Choosing the Right Therapist

October 21, 2013

By Jerry Nelson October 20. 2013

What is Psychological Health?

I have spent the last seven years working with our military Service Members and their families as they contended with the cycle of being deployed, coming back and being deployed again. As you can imagine, their service to our country impacted every area of their life. This was especially difficult for our National Guard and Army Reservists who came back home to their community without the same resources available to active duty personnel.  Working closely with these individuals, reinforced for me that our daily life consists of four main areas, as illustrated below, and that there is a lot of overlap. Psychological health takes a holistic approach to wellness – recognizing we are an integration of mind, body, and spirit. Difficulties in any one or more of these areas can have a major impact on other areas. Psychological health is achieved with balance in these four areas.

4 spheres


When Should a Person Seek Assistance?

I also used to work as a surgical nurse and often assisted with cancer surgery.  Most cancers start as a small group of cells that can grow to produce a noticeable lump.  If caught early enough, the cancer can be stopped in its tracks. In our daily life we can have early warning signs, lumps if you will, starting in any of the four areas illustrated above. These can spread into other areas and infect how you view yourself and/or others. For instance, there may be a situation in the social aspect of your life where a relationship has gone bad, such a divorce, unforgiveness, hurt by a friend, etc. Soon you notice you don’t want to associate with others, your appetite has gone away, sleep is impossible, you’re grumpy and irritable and it seems life is spiraling downward. It doesn’t take long for all four areas of your daily life to be affected.  It may be time to do something about these signs and look for a change.

Need a Change?

Need a change

Often the longer we wait to do something about the warning signs, the more entrenched the problem becomes in all aspects of life. Perhaps there is a lot of uncertainty in your life and you feel like you’re in a giant maze.  My experience with military Service Members and their families, as well as private practice, revealed that often changing one area of life, (such as emotions, behaviors, relationships, or even a direction in life) can help bring back the psychological health that was once enjoyed.


How CAN a Counselor Help?

Counselor Help 1 Counselor Help 2

You can think of a counselor as someone who comes along side of you and helps you sort out the changes you want to make. Often this involves giving you a new perspective on an issue, or developing new skills to approach old problems in a new way. Maybe you need someone to be more directive and point out things you just can’t see. In the illustration above, can you see the young woman/saxophonist, or the young woman/old woman? Some people can see the images right away, but others need more direction to make the distinction.

Wrong Results?


I often hear “I tried counseling and it just didn’t work,” especially from men.  Perhaps the problem was you weren’t getting the results you were looking for after just one session. No matter who the counselor is, try to give it at least 2 to 3 sessions before you leave counseling with that individual. However, research shows that the best predictor of a positive outcome is being connected to your counselor. One way to avoid future conflicts is to interview several counselors before starting counseling sessions. I recommend you briefly describe your problem and ask the counselor how much experience they have with that problem. Ask them what their approach to your problem would be. Also ask them how they know when someone is done with counseling. You are listening for two things: the first is the actual answers the counselor gives you; and the second is how they answer you. Do you like what you hear and do you think you can connect with the therapist? You have a right to be proactive in your counseling.

The Bottom Line!

 Bottom Line Military

The military has a credo of leaving no one behind. Finding the right counselor to come alongside you as you work through some things in your life goes a long way toward having, and maintaining, psychological health.

Contact Jerry right now at 608-785-7000 x221 to schedule an appointment or click here to make an appointment request. 

Eating Healthy, Exercise, and Wellness

July 29, 2013

Wellness blog:    7/22/13 by Diane Walker

This past week, I attended the National Health and Wellness conference in Stevens Point, WI.  I have been out of the health and wellness world for quite some time; it felt very good to be back. There are tons of exciting and wonderful things happening in the world of health and wellness, including the creation and support of new jobs. There were physicians, nurses, therapists (mental, physical and massage), wellness coaches, retired people, college students, teachers, etc.. in attendance. The first keynote speaker was Larry Cohen, the guru of the smoke free movement. He is currently working on a project to bring refrigeration to poverty stricken areas. He believes, and research shows that if fresh fruit and vegetables are prominently displayed and accessible, more people will choose to eat them on a regular basis. I attended seminars in plant based eating, blogging for wellness, motivational interviewing, nutrition, Pilates, and yoga. I also completed a 5k run (without stopping) for the first time in a few decades!!


