Summary: Everyone knows women who have body image issues. The secret: men have them too.

The Beefcaking of America - A seismic shift in gender roles is turning men into objects of desire--much as women have traditionally been. At the leading edge of this social revolution, a very select group of women care--unusually stringently--about men's bodies. Increasingly, men are running into a double standard of attractiveness--what women like about men's bodies and what men think is manly.

Men don't look like they used to. Think of Fabio. Arnold Schwarzenegger. Or the countless men who, in cologne ads, lie like languid odalisques on sandy beaches. In movies, heartthrobs from Alec Baldwin to Keanu Reeves are seen shirtless, with rippling pecs and lats; on fashion runways male models in skin-tight tanks and jackets unbuttoned to flaunt washboard bellies pace before cheering crowds.

"There's coming to be an acceptance of men as sex objects, men as beautiful," reports fashion arbiter Holly Brubach, style editor for the New York Times Magazine. Male mannequins now sport genital bulges and larger chests, and for the first time in window-dressing history, have achieved equality with female mannequins. The male body is even being used to sell cars, no doubt to both men and women: "If the beautiful lines of the new Monte Carlo seem somehow familiar, they should," reads a current ad. "After all, we borrowed them from you." Above the caption, melting photos show the classic waistline of a woman, curving leather, and the sinewy torso of a naked man. A closer look at each photo reveals a masterful blend of male and female images, of shadowy clefts and powerful bulges.

I've always loved to look at men. There is power in a certain kind of masculine beauty, and it's a turn on. Am I alone? No, according to the first national survey ever of men's appearance and how they feel about it, collected from Psychology Today readers. It turns out that the world indeed is changing, and that there is now a subset of women who themselves are attractive, educated, and financially secure, who care about every aspect of the way their men look. They can choose good-looking men, and they do.

Those women, by the way, are currently a minority. Still, all revolutions begin with a band of pioneers. And when I look around at what's happening in the culture, I sense a sea change.

The male body has arrived. Not only is it being offered up for scrutiny, it seems to be both hypermasculine and strangely feminine, a new mix that accurately reflects tremendous and ambivalent changes in our culture.

What's happening to men's bodies--and how do both men and women feel about it? In Psychology Today's November/December 1993 issue, we asked our readers to help us delineate what seems to be a seismic shift in male body image. Over 1,500 of you responded with completed questionnaires and comments, which were analyzed in depth by psychiatrist Michael Pertschuk, M.D., and his colleagues. About twice as many women answered as did men, demonstrating women's keen interest in the subject. The answers revealed fascinating shifts and misconceptions:

Men believe their appearance has a greater impact on women than women themselves actually acknowledge. From hairline to penis size, men believe their specific physical features strongly influence their personal acceptability by women.

Women, in general, are quite willing to adapt to their own mate's appearance, accepting features such as baldness or extra weight, even though their ideal male is different. Women tend to like what they've got--whether he is bearded, uncircumcised, short, or otherwise "off" the norm.

A significant subset of women who are financially independent and rate themselves as physically attractive place a high value on male appearance. This new and vocal minority unabashedly declares a strong preference for better-looking men. They also care more about penis size, both width and length.

For both men and women, personality wins hands down: it's what men believe women seek, and indeed, what women say is most important in choosing a partner.

Nonetheless, men still care about their own looks. Though men give top priority to their sense of humor and intelligence, a nice face is a close third, and body build is not far behind. Women give an overall lower significance to men's physical appearance, but height is still an important turn-on for women.

Men are scared of losing their hair, but women are more accepting of baldness in a mate than men realize. Both men and women prefer clean-shaven men--today.

Men are less worried about being overweight than are most women, but more concerned about muscle mass--reflecting our cultural ideals of thin women and powerful men. The muscle-bound body build was highly rated by men, while women preferred a medium, lightly muscled build in their ideal males.

Curiously enough, there seems to be emerging a single standard of beauty for men today: a hypermasculine, muscled, powerfully shaped body--the Soloflex man. It's an open question whether that standard will become as punishing for men as has women's superthin standard.

We are moving away from the old adage: men do, women are. As noted anthropologist David Gilmore, Ph.D., author of Manhood in the Making, states, "That dual view will never entirely go away, but now we're reaching some kind of compromise, where there is more choice. Women can choose men who are not rich or successful, but who are beautiful."

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What's in a Man?

It seems that the whole idea of what it means to be male is molting. Cultural upheavals from the women's movement to the national emphasis on health and fitness have altered our sense of how a man should act and look. The new male is no longer the unquestioned head of the household, in control of the nuclear family if nothing else. Gender parity in the workplace has made inroads: today a man may easily have a female boss. Men's health has been given new emphasis ever since several post-World War II studies found that men were at greater risk of heart disease than women.

