What I find strikingly poignant was how painful this ordeal was for Thomas Jefferson. Jefferson’s draft of the Declaration of Independence was subjected to more than 80 changes during the period that the Continental Congress deliberated. Most of the changes were minor and served to enhance Jefferson’s work.

One section that didn’t survive the cutting room floor hurt him significantly though. Jefferson wanted to include a section that addressed the pain of parting from the British Crown. “After all, the Brits were our friends, we were leaving them, we might have been a free and great people together,” he lamented. The Congress however, was not in a conciliatory mood. The abrupt ending of old ties with England was not on their mind; their focus was on the denunciation of high-handed treatment.

We all know “the rest of the story.” We handed the Crown their heads in the Revolutionary War. They came back at us again in 1812, burning the White House and the Capitol in the process, but were eventually vanquished in New Orleans, never again to return to American soil as an army.

I believe Jefferson was troubled by the act of burning one’s bridges. I believe that in spite of the waging of two substantial wars on his watch, he perceived that the United States of America and Great Britain would eventually rekindle their relationship. How right he was, and how beneficial for us (World War II immediately comes to mind.)

Relationships that damage us, cause irreparable harm, or serve as an ongoing threat to our well-being should end, and stay that way. But these should be in the minority, because with ardent dedication to damage control and the contributions of father time, allies that became enemies can become allies again. We should all cherish the desire to grow old together in harmony.

Happy 234th Independence Day.

On a 3X5 index card, have your client write down the following five questions, and recommend that they ask these after the doctor has completed the initial assessment and has evaluated the client’s history and presenting symptoms.

1. “What do you think is wrong with me?”
2. “What might be causing this?”
3. “What else could it be?”
4. “Is there more than one treatment for my disorder?”
5. “Would you please tell me about the medication(s) you’re prescribing for me?”

Why suggest clients do this? Because these questions, simple as they may be, often go unanswered due to the flurry of activity in physician offices. So clients have to empower themselves to maximize the benefits of office visits. And an empowered client is usually a compliant client.

Therapists are at times reluctant to pursue collaboration with physicians who are intimidating, boorish, insulting, controlling or egotistical. Physicians also carry their own stereotypes of therapists as being too ‘theory oriented,” “touchy-feely” or not “symptom focused.”

These contradicting viewpoints demand that professionals sharing client care become familiar with each other’s role and respect the value of each other’s views and opinions. For the non-medical clinician though,

With this in mind, here are some tips for working with physicians:

• Approach physicians in an assertive, confident manner. This will endear you to doctors faster than anything else. If you find yourself apprehensive or anxious, jot down your points or questions on an index card or notepad. Be succinct and make eye contact.
• If you work in an on-site system, find the “main traffic area” and place yourself in the middle of it. Greet physicians as they walk by with a smile and where appropriate, a handshake. This builds goodwill – an ally you’re going to need.
• Establish your expertise as a competent worker, and respond timely to physicians that reach out to you. This speaks for itself. Do your job, do it well, and be available. Once you establish your competence, you’ll become the “go-to” person, particularly for difficult cases.
• Speak their language. This means focusing on symptoms and eschewing any theory jargon. For example, if after placing Ms. Jones on Cymbalta for a few days she has become more restless or agitated, report this only. This is not the time to discuss her repressed memories from childhood.
• Never recommend a specific medication treatment. This is an egregious boundary violation, unless the doctor asks for your suggestion(s). Medication decisions are made by the physician in concert with input from the client system.
• Understand and appreciate cultural differences. Physicians are under severe time constraints, which should be respected. Physicians take a tremendous amount of responsibility for their patients’ well-being and in facilitating change in their patients’ condition. Non-medical clinicians on the other hand, often place the responsibility for change on the backs of their patients. This difference can create conflict which in turn fuels skewed expectations of one another. So recognizing and appreciating role differentiation between the non-medically trained practitioner and the physician can be a productive step toward working collaboratively.

Placebos account for the successful treatment of depression, pain, asthma, arthritis, hypertension, insomnia and other conditions. In the classic placebo effect, a person consciously believes that a substance is therapeutic, and this belief generates a positive effect on medical or psychological symptom improvement.

For several decades however, scientists and researchers have known that placebo effects can also arise from subconscious associations as opposed to conscious beliefs. Any stimuli that a patient may link with symptom improvement – a physician’s white lab coat, a physical examination, the touch of the stethoscope to the chest or the smell of alcohol in the examining room – may induce positive physiological responses even if a patient has no explicit belief or faith in the treatment being administered.

The placebo effect probably accounts for most of the benefit associated with treatments such as acupuncture, aromatherapy, homeopathy and most other alternative treatments. Thirty three percent of the response to antidepressants is attributed to the placebo effect.

Conditions linked to significant psychological distress are most likely to respond to placebo.

Some possible mechanisms for this are as follows:

• Psychological theory – psychology affects biology, beliefs affect biochemistry.
• Nature taking its course – we often get better by doing nothing at all.
• Process of treatment – touching (when appropriate), displaying a caring attitude, being attentive and communicating effectively – may elicit a placebo response.