I have dabbled in the health and wellness world most of my life. I have coached numerous teams for both boys and girls, I was an aerobics instructor back when “step” aerobics was the thing to do, and have been a certified personal trainer. Since becoming a full-time outpatient therapist, I noticed that I have let some of the things I “used to know, go away”. After this conference, I am once again motivated to become involved in the wellness world. How many times has someone (or yourself) talked about needing to lose weight, or getting fit, or been told to make changes in your habits by a doctor or loved one? We all cope with health and wellness in our own ways and most of resent being “told what to do”. Our brains reject “being told”, or at least mine does. Weight and fitness are very personal issues; becoming healthy is an individual quest and can often be successful only after personal reflection. Reasons to make changes may include; I want to look/feel better, my clothes don’t fit anymore, my doctor says I am unhealthy, my spouse tells me I have gained, etc.. If we are able to decide on a health plan, course of eating and exercise, that we WANT and REALLY LIKE, we are significantly more invested in succeeding. Again, this is an individual choice.  The fitness “gurus” and “weight professionals” have tons and tons of answers for us, just look at the best selling books in the book store. There are entire sections devoted to weight loss and how to become fitter. How do we sort through all this information?  Where do we start?


First, find some time to sit and reflect about why you want to make changes in your lifestyle. This can be done in a few minutes, or over several quiet sessions. Sometimes, writing down ideas and thoughts can be helpful, this allows us to rule out things that might not work or we don’t really like. Support during this process is important, but choose carefully. Make sure your support system is truly that, supportive.  Once you have determined your reasons for making changes, recognize that change is very difficult and takes time. All the sessions I attended this past week emphasized that our brains go backwards in times of stress; we revert back into old patterns often without realizing it. Be true to yourself and begin slowly. Set goals that are reachable and can be relatively quick; this provides encouragement to keep on track.


Watch our website for tips as a health and wellness section will be added and updated regularly. Also, feel free to call and set up an appointment with Diane as you begin to make changes. Our bodies don’t really like change; it may become difficult to maintain and continue on our chosen path. Research shows that positive physical health has a direct and influential link towards positive mental health, to become “happy”.


Click here to schedule an appointment with Diane and begin living well again!

Unleash the Power of the Positive in You….

April 25, 2013

The power of the positive…….by Diane Walker

What really happens to us when we get “stuck in the negative”; what does our body experience as a result? Conversely, how does our body react when we have a more optimistic outlook, believe in the good?

Research shows that men in unhappy marriages/relationships have a shorter lifespan of 10-15 years compared to those in happy marriages. For the purposes of this writing, we’ll define a happy marriage as one in which both partners exist on equal footing, emotional safety is present for both partners, and the ability to be completely ourselves is constantly present.

Negative thought patterns can lead to depressive symptoms, lack of energy, physical illness, unsatisfactory relationships, anxiety, anger, and that feeling of “just wanting to stay in bed all day.” It is often very difficult to maintain positive relationships when we don’t trust or believe in the goodness of others. Negative thought patterns can be instilled when we’re kids, by parents, school experiences, “life” in general. Most of us have some type of trauma in our childhoods, experiences and perspectives are individual and varied. We view our pasts through our own rose colored glasses, our own perspective, which has to be as important as anyones.

Let’s look at recent events in this country such as the Boston bombing a few weeks ago. We think about the victims with sadness, horror, and anger. We ask “why does this have to happen”; we want answers and feel like someone has to pay. Sometimes, we may get stuck in thinking we can’t explore the “unsafe” world, we don’t want to leave our houses. We may start or continue viewing other’s intentions as negative, wanting something from us, “why would you want to spend time with me”. We may look at the incredibly terrifying experience as a whole, not the incredibly compassionate events that take place within the tragedy.

What happens when we see the positive in this world; we acknowledge the negatives and violence, but do not let them define our own life’s parameters. Positive thinkers live longer, are healthier, are quick to smile, see the best in others, are motivated and believe in the power of change, and have deeper and more satisfying relationships.
The research surrounding positive thinking is prevalent and everywhere. Some people are born with natural optimism, others learn the secret of positiveness as they age. This is a skill that can be learned, that can transform your life. What about the people who help the victims of the bombing, the vast numbers of people who send cards, donate prosthetics, time, money, and smiles. How do some people get to forgiveness and begin the process of moving on with their lives?

