention Deficit Disorder?
• Voicelessness: A Personal Account

Parenting

• Giving Your Child "Voice" Fundamental to a child's self-esteem and emotional well being is their sense of "voice." How do you ensure your child receives this lifelong gift?
• The Dance If you want to inoculate your child against depression and help build their self-esteem, you must learn how to dance.
• Do Parents Matter? The debate has been contentious and highly publicized. One critical issue has not been addressed.

• Voice Lessons: Littleton, Colorado (Guest column reprinted from the Brookline Tab, May 13, 1999 and excerpted in Massachusetts Psychologist, June, 1999) What can be learned about parenting from the Columbine High School tragedy?
• What is a Wookah? What does a child with "voice" sound like?
• Voicelessness: The Depressed Teenager Alienation and despair have reached epidemic proportions in high schools. How can you help your child?
• Voicelessness
• The Four Questions Who am I? Do I have any value? Why doesn't anyone see or hear me? Why should I live?
• Six Questions About "Voice" and "Voicelessness" What is "voice?" Why is it important?
• Voicelessness: Narcissism Narcissism is a misnomer. At their core narcissists don't love themselves -- in fact their self barely exists, and what part does exist is deemed worthless. All energy is devoted to inflating the self...
• Voicelessness: Holiday Blues If you become depressed at holiday time, you are not alone.
• Depression and the Subtext of Family Life In the psychology of children and adults, hidden messages rule.
• Adult Children of Narcissistic Parents: Is Love Enough? Important lessons about love and "voice" can be learned from the adult children of narcissistic parents...
• Little Voices Deprived of voice in childhood, some people shrink or twist themselves like a pretzel to fit others' worlds.
• Voicelessness: Depression Many chronically depressed people experienced childhood voicelessness. How does voicelessness affect adult depression?
• Bill Clinton: A Case of Attention Deficit Disorder? Unfortunately, Hillary did not get it quite right when she explained Bill's sexual escapades...
• Voicelessness: A Personal Account What happens when a dying parent values one small part of us and neglects the rest? (Invited talk: Contemporary Spiritual Experience, Brookline, MA, Sept, 2002).

Relationships

• Why Can't Some People Maintain Intimate Relationships? Many people retreat from close emotional contact, frustrating spouses and partners.Here's a look at the problem from the perspective of childhood "voicelessness."
• Why Do Some People Choose One Bad Relationship After Another? Psychoanalysts, citing Freud's "pleasure principle", have suggested masochism as the answer. Why else would people suffer the same pain and humiliation over and over again? Here's another explanation based upon the need to exist in other's eyes.
• Relationships: The Role of the Hidden Messages Hidden messages from childhood secretly affect adult relationships. Here's an example.
• Couples Counseling: Is Better Communication Enough? We've read it in all the popular magazines: better communication leads to a happier marriage. But is better communication enough?

Psychotherapy

• Psychotherapy and Humanism Life experience has taught me that humanism plays a critical role in the healing process.
• Psychotherapy: Truth or Revisionist History? Can a therapist uncover the truth about a client's past? Here's a case example based upon a mother's diary.
• A Person Appears in My Office What happens next? How does therapy begin?
• Psychotherapy in the Internet Age To "e" or not to "e", that is the question...
• So, You're Thinking About Becoming a Therapist? Learning about subtext is critical. Here's an exercise based upon Robert Frost's poem, "Stopping by the Woods on a Snowy Evening."
• Therapy on the High Seas: A Search for Self What happens when an adult child of a narcissistic family faces progressive heart failure? Consider this account of a man's struggle for physical and emotional survival.
• Dreams, Imagined Dreams--Failed Therapy Therapists can not only heal, they can hurt.
• Depression: Why See a Therapist if You Can Just Take a Pill? Sometimes medication is the easiest and most inexpensive answer for depression. But there are good reasons to consider therapy, even if you are on anti-depressants.
• Vulnerability: the roots of compassion Response to the 9-11 terrorist attack. September 27, 2001

Recommended Books

• The Voicelessness and Emotional Survival Reading List. Books recommended by Dr. Richard Grossman and Message Board members.

back to: Essays on Psychology and Life Homepage

Contents in Self-Help Stuff That Works Website:

Introduction
Immediate Relief of Negative Feelings
Self-Help Stuff That Works - The Book
Bonus Chapters
Bite-Size Self-Help That Works

Introduction

• Self-Help Stuff That Works Homepage
• About Me
• About the Author of Self-Help Stuff That Works
• Explore This Site
• Making Changes Stick