Using the placebo effect:

• Inspire patient confidence by looking and dressing professionally.
• Display symbols of comfort – soothing artwork, positive affirmations or the gentle sound of water tricking from a “mini-fountain” – in your office.
• Discreetly take notes during therapy sessions.
• Lean slightly forward when addressing the client and asking questions.
• Solicit the client’s beliefs and input when selecting treatment interventions.
• Most importantly, instill HOPE and OPTIMISM when discussing the prognosis of the client’s presenting problem.

I can imagine a day when a clinician, faced with a client who has major depression, will be able to order a gene scan that will predict response to a certain medication. Advances in neuroscience will clarify the underlying pathology of mental disorders thereby paving the way for taking the “guesswork” out of what medication will work for whom. This will ease the burden on medication prescribers considerably.

Finally, gone will be days of vague and undifferentiated diagnoses that rely heavily on client self-report.

This is my take, what do you think?

• - A frequent, and I would say surprising cause of low male libido is anger toward their wives or significant others. Anger sucks the energy out of a man’s desire for sex. When men make a statement in therapy such as, “I just don’t want to be anywhere near her,” this translates into not wanting to have sex with her either. Anger activates the “fight or flight” response, and most men are more comfortable fleeing conflict with the women in their lives. They become very ashamed of speaking up about their low sexual desire, and retreat to their “man cave.”

 

• - Low male libido is influenced by the biological condition known as “andropause,” the counterpart of menopause in women. This most often occurs in men whose testosterone counts have decreased with age. Testosterone fuels sex drive in men, so low levels of this hormone equates with low sexual desire.

 

• - Physical illnesses, such as heart disease, stroke, certain cancers and hypothyroidism are responsible for low male libido. The same is true for prescription medications such as antihypertensives, (medications used to treat high blood pressure), and antidepressant drugs such as Prozac, Lexapro and Effexor. Physical illnesses and prescription medications cause low sex drive in men because of decreased blood flow to the genitals. This strikes terror into the heart of a guy to even think that he might not be interested, because his sense of self is usually tied up in his virility.

- Fear develops because most often we identify with it through our negative personal experiences. As a result, it does not logically follow that the way we react to fear is always appropriate. It becomes the worrier in our head that interprets a situation to mean the worst will happen. Then once we become frightened into believing the worst, automatically we begin the process of scanning our world for evidence to support our limiting beliefs. We are then examining fear in an un-empowered way.

- Most fears are irrational. The majority of what we fear is a product of our own personal, negative self-programming. This in turn, makes us feel helpless and fuels the desire to run away.

So how do you get past your fear of something? Here are a few suggestions:

1. Notice it. When you’re afraid, simply step back and acknowledge it. Don’t try to analyze, understand, assess or figure it out – just notice; that’s all. Stepping back helps you gain perspective and serves as a temporary respite from the concerns associated with the fear. Put another way, you’re able to give yourself some emotional space.
2. Distinguish what is real from what is imagined. Most fear is associated with future “what-ifs” and past “could’ve- beens,” but some of it is legitimately in the present. For example, if you were to say something silly at a business meeting and it embarrasses you, that is real. Concluding, however, that you will never be taken seriously by your colleagues again and that you will lose your job is likely imaginary.
3. Ask questions. What is this fear really about? If it came true, what would that mean? What is this fear keeping me from doing? What other questions do these questions raise? If queries such as these seem useless to you, remember this: poor logic lies at the root of practically all fear.
4. Professional assistance. If fear is immobilizing you, or in some other way interfering with your activities of daily living, the services of a trained therapist or counselor may be worth considering. Phobias respond quite favorably to intervention strategies tailored to your specific needs.

We all struggle with fear because of its association with the way we human beings are wired. The challenge is to understand and change the way we respond to it. The next time you’re experiencing fear, don’t F orget E verything A nd R un, decide instead to F ace E verything A nd R emain.

That’s one of the shocking facts in “You’ve Got Drugs!” an annual report on Internet access to controlled substances from Columbia University’s National Center on Addiction and Substance Abuse. The report, released late last year, also points out that while 18 U.S. states either have or are considering laws that restrict the sale of prescription drugs over the Internet, researchers were able to locate 365 Web sites offering the medications. Of these sites, 85% do not even require a prescription. Some even sell online-only consultations with physicians willing to write prescriptions that consumers can fill at their local pharmacies.

To be sure, many online pharmacies are legitimate. But this type of illegal activity places their reputations in jeopardy. That’s because federal laws and regulations lack both the teeth and the funding to stop these illegal sales.

It is no startling revelation that kids these days are Internet-savvy. One 16-year-old who started ordering illegally off the Internet at age 11 put it this way to the Columbia researchers: “I doubt laws will work because if there is a will, there is still most definitely a way. You find ways and means to get whatever you want.”