How do some people learn the power of hope, despite everything they have been through in their lives. One Sunday, there was a story about a guy who never learned to read. He is a World War II veteran who survived the landing at Normandy. He worked as a civilian after the war until retirement age. His wife and co-workers covered for him so no one ever knew he couldn’t read. His lifetime dream was to read a book before he died. He is now 90 and has finally read several books; he tries to explain his intense feelings related to accomplishing his goal. He said, “Get in there and learn, you ain’t going to learn in that pine box”. How simple would it have been for him to just forget about this and live his life the way he always had. Change is possible at any age, in any environment, in any circumstance if we want it badly enough.

We can all learn the power of positive thinking and embracing positive change. Counseling can help with your outlook.

To schedule an appointment with Diane, click here now or  call 608-785-7000 x221!


Here is a great video on Mental Health Wellness vs Mental Illness…


Online and Telephone Help Now Available

April 10, 2013

Click the link below to get help fast! Get scheduled with a provider today!

Online or Telephone Help!!

Evidenced Based Practices for insecurely attached children and trauma

February 20, 2013

I am frequently asked about “attachment therapy” and “attachment parenting” and various treatments. Many books and others claim success with their approach and individuals often write glorious reviews of these approaches. Yet, we know that these approaches are NOT supported in the literature and withstanding the scrutiny of peers. As such, I wanted to just briefly compile a short list of assessments, tools, treatments and theory approved by Advocates for Children in Therapy that is evidenced based (researched and replicated with a control group) and a list of unsupported assessments, tools, treatments and theory. These can also be found on the Advocates for Children in Therapy website as well as literature such as Handbook of Attachment, Disorganized Attachment, Disorganized Attachment and Caregiving, Parenting Representations, Clinical Applications of the Adult Attachment Interview and others. I have also included a list of accepted assessment tools for assessing attachment quality.


Parent-Child Interaction Therapy (PCIT)

Kazdin Method for Parenting the Defiant Child

Attachment and Biobehavioral Catch-up Intervention

Circle of Security

Incredible Years

Adult Attachment Interview

Strange Situation

Attachment Q-Sort 

Attachment Story Telling Completion Task

Attachment Doll Play Assessment

Adult Attachment Projective Picture System

Caregiving Helplessness Questionnaire

Working Model of Child Interview

Parent Development Interview

Circle of Security Interview

Attachment Script Sets

Ainsworth Maternal Sensitivity Scales


Below is a list of treatments and interventions, tools and theories  NOT recommended:

  • Attachment Disorder
  • Attachment Therapy
  • Attachment Therapy Parenting
  • Beyond Consequences
  • Cline/Helding Adopted and Foster Child Assessment
  • Cline/Helding Adoptive Parent Attitude Assessment
  • Complex Trauma
  • Corrective Attachment Therapy
  • Critical Care Parenting
  • Dr Post’s New Family Revolution
  • Dyadic Developmental Psychotherapy
  • Emotional Deficit Syndrome
  • Family Centered Regulatory Therapy
  • Holding Therapy
  • Holding Time
  • Humanistic Attachment Therapy
  • Integrative Dyadic Psychotherapy
  • Nancy Thomas Parenting
  • Family Attachment Narrative
  • Pre and Peri Natal Psychology
  • Rage Therapy
  • Rage Reduction Therapy
  • Randolph Attachment Disorder Questionnaire
  • Reactive Attachment Disorder
  • Stress Model
  • Theraplay
  • Z-Therapy

On the Advocates for Children in Therapy Website, they list the names of proponents of the above treatments.  When entrusting your care and the care of your children to someone following one of these models, caution and care must be taken. While there may certainly be some benefits, there is a possibility of doing more harm than good. Remember, the motto of the creators of the Circle of Security state “Parenting in 25 words or less: ALWAYS be BIGGER, STRONGER, WISER, and KIND. Whenever possible, follow the child’s need. Whenever necessary, take charge.” Ensuring proper  treatment for your child is a take charge moment!!!

Back to School Special! A “Wing and a Prayer!”

September 4, 2012

For the past two decades, much research has been done on the student-teacher relationship. Attachment theory proposes that that a child develops a hierarchy of caregivers and that it is the caregivers role to perform the necessary tasks of becoming a haven of safety from which a child’ explores and a base of security to which a child returns. A close and supportive relationship between teacher and student would assume that a teacher performing this role would allow a student to focus on the tasks at hand – peer interaction, academic performance, and interaction with other adults; however, few studies have been able to examine this directly. One study by Ahnert and colleagues (2012) has provided clear and substantial evidence that a teacher who provides a haven of safety and base of security directly influences a child’s ability to regulate stress in a classroom setting.

