Dan’s guest Tuesday on his noon web chat will be psychologist Tamara Chansky, author of Freeing Your Child from Negative Thinking: Powerful, Practical Strategies to Build a Lifetime of Resilience, Flexibility, and Happiness.

Hi Dr. Gottlieb,

My young daughter is having a difficult year. She has been doing various sports and playing music for several years with much success. But this year, her first in high school, things are not going well.

She has been getting low scores in her athletics compared to her friends. She also did not make the high school band while her friends were accepted.

She has always excelled at everything and now is beginning to feel that she is not talented and is becoming depressed and withdrawn.What’s  the best way to talk to her about this?  

Dear Susan,

 I'll get to the “how to talk to her” part in a minute, but let's first figure out what the problem might be.

What your daughter is experiencing is too common among many girls her age. Children that age are beginning to learn about their identity, how they are the same as and different from their parents and friends. One way they do this is by experiencing success and failure, watching peers, and having plenty of downtime where they can dream about the future.  

In today's world, however, not only do children not have enough downtime, they don't have the luxury of failing. A generation ago, children’s afterschool activities were about play; now they are about achievement. And “average” has become the equivalent of failure!

The goal is no longer to do your best; it’s about living up to some impossible standard. This push for perfection comes from the family, school and peers and the larger culture. I actually heard a car commercial last year that said: “Good enough is no longer good enough!”

So what is it like for our children to grow up in that culture? Overachieving girls often come from families whose parents model high achievement and self-sacrifice. Failure is crushing to these children because it's not about what they have or haven't done, it's about who they are. “If I fail,” many of these children think “that means I am a failure.” The stakes are sky-high for each event.  Even when they succeed, the sense of accomplishment doesn't last because there is always more to accomplish right around the corner.

At its extremes, perfectionism can be a symptom of Obsessive-Compulsive Disorder and can lead to depression or eating disorders.  Susan, your daughter might not be this extreme at all. This could present you and your family with an unexpected opportunity to make some changes.

Of course your daughter has to learn the value of failure. Without it, she would never develop resilience. Surveys show that many of today's children, when they hit the workforce, have plenty of knowledge but poor problem-solving skills and not much resilience. That's because they have been pressured to achieve and protected from failure most of their lives. 

So how do we teach your daughter that failure is ok? Not by lecturing! One way is through role modeling. Tell her about the failures in your life, past and current. You might also want to say what failure feels like and what it meant to you when you were younger and what failure means to you now.

Perfectionists often feel as though no one understands them, so don't try to talk your daughter out of her feelings; it will just make her feel more isolated. Instead, help her give voice to the emotions underneath her thoughts about being a failure.  

Remember, the fear of failure is about avoiding fear more than failure. Usually when children voice fear, we help them avoid it. But imagine the sense of freedom if she could give voice to her fear, and you could help her learn to tolerate that fear. And then when she does fail, you can talk about how she might feel badly, but she has less to be afraid of.Here's the big opportunity. Your daughter needs role models for hanging out and having fun.

Everyone in the family has to be able to relax and laugh at themselves. Laughter is like chicken soup for perfectionism. An early supervisor once said that the world is full of people trying to act like filet mignon when we know deep down we are meatballs! We need to stop trying to be the person we think we should be and spend more time hanging out with people we love.

Although divorce harms all children, according to the American Association for marriage and family therapy, only 25% of children of divorce have serious long-term emotional difficulties.

Dan will talk with Child Psychiatrist Mary Ann Ager about the impact of divorce on children before opening the chat up to all.

Dear concerned husband,

Sometimes marital problems are mostly because of one person.  Sometimes, but not often.  Certainly this is the case with the abuse or violence where one spouse feels unsafe in the matter.  If you haven't harmed her physically or psychologically, nevertheless If your behavior is so irritating to your wife that she will not go into therapy until you have done some work, so be it.

On the other hand, if she is willing to go into therapy with you, I would recommend that.  Very often in marital therapy I have one spouse working for an entire session, sometimes two or more on their issues.  That way the observing spouse can get to see and understand you from a different perspective.  Because after all, the goal is not just behavior change, the goal is mutual respect and understanding.  I am sure your wife would also benefit from talking to a therapist about her marriage with you sitting in the room.  It would help you understand the impact of your behavior beyond her surface reaction.