This reminds me of a television commercial that ran several years ago, asking: “It’s 10 p.m., do you know where your kids are?” Now the question is, it’s the Internet – do you know what your kids are doing there?

It’s hard enough raising responsible kids without having to worry about what they’re doing behind our backs. Without a doubt, the Internet is a prolific 21st century marvel when it comes to accessing information and the advancement of learning for children. These benefits come at a price, however. The Net is also the largest playground ever for kids to encounter all sorts of temptation.

If your kids have purchased drugs illegally via the Internet, or if you suspect they are trolling Web sites tempting them to do so, here are some options for action:

• - Option 1: Talk to your kids. Explain what’s wrong with buying medications illegally, in terms they can understand. Tell them in no uncertain terms that you strictly forbid them to buy drugs on the Internet. Be specific about the consequences (your choice here), and make it clear that disciplinary actions will be enforced on the very first violation.
• - Option 2: If you suspect or find out that option 1 isn’t working, move the computer out of the kids’ bedrooms and into common spaces (living room, kitchen, etc.). Tell them that the computer will remain in a common area for a set period of time, so that you can monitor their Web use.
• - Option 3: If options 1 and 2 aren’t working, check the computer’s browser history. Yes, this is spying. But if you believe your child is really involved in an illegal activity, you have an obligation to investigate.
• - If options 1, 2, and 3 fail, install parental blocking software or Internet filters. These programs let you create a list of Web addresses and keywords the computer will be unable to open; some also generate reports on Internet use and block certain types of interactions. Popular brands include Net Nanny, Safe Eyes and CyberSitter, and they typically sell for $30 to $60. This is your last resort, short of banishing the computer from your home.

In spite of these actions, as the above mentioned 16-year-old pointed out, “If there’s a will, there is still most definitely a way.” Still, you need to do the right thing. Perhaps your kids will thank you later. Either way, raising children and teens to act responsibly and enforcing appropriate behavior, are the toughest tasks you will ever take on.

So what’s the problem here, after all, details are important right? Well yes, trouble is there’s always one more detail. Many people over procrastinate by demanding to know every fact – even irrelevant ones. For example, you know the car you want and have researched its track record extensively but continue to debate endlessly over paying extra for the optional seat warmers – and you live in the Deep South.

I’m dear friends with a woman who is convinced that before she can launch the speaking business she so passionately claims to want, she has to write five books and have published over 50 articles in her field. I’m not kidding here, I couldn’t make this up.

The next time you’re experiencing “paralysis by analysis,” ask yourself what’s really holding you back. The chances are pretty good that it has nothing do with the seat warmers or credibility as a speaker. Realistically maybe you can’t afford the car, and that aforementioned friend of mine, I’m not so sure she is as stoked as she claims about becoming a professional speaker. So decide already! So what if your rear end is a bit chilly on the only three very cold days of winter. You’ll survive and at the same time will have saved some money. With over procrastination, the devil truly is in the details.

I rarely fly Southwest Airlines. I have no bias against this airline, I just tend to choose the other major carriers in that I am able to book a reserved seat. I’m no longer certain I will continue that policy. All of my connections to Boise,Salt Lake City and eventually back to New Orleans were via Southwest on this recent trip.

During this current recession, Southwest has remained profitable, although less so as fewer people are flying these days. When oil prices spiked last year and fuel costs subsequently escalated, the airline still operated in the black. There’s never been a hint of a discussion regarding bankruptcy with this carrier, and they have eschewed charging checked baggage fees – even at the height of the oil price crisis. Yes, fares rose, but no more than what competitive carriers – Delta, Continental and United – were charging.

Why this continuing track record of success despite often trying circumstances? I can answer it in one word: Attitude. From the baggage handlers to the pilots, these people seem as though they really enjoy what they’re doing and actually want to be at work! And how is it that 180 people can be loaded and locked on an airplane in approximately fifteen minutes when it takes the other major carriers at least thirty minutes? Attitude again. Flight attendants, with a friendly smile and a kind word, strategically position themselves in the aisles directing people to the next available seat and to the overhead bins above. Systematically the plane loads from the front to the rear. Passengers simply follow the herd and the cues. No one enters the cabin and rushes to aisle 32. Does anyone really want to be there anyway? At some point on full flights, only middle seats remain for those boarding last, but these folks seem to already know that.

Flight instructions are conducted in a tongue-in-cheek, slightly irreverent-like manner. C’mon, does anyone really not know how to buckle a seat belt or what to do with the oxygen mask that could drop down from the panel above? They make the boring FAA stuff fun.

The ubiquitous, irritating service cart – a mainstay on other carriers – is absent on Southwest flights. Drink orders are taken and simply served on trays, so the aisle is not consumed by flight personnel. This is a model of efficiency for a task that never was rocket science in the first place.

This airline has to have one heck of a training program, and when it comes to success in any business, the tried and true constants always have any always will dominate: Offer a fair price, service that distinguishes you from others, and a positive attitude that resonates with the customer, and they will come back. And on Southwest, they keep coming, and coming and coming.