The challenge that is currently being faced by researchers is finding interventions that are effective. Reflection based interventions (teacher reflects on their behaviors, feelings, intentions, and thoughts) have been promising, but inconclusive. Interpersonal Skills interventions (skills for communicating and interacting with others) have also been promising, but inconclusive.  Hughes (2012, p. 322) suggest that “teachers’ goals and teaching philosophy, teaching self efficasy, and self awareness of their own emotional states and capacity to use this awareness to regulate one’s behavior likely affect their responsiveness to different interventions.”

As I sent my daughter off to school this morning to begin third grade, she was so excited and a bit anxious about school. She set her alarm, got herself dressed and groomed. She came into the bedroom excitedly pronouncing her feats with a big smile on her face and the enthusiasm of a child on Christmas morning. It was delightful! We had breakfast together and played as has been our school morning rituals since kindergarden. When it was time to go, we took all the pictures we could until she gave the proverbial ,”UGH” and then it was off to school!

This year, she has her first male teacher. There is also a boy in her class that pulled her hair once two years ago that makes her anxious as well. Truthfully, I found myself a bit anxious wondering if this male teacher will provide the haven of safety and base of security that I know her previous teachers were able to provide. Certainly, I am gender stereotyping, but I am a worried protective father sending his daughter into the world. This week, my prayers have been filled with themes of protection and safety for her!!

What I take comfort in at these times, are God’s promises He has made to us:

Psalms 84:11 states “The Lord God is like a sun and shield; the Lord gives us kindness and honor. He does not hold back anything good from those whose lives are innocent.”

Isaiah 43:2 states “When you pass through the waters, I will be with you. When you cross rivers, you will not drown. When you walk through fire, you will not be burned, nor will the flames hurt you.”

Psalm 61:3 states “You have been my protection, like a strong tower against my enemies.”

What is most comforting, is my daughter knows Jesus at her age. All the promises He has made He has graciously offered to her as well. I take refuge in knowing He is watching over her when I cannot, he is protecting her when I cannot, and through the power of the Holy Spirit, He is supporting her her when I cannot and comforting her when I cannot. I believe in Him and His word. I trust Him. I pray to Him. Praise the Lord, God our Savior, who helps us everyday (Psalm 68:19)

Ahnert, L., Harwardt-Heinecke, E., Kappler, G., Eckstein-Madry, T., & Milatx, A. (2012). Student-teacher relationships and classroom climate in first grade: How do they related to students’ stress regulation? Attachment & Human Development, 14, 249-263

Hughes, J.N. (2012). Teacher-student relationships and school adjustment: progress and remaining challenges. Attachment and Human Development, 14, 319 – 327




Addiction: How to Recognize It and What to Do about It

June 15, 2012



Addiction to alcohol and other drugs is a chronic disease. It is progressive, continuous, and long-term. Alcohol or drug abuse means that a person has control over whether he or she drinks or uses but uses it to excess – experiencing emotion, physical and sometime, legal consequences. Alcohol or drug dependence means that a person has lost all control over his or her drinking or using behavior.


Addictive Behavior

People who suffer from addictive diseases engage in compulsive behavior and gradually lose control of their lives. They continue to drink or use drugs, even when they know it will lead to negative consequences. They tend to have low self-esteem and almost inevitably suffer from anxiety and depression.


If someone in your life suffers from addictive disease, you have experienced his or her extreme behavior, ranging from depression to exhilaration. You probably have also experienced the person’s state of denial (“I can quit anytime” or “I don’t have a problem”), dishonesty, frequent disappointments, and the series of ruined relationships. These are the hallmark behaviors when a person suffers from addiction to alcohol or drugs.


Who Is Affected by Addictive Disease


Alcoholism and drug addiction affect people from all parts of society. Addictive disease affects rock stars, writers, artists, and homeless people. Victims also include stay-at-home moms, teenagers, and corporate executives. There are addicts who are students at top universities and physicians in your local hospital. They may be teachers at your neighborhood school or salespeople at the local hardware store.