I hope that helps

Dear Doctor Dan,
I am a faithful reader of all things Gottlieb, so I am hoping you could advise me about some distressing issues in my life. 
How can I go about helping my daughter find a therapist for my grandchildren who are ages eight and five?  Their parents recently divorced and the older child is having real problems with sleeping overnight at his dad's house.  He says he is ok with spending time with daddy but does not want to stay away from home.  He has no trouble sleeping overnight at my house but has done that since birth quite a lot.
My daughter says that her ex tells her that the child "has to learn to cope" and that is what they have been doing.  I think it will take a matter of time and will resolve itself,  but I also think they could use some counseling to deal with this issue and other divorce related things. 
Can you guide me so that I may guide her in steps to find a compatible counselor 
Thank you
concerned grandmother 

dear concerned, 

Your letter brings up several issues, so let's talk first about what needs to be done and then we can talk about what you can and cannot do to help make it happen.

Although divorce harms all children, according to the American Association for marriage and family therapy, only 25% of children of divorce have serious long-term emotional difficulties.  Although this is a very high percentage, keep in mind there is a good chance your grandchildren will be okay without intervention.

But there are many things parents can do to help mitigate the effects of divorce.  The first and most important issue is safety.  All children need safety in the wake of this upheaval, but especially young children.  And children find safety in consistency and predictability.  Much as possible, schedules should remain the same week in and week out, especially in the months following a divorce.

Most children of divorce feel that the bottom has just dropped out of their lives and that everything they knew to be true is no longer true.   So your grandchildren need to be reassured with words and actions that they are loved by both parents and both will take good care of them.  So both parents must be very careful not to cancel plans and to show respect to one another in front of the children.

I often tell divorced parents that they must love their children more than they hate each other.  Therefore they must develop a workable plan that gives children easy access to both parents.  And of course, no parent should never ever speak angrily about their child's other parent.  At best, it sets up a loyalty conflict for the children.  And worst, children feel they have lost both parents.

Believe it or not, I would not recommend counseling unless they are showing signs of distress.  Signs to look for include
·         acting younger than their chronological ag
·         moodiness
·         sleep difficulties
·         acting out in ways they hadn't before
·         problems with friends or school
·         irrational fears and compulsive behavior.

Many children of divorce will show some of these symptoms in the short run, but if they persist, it's time to seek help.  But I wouldn't automatically seek counseling and here's why: children of divorce already feel pretty alone and wonder if there is something wrong with them which may have broken up the family.  If they are "sent" to therapy, the process itself could reinforce that belief.  I believe that if younger children of divorce need therapy, it should be family therapy unless there is a compelling reason not to.

Finding a therapist?  Make sure the therapist is trained in marital and family therapy.  But even so, not all family therapists are trained in working with small children, so you need both.  You should be able to find one in your community through the American Association of Marriage and Family Therapy.  Alternatively you could look up your State Psychological Association or National Association of Social Workers.  But please make sure whatever therapist you find is trained in both divorce and working with young children.

So now we come to you and what you can do. First, divorce is a trauma not just for parents and children, but for grandparents also.  Just like your grandchildren, you may have gone through these years thinking that your children and grandchildren were safe and secure.  And now this.  I have spoken with so many grandparents of divorce children whose hearts are broken by what's happening to their children and grandchildren. It feels the stakes are so high and you feel so powerless.

I will assume you have a good relationship with your daughter, but it's also important that you maintain at least a respectful relationship with your son-in-law and avoid criticism or blame.  If your daughter wants to do so, listen to her with compassion and empathy, but please try not to reinforce her resentment or help her feel like a victim.  As I am sure you know, if you were to get in the middle, the outcome is never good.  I've talked before on these pages about how and when to offer advice to our adult children, when it's respectful and when it is intrusive.  And I have said that within very broad limits, we have to respect the resilience and problem solving skills of our adult children.  But when grandchildren are involved, it gets more complicated.

Feel free to tell her about your concerns, but please don't push as your daughter feels vulnerable enough.  Offer to be an additional resource for your daughter, grandsons and even your son-in-law.  If you are able, spend extra time with the children it might help everyone out.  And perhaps you could even include the other set of grandparents in some of the social activities.  It would certainly make the children feel better.I hope this helps and I wish everyone healing.   