Negative Feelings

• Immediate Relief of Negative Feelings
• Angry: Argue With Yourself And Win!
• Bored at Work: Zoning Out, Bored at Home: Wasting Time... The Old Fashioned Way, Always Bored: The Ocelot Blues
• Tired: Be More Energetic
• Worried: Expect the Best
• Impatient: Having the Time
• Annoyed: Meanings and Feelings
• Frustrated: Positive Thinking - The Next Generation
• Discouraged: Just Keep Planting
• Stressed Out: Stress Control
• Insecure: Insecurity and How to Be More Self-Confident
• Depressed: Optimism
• Discontented: The Root of All Happiness and Contentment
• Relatives Upset Your: Attitudes and Kin
• Improve Performance: A Wiser Adviser
• Parenting Problems: Necessary Conflict
• Trouble Makers at Work: The Trouble with Troublemakers

Self-Help Stuff That Works - The Book

• Introduction
• How to Use This Book
• Comments by Readers
• Questions and Answers

Part One: Attitude

• Attitude - Table of Contents
• Optimism
• Optimism is Healthy
• A Wiser Advisor
• Honest Abe
• Master the Art of Making Meaning
• Brighter Future? Sounds Good!
• Adrift
• Maybe it's Good
• You CAN Change
• The Neutralizer
• Stress Control
• The Old Switcheroo
• Having the Time
• Think Positive Positively!
• The Uncertainty Principle
• Unpleasant Feelings
• The How of Tao
• Pillar of Strength
• Meanings and Feelings
• Expect the Best
• Fighting Spirit
• How to Improve Your Self-Esteem
• All in Your Head
• Think Strong
• Where to Tap
• A Simple Way to Change How You Feel
• We've Been Duped
• How to Like Yourself More
• Rx to Relax
• Interest is Life
• Positive Thinking: The Next Generation
• From Hope to Change
• Be All You Can Be
• Riches
• Adventure
• The Ocelot Blues
• Argue With Yourself and Win!
• Constitutional Right
• Why Ask Why?
• Science of Happiness
• A Slave to His Destiny
• Attitude Principles

Part Two: Work

• Work - Table of Contents
• Zoning Out
• Time Management Made Simple
• Envision it Done
• Use What You Get
• Do You Want to Give Up?
• As Good As Gold
• Law of Return
• Personality Counts
• R-e-s-p-e-c-t
• A Terrible Thing to Waste
• "I Don't Know What to Do With My Life"
• Sometimes You Shouldn't Listen
• Just Keep Planting
• Getting Paid to Meditate
• Be More Energetic
• Burn Your Own BTUs
• How to Earn More Money
• The Trouble With Troublemakers
• The Spirit of the Games
• A Lasting State of Feeling Great
• You Create Yourself
• Wasting Time the Old-Fashioned Way
• Taking Credit
• Make it Happen
• Forbidden Fruits
• Life is a Meditation
• Play the Game
• Self-Help
• Speedy Reading One Chunk at a Time
• Thousand Watt Bulb
• An Island of Order in a Sea of Chaos
• The Samurai Effect
• Unnatural Acts
• The Shortest Distance
• American Reading Ceremony
• Work is Good Therapy
• Work Principles

Part Three: People

• People - Table of Contents
• How to Avoid Feeling Socially Awkward
• Your Inner Guide to Self-Esteem
• Complaint Compunctions
• Here Comes the Judge
• The Power of Listening
• Confidence With People
• Attitudes and Kin
• Very Impressive
• Make Your Own Labels
• Danger
• How to Find a Lifemate
• Personal Propaganda
• Play Yourself Down
• The Conflict of Honesty
• E-Squared
• How You Measure Up
• Send a Blessing
• Personality Myth
• Suggestive Moves
• We're Family
• Mastery
• Is That Clear?
• To Zip or Not to Zip
• Take the Sting Out
• How to Be Close to Your Friends
• How to Have More Life in Your Time
• How to Melt Hard Feelings
• How to Get What You Want From Others
• Elicit Your Own Acknowledgement
• Self-Confidence
• The Power of a Poker Face
• TRUE Love
• Right Makes Might
• The Bad Apples
• Refuse to Flinch
• Forging Mettle
• People Principles
• Parting Shot
• Index

Bonus Chapters

• Bonus Chapters Homepage
• The Bad News About Bad News (and What You Can Do About It)
• A Friend in Deed
• Conversation on Optimism
• Thoughtical Illusions
• Interpretations

Bite-Size Help

• Bite-Size Self-Help That Works Homepage
• Why Failing to Lose Weight Is a Good Thing
• How Thinking Negatively Can Make You Feel Better
• How to Make People Like You For Five Cents
• How Being Irresponsible Can Improve Your Life
• How to Have More Time (and Less Stress)
• The Ancient Hindus Used the Same Technique as Modern Cognitive Science to End Human Misery
• Is There an Easy Way to Stop Feeling Angry or Annoyed?
• The Root of All Happiness And Contentment
• Why Optimism Is a Self-Fulfilling Prophesy
• How to Be Healthier Without Lifting a Finger
• How to Persist Without Willpower
• Invigorate Your Life In a Profound Way Using a Technique Developed In a Concentration Camp
• Why Pessimism Shuts Down Our Immune System
• What Was Abraham Lincoln's Religion?

back to: Self-Help Stuff That Works Homepage