Studies have shown that there is a genetic predisposition to alcoholism. About half of all alcoholics had an alcoholic parent. Men seem to be more vulnerable than women to the alcoholic traits of their parents. Women may be more affected by factors in the environment (such as financial and life circumstances) than by inherited factors.



The Physical Side of Addiction


Chronic alcohol abuse produces long-lasting damage in many areas of brain function. It damages the capacity for abstract thinking, problem solving, memory, and physical dexterity. It also impairs verbal, visual, and spatial ability. The extent of damage to brain tissue depends on the extent of heavy alcohol abuse. When the drinking stops, a certain amount of healing is possible.


Prescription Drugs


Prescription and illegal drugs with psychoactive side effects target the brain and can change a person’s mood. This causes these drugs to be potentially addicting. Some people think that if a doctor has prescribed a drug, it is not addictive. This is not true.

It is important to tell your doctor if you:


•            Are an alcoholic (using or in recovery)

•            Have ever been addicted to any drug

•            Have taken more than the prescribed dose of a prescribed drug

•            Have taken a prescribed drug for a long time

•            Take a prescribed drug with alcohol


Addictive disease is often progressive and can be fatal. Thankfully, with proper treatment, recovery is possible.




The first phase of treatment of addictive disease focuses on the physical effects of alcohol or drug use. This phase can include detoxification or treating life-threatening disorders such as liver failure.


Since addictive disease is primarily a brain disease that results in behavioral symptoms, the main treatment is psychosocial therapy. Treatment usually focuses on the irrational feelings and distorted thinking that accompany chronic alcohol or drug abuse.

Alcoholism and drug addiction are chronic diseases that require a lifetime recovery plan. Most successful treatment plans include a focus on the 12 steps of Alcoholics Anonymous and involve ongoing, long-term participation in self-help groups. Patients who have been hospitalized for treatment may continue group and individual psychotherapy after they leave the hospital, in addition to attending 12-Step meetings.


Treatment of the Family


Addiction affects every member of the patient’s family. As the disease progresses and the patient continues to drink or use, it causes a range of emotional, spiritual, and financial problems for almost everyone involved, including family, friends and coworkers. When the family is ready to begin the recovery process, Al-Anon and Alateen are excellent resources. A qualified family therapist who understands the process of addiction and recovery may also be consulted to work with the family.


What to Do When an Alcoholic or Addict Won’t Stop


Sometimes the alcoholic or addict is in such a strong state of denial that the best alternative is to arrange an intervention. This process involves arranging for a professional interventionist to organize a meeting of the family, friends, and employer of the patient. The interventionist helps the group prepare a confrontation that will be followed by the patient entering a treatment center. The patient’s family and friends usually write a brief statement describing how the drinking or drug use has affected them. The interventionist and the group then meet with the patient and read their statements to the patient with the guidance of the interventionist. These interventions, when managed by professionals from respected treatment organizations, often result in successful treatment of the addiction.


If you or someone you know is struggling with alcohol or substance problem, call us at 608-785-7000 or click here for an appointment request. 

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Predicting Harsh Parenting In Toddlerhood and Beyond….

April 1, 2012

Observation and research data shows that level of parent sensitivity during the first year of life can predict harsh parenting during toddlerhood.  These early predictors , while not in and of themselves the cause, put children at risk later in toddlerhood and school age for behavioral and emotional problems in both the home and school setting. These caregiving patterns, without intervention, have been shown to remain constant and stable through the child’s development into later childhood years.

Attuned sensitive caregiving involves a three task process for caregivers: 1) perceiving a child’s cue 2) interpreting the child’s cue accurately 3) responding to the child’s cues promptly and appropriately. Many internal (what is going on in the caregivers head and heart; depression; anxiety) and external factors (marriage distress; social support network; if a daycare, number of other children) are involved regarding how well a caregiver accomplishes the tasks of providing sensitive and responsive care-giving.

Harsh caregiving may include subtle and blatant acts, either verbal and/or physical ranging from ill timed tone of voice (caregiver is irritated) through physical aggression (slapping or worse).

Parents at risk for harsh and/or abusive parenting may display a challenge in one or more of the above three areas. Milner (1993, 2003) describes four stages involved in parenting strategies that  put children at risk for physical abuse.