Dan will be joined in his chat about schizophrenia by Joseph Rogers, chief advocacy Officer of the mental health Association of Southeastern Pennsylvania. Rogers has a history of psychosis and spent time living on the street with a diagnosis of schizophrenia. The chat starts at noon.

Hello Dr. Dan,



I watched the movie, “The Soloist” tonight about Steve Lopez’ relationship with Nathaniel Ayers, the inspirational homeless musician in LA.  I’m thinking you may have seen the movie/read the book.  There are some very compelling scenes depicting some schizophrenic episodes with Nathaniel hearing voices that  clearly distract him from reality.  I’m wondering if, from your experiences and expertise, you can share your insights on the authenticity of the movie, especially regarding the relationship between Ayers and Lopez and the mental illness symptoms of many of the homeless people depicted in the film.



I’m a Theology teacher in a Catholic high school and in my Senior classes, we study homelessness—the realities, the impact, the causes and consequences.  I’m thinking that this movie may be useful.



I look forward to any insights you can offer me, Dr. Dan.



Peace and blessings,

Suzy Eyler

  Dear Susie Eyler,

As you may know, schizophrenia is one of the most disabling of all of the psychiatric disorders.  It affects over 2 million people in this country and about 15% of them are either on the streets or in prison.  Like we saw in the movie, first symptoms occur in men in their late teens and early 20s, later in women.  The hallucinations and delusions that you saw may be the most dramatic symptom of schizophrenia but far from the only ones. These symptoms make most with schizophrenia fearful and withdrawn, but sometimes they can become terrified of what happens in their minds.

And because those with schizophrenia look and act strange and appear timid and frightened, they are at high risk to become victims of violence, especially if they are in prison or on the streets. 

We have known for a while that schizophrenia is a brain disorder that is based in genetics, we are still pretty far from understanding the exact causes.  But that doesn't mean it's untreatable.  New medications are coming out every day with more awaiting approval from the FDA.  There have also been improvements in our understanding of what psychosocial treatments are more effective.  Some of the cognitive therapies are also showing promise.  And with good and consistent treatment, it is estimated that after five years 50% are improved enough that they are able to function independently.  Another 25% are improved but require ongoing supportive therapies.  Of the remaining 25%, about 15% of them are hospitalized.  Sadly, suicide accounts for the other 10%. 

But those statistics are for people who receive treatment.  People who have supportive networks to make sure they get the treatment they need.  And that is not the case with many people who have schizophrenia or other major mental illnesses.  They are left to the care of public institutions that are overburdened, underfunded and unable to effectively meet the needs of those who need their services most.

    Which gets us to Nathaniel Ayers in "The Soloist"

  Given the Hollywood requirement for both drama and relative simplicity, I think they did a pretty good job of portraying schizophrenia fairly.  But what they did beautifully was to portray the humanity behind the illness.

I discovered this as a brand-new psychologist in 1969 when my first patient, Norma, shuffled into my office for the first independent psychotherapy session of my career.  Norma had schizophrenia and had carried the diagnosis for 30 years.  I was 23 years old at the time!  Of course, I had to prove to both of us that I was a competent psychologist who would treat her.  As soon as we started talking, she nailed me.  She told me in her own confused way that I had no idea what I was doing and that I was making it up!  Of course, she was right.  But she wasn't angry or hostile about it as I might have been if the situation was reversed.  Instead, she was more playful which enabled me to get comfortable with the relationship we had rather than the one we were supposed to have.  Norma and I didn't communicate well with words, often we didn't understand each other's language at all, but there was a connection.  Sometimes when the words stopped, we looked in each other's eyes and smiled.

Norma never really got better, and a couple of years later, I heard that she died on the streets.  I cried as I would have hearing any friend had died.

20 years later I was working with a 20-year-old girl who was suffering with depression and an eating disorder.  One day she said "I feel like my soul is a diamond locked inside of a malignant tumor."  Hearing that, I thought of Norma and my eyes welled up with tears.

If Norma's mind was clearer, I am sure she could have said the same thing.  And my guess is that most people living on the streets could also say the same thing.

You see, in my mind, these are not street people or schizophrenics, these are people who experience their lives the same way my 20-year-old patient did.

And our responsibility as a community is to know that and do whatever we can to see that diamond.