Parents at risk for abusive behavior to children often display the following (Milner; 1993, 2003):

1) Less attentive and attuned to their children’s behavior when compared to average, non-abusive and low risk parents

2) Interpretations of the child’s behavior are often negative, including hostile intent (they are doing this to me) and generalized (they always do this; it is how they are wired)

3) Exclusion of the context of behaviors (bad day at school, sad because their friend was hurtful, it is late and the child is tired, etc).

4) Rigidity to parenting strategies and lack insight into how well their strategies are working and the emotional/physical impact of said strategies

Furthermore, other studies  have shown a lack of respect for the child economy and “physical” interference with the child’s behavior, especially during periods of exploration, are also a characteristic of some parents who demonstrate harsh/abusive parenting as a pattern.

The suggested intrusive as well as harsh/abusive parenting as a pattern seem to share a lack of empathy or understanding for the child behavior and motives in both average, daily interactions and discipline moments (Joosen, Mesman, Bakermans-Kranenburg & van Ijzendoorn, 2012).

Caregivers may be misattuned to their own thoughts and dialogues and may or may not be aware of these strategies, often using justifications for their own behavior. This adaptation may often be as of a result of their own history of being cared for, current environmental or relational conditions, and/or their own mental health issues.

For example; in a custody situation, the caregivers may be already stressed and while their has been no historical evidence of harsh caregiving, the threat of the marriage ending may produce enough stress that a parent becomes less attuned and sensitive to their child. They may read the child’s cues properly, but may attribute this cue to something that the other parent (acussed) has done to the infant/child. While the parent may respond appropriately to the child, the attribution of the child’s cue may inadvertently cause the the parent reading the cue to begin to act subtly hostile towards the other parent. Over time, this may become a full blown need to “protect” the child from the other parent and over the years resulted in intrusive caregiving to the child – questioning everything and acting very anxious – which the child would pick up on and adapt accordingly.

Meanwhile, the “acussed parent” over time experiences the child withdrawing due to the anxiety and rather than address this miscue (has a need but is expressing it indirectly, not at all or the opposite of what they need), acts on it, becoming more harsh and resentful towards the child or withdrawing from the relationship with the child.

While sometimes harsh parenting is intergenerational, sometimes it brought on by the situation and environment, and sometimes it is both.

This is why in a custody or placement decision an important part in an assessment is to evaluate the attachment of the child to each caregiver and gain a deeper understanding into the complexity of these dynamics, how to arrange a placement schedule that is beneficial to the child, and help the parents be the best versions of themselves they are meant to be. Parenting is forever – in the eyes of a child. Contact us for more information at 608-785-7000×221 or email info@effectivebehavior.com

Attachment and Custody: The King Solomon Dilemma

February 7, 2012

Written by our Consulting Psychologist – Kip Zirkel, PhD.

The whole area of infant/toddler placement continues to be one of the most difficult issues facing Guardians ad litem, Family Court Commissioners and custody evaluators, and to date there have been little in the way of social science research to give us any guidance. In fact, the two primary research teams who have focused on this issue have come to opposite conclusions, with Judith Solomon’s group suggesting that overnights for young children should be avoided* (see note below), and Kelly and Lamb on the other side suggesting that young children can do quite well with overnights.  The struggle to balance parent’s right to have an ongoing relationship with a child with the child’s need for developing a secure and predictable attachment is at the heart of the problem, and now we have several new studies which go a long way towards resolving these contradictory findings.


A recent series of ongoing research studies down in Australia (McIntosh and friends), along with a similar report coming out of the University of Oxford, have begun to shed some light on this issue. And we are also fortunate to have the entirety of the most recent issue of the Family Court Review (July 2011) devoted to infant/toddler attachment and the question of custody and access plans. Interestingly, these articles are coming out at right about the same time as the “50/50” initiative (commonly referred to as the “father’s rights” campaign) is gathering steam around the country. It appears that the issues raised in the research studies mentioned above will generate quite a bit of discussion and argument.


Perhaps to oversimplify a bit, on one side of the table are the “shared placement” proponents, who claim that children need the advantage of a shared placement plan with two involved parents (often interpreted as parents sharing an exact “50/50” division of parenting time) and that states should have  statutes supporting this presumption.  Father’s rights groups traditionally have argued for this approach, citing a supporting body of research to support their legislative initiatives.


On the other side of the table are the “primary residence” proponents, who argue (and also cite research) that babies and toddlers need the safety and security of a primary residence, that there should be a primary caretaker (typically the mother in most cases) and that the non-residential parent should have frequent, ongoing contact. However, overnights should be postponed until the baby reaches a certain age (ranging from 2 until about 4). This argument also presupposes that the very earliest months of a baby’s life require the establishment of a secure attachment to one parent, and that if this process is disrupted, there will be serious emotional consequences down the road.


Upon reviewing the three recent research reports noted above, it is clear that those who argue that a baby or toddler should have one primary residence have the force of this research behind them. This should come as no surprise to most of us, since I along with many of you have agreed that one should not disturb the delicate attachment process by splitting the baby between two homes, but that the non-residential parent should be gradually “phased in” as the baby matures and develops the capacity to separate from his or her primary caregiver. I will summarize below the major points raised by these articles. Of course you are encouraged to read the original sources for yourselves, but if you don’t have the time or inclination, perhaps this summary will assist and inform you.

  1. First of all, gender doesn’t matter. Babies can attach to either gender, as long as that individual is present, available emotionally, sensitive to the child’s moods, “in tune” with the child, responsive, and is not absent for long periods of time.
  2. Every baby needs to form the security of at least one parent (or parent-figure) in order to ensure the attachment security grows. This early attachment should not be disrupted or compromised.
  3. The quantity of time the infant spends with a parent is not as important as the quality of that relationship (although of course there has to be a minimum period of contact for the quality of the relationship to flourish.
  4. Shared time works best for parents who cooperatively work it out without the intervention of courts. But then we don’t see these in the course of our legal practice.
  5. Shared time arrangements for children of any age pose particular risks if there is ongoing conflicts, or the mothers express ongoing safety concerns.
  6. Shared care carries special risks for children under the age or 4, even with cooperative parents.
  7. Parents who enter into shared care arrangements tend over time to drift back to “mother primary” care.
  8. There is no research establishing a clear link between shared time and better outcomes for children. Better outcomes for children arise from a host of other factors (i.e., the quality of care, relationship between parents, temperament of the child, absence of conflict, etc.).
  9. Care arrangements in infancy should support the growth and consolidation of the primary relationship, yet allow for the familiarity and growing attachment with the “second” parent.
  10. If the attachment process in the first two years of life is disrupted, it will affect the hard wiring of the child’s brain, with far reaching consequences later including the possibility that the child will not attach securely to other parent-figures.
  11. Overnight care is not essential to the formation of secure attachment in young children. Overnight care arrangements essentially are ordered to address the rights of the parent rather that the best interests of the child.
  12. Equal or near-equal distribution for giving time is not normative, even in intact families. It is not clear why a separation/divorce situation would require something different.
  13. Thorough assessment of the attachment quality between a child and his parents is an essential component, if not the most important component, of a custody evaluation.

These are the major points brought out in these recent research efforts. They may raise more questions than they answer. For one, how does one go about doing an assessment of the attachment between parents and children in a timely and efficient manner? What factors should be given more weight in doing assessments? Should we attempt to “improve” the attachment between a child and a parent rather than simply placing the child with the other, presumably healthier, parent?

I would encourage you to read through the most recent issue of the Family Court Review (July 2011), available through the AFCC organization.


Click here to register now for our two hour CEU inservice at UW La Crosse. Webinars coming soon!

Contact us for further information on having an attachment assessment completed at info@effectivebehavior.com or click here to make a referral. 

* Clarification:  Dr. Carol George (personal communication, February 19, 2013) “Our position is similar to Jenn McIntosh’s position, which is under high conflict and poor parental communication, overnights are not a good idea.  If parents can negotiate these problems between adults, security can be obtained.”


January 5, 2012

Where Do I Start?

(from American Foundation for Suicide Prevention www.afsp.org)

Know that you are not alone.

If you have lost someone to suicide, the first thing you should know is that you are not alone. Each year over 33,000 people in the United States die
by suicide — the devastated family and friends they leave behind are known as “survivors.” In fact, research shows that during the course of our lifetime
85% of us will lose someone we care about to suicide. That means that  there are millions of survivors who, like you, are trying to cope with this
heartbreaking loss.Survivors often experience a wide range of grief reactions, including some or all of the following:

  • Shock is a common immediate reaction. You may feel numb or  disoriented, and may have trouble concentrating.
  • Symptoms of depression, including disturbed sleep, loss of appetite, intense sadness, and lack of energy.
  • Anger towards the deceased, another family member, a therapist, or  yourself.
  • Relief, particularly if the suicide followed a long and difficult mental illness.
  • Guilt, including thinking, “If only I had.…”

These feelings usually diminish over time, as you develop your ability to cope and begin to heal. We care and want to help.

Professional, compassionate help is available. Call us at 608-785-7000 or click here for an appointment request. 

National Violent Death Reporting System findings with respect to suicide in 2008:

 For 2008, a total of 15,755 fatal incidents involving 16,138 deaths were captured by NVDRS in the 16 states included in this report. The majority (58.7%) of deaths were suicides, followed by homicides and deaths involving legal intervention (i.e. deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (26.4%), deaths of undetermined intent (14.5%), and unintentional firearm deaths (0.4%). Suicides occurred at higher rates among males, American Indians/Alaska Natives (AI/ANs), non-Hispanic whites, and persons aged 45–54 years. Suicides occurred most often in a house or apartment (70.6%) and involved the use of firearms (51.5%). Suicides were precipitated primarily by mental health (45.4%), intimate partner (30.9%), or physical health problems (22.6%), or by a crisis during the preceding 2 weeks (27.9%).

 Suicide Patterns

Similar to the 2005–2007 NVDRS data years, the suicide rate for the 2008 data year was highest among males and American Indian/Alaskan Natives, although at least 85% of the suicide victims each year were of white non-Hispanic race/ethnicity. Also, the 2008 suicide rate was highest among those of aged 45–54 years, in general, but the highest rate remained among males of aged ?85 years. These findings have also been documented in other reports (10,11 ).

In 2008, mental health issues (i.e., having a current depressed mood and/or a current mental health condition) remained the most common health characteristic among decedents, which was also reported in previous years (79). Intimate partner and relationship problems, alcohol/substance abuse problems, serious physical health problems and crises immediately prior to death also remained common characteristics or circumstances among decedents (7,8,12–16). This report also showed that intimate partner problems were more common among male decedents and diagnosed mental health conditions were more common among female decedents. However, both male and female decedents were almost equally as likely to be noted as having a current depressed mood prior to death. This finding supports previous research that showed females are more likely than males to seek mental health care and receive a diagnosis for their mental distress (17,18). Among those who received a diagnosis, the majority of both male and female decedents were diagnosed with depression. However, this report revealed some differences in diagnoses by sex; attention deficit disorder was more commonly found among male suicide decedents and bipolar disorder and anxiety disorder were more commonly found among female decedents.

Another similarity with previous data years was that nearly 30% of suicide decedents in 2008 disclosed their intent to commit suicide to others and approximately 20% had made previous suicide attempts (79). This finding indicates that there still remains the need for proper follow-up treatment and monitoring for those who attempt suicide as well as the need for public education on how to respond and seek help when faced with someone disclosing suicidal intentions (79,19).

In contrast to previous NVDRS data years, slightly greater proportions of suicidedecedents in 2008 were identified as having job problems and having financial problems prior to death. In 2008, both proportions were estimated to be 13.4% whereas, in previous data years, the proportion of suicide decedents identified as having job problems ranged from 11.1%–11.5%, and the proportion identified as having financial problems ranged from 11.0%–11.7%. Financial hardship was not found among decedents of undetermined deaths, which further indicated this circumstance was more associated with suicide. Financial and job problems were more common among male decedents and decedents aged >50 years. Job loss can trigger a cascade of negative events, such as more financial problems and relationship problems (20), which can increase risk for suicide. These findings suggest that strategies that incorporate financial planning and social support are warranted for those who might be at risk for losing employment, particularly during difficult economic times.

 Description of System: NVDRS collects data regarding violent deaths obtained from death certificates, coroner/medical examiner reports, and law enforcement reports. NVDRS data collection began in 2003 with seven states (Alaska, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, and Virginia) participating; six states (Colorado, Georgia, North Carolina, Oklahoma, Rhode Island, and Wisconsin) joined in 2004, four (California, Kentucky, New Mexico, and Utah) in 2005, and two in 2010 (Ohio and Michigan) for a total of 19 states. This report includes data from 16 states that collected statewide data in 2008; data from California are not included in this report because NVDRS was implemented only in a limited number of California cities and counties rather than statewide. Ohio and Michigan are excluded because they did not begin data collection until 2010.

To view the entire report, visit:  http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6010a1.htm?s_cid=ss6010a1_e&source=govdelivery

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