According to cultural critic Hillel Schwartz, Ph.D., author of Never Satisfied, that awareness of men's physical vulnerability led to a new concern with their bodies. Then, in the 1960s, the Kennedy excitement with amateur sports helped kick off a resurgence in exercise and jogging. Of late, the phenomenal rise of self-help groups and popular movements such as Robert Bly's "wild men" has led to a new male awareness of feelings, and growing intolerance of the once typical "tough guy" upbringing. Marks and scars are no longer badges of honor.

The old ideal of American maleness is under attack, according to the New York Times. "Today, the world is no longer safe for boys," wrote Natalie Angier. "A boy being a shade too boyish risks finding himself under scrutiny...for a bona fide behavioral disorder." American boys are being diagnosed in record numbers with hyperactivity and learning problems.

As ideals of manhood shift, so has the ideal male body. While it is clearly more masculine--well muscled and sexually potent--it is paradoxically feminine as well. Our ideal man is no longer rough and ready, bruised and calloused, but, as Schwartz puts it, "as clean skinned and clear complected as a woman." His body is "no longer stiff and upright, but sinuous and beautiful when it moves. Sinuousness didn't used to be associated with manliness." As a sexual object, a source of pure visual pleasure, men are increasingly being looked at in ways women always have.

This fascination with male beauty is not entirely new--consider the ancient Greeks, the beautiful boy of the Renaissance, or Elizabethan noblemen parading the court in revealing tights, silks, satins, and jeweled codpieces. Charles Darwin himself popularized the idea of women as selectors of plumed and spectacular male mates. "He was speaking of finches and partridges," explains historian Thomas Laqueur, Ph.D., author of Making Sex: Body and Gender from the Greeks to Freud (Harvard University Press, 1990), "but we generalized to humans. It was known as the peacock phenomenon--the notion of the male as the one with plumage." It wasn't until the rise of capitalism and the bourgeoisie that men renounced flagrant beauty and adopted the plain suit as a uniform. During the so-called "great masculine renunciation" men began to associate masculinity with usefulness. Then, notes Laqueur, "gradually women became the bearers of the science of splendor."

The consequences of today's shift in male body image are already apparent. The number of men exercising has soared--8.5 million men now have health club memberships, according to American Sports Data, a research firm. And men spend an average of 90.8 days a year in the club (that's over 2,000 hours). That's nine days a year more than women.

Men may be nicer to look at, but males with body image disorders are showing up with increasing frequency in psychiatrists' offices. More and more men are abusing steroids in an attempt to build muscle. An article in the American Journal of Addictions noted that "anabolic steroids are increasingly used for the nonmedical purposes of enhancing athletic performance and physical appearance. As illicit abuse patterns increase, so do reports of physical dependence, major mood disorders, and psychoses." In the 1980s, body-image studies by psychologists Elaine Hatfield and Susan Sprecher found that men were catching up to women: 55 percent of women were dissatisfied with their appearance; men weren't far behind, at 45 percent.

Mirror Mirror: Women Look at Men

For both men and women, male personality is regarded as the most significant quality in attracting a mate. In a sense, this flies in the face of our concern with appearance: it lets us know that no matter how enormous our body obsession, both men and women still rate inner beauty as paramount. In the accompanying survey, intelligence and sense of humor were rated most important, and sexual performance and physical strength least important.

However, there are intriguing differences, even misconceptions, between the sexes about the importance of certain physical characteristics. For instance, men believe an attractive face is more important to women than empathy and the ability to talk about feelings. They also put more emphasis on body build than women do. In general, men judge their physique to be more important than women do.

Yet appearance is still only a piece of the pie. Women's sexual response to men is more complex than men's to women. "How odd and unsettling an experience it is," comments Brubach, "to look at all these ads of sexy men sprawling on beds and beaches. I think, 'What a nice chest or legs,' but I don't ever feel that this would be enough material for me to have a sexual fantasy. For most of the women I know sex appeal isn't purely about physical appearance."

Gilmore agrees. His studies of gender and sexuality in tribal and modern cultures have found that for women, "the male image conveys much more than sexual virility. Male power, wealth, dominance, control over other men--all those inspire a response in women. The pure visual image of the handsome man, the languid beautiful male is attractive. But it does not necessarily connect with inner virility, which also turns women on. What's so interesting about this subject is that men today get a double message: The culture tells them, 'Be successful, be the boss of bosses, and women will fall at your feet.' The media tell them, 'Look like a model, and women will fall at your feet.'"

Some women, of course, value male looks very highly. One of the most fascinating survey results was that women who rated themselves as more attractive tended to rank men's facial appearance and sexual performance higher. These women were a little older on average (mean age 38), thinner (only 6 percent met criteria for overweight) and better off financially (almost half earned over $30,000 annually).

This is particularly intriguing given the anthropological literature about female mate selection: In most cultures, women seem to choose sexual partners on the basis of a male's ability to protect and provide for a mate and offspring--whether that is a big salary, hunting game, or achievement as a warrior. Throughout the Mediterranean, notes Gilmore, men are compared to brave bulls, fierce bears, virile rams--"all admired for their courage, force, and, especially, their potential for violence when threatened. And when women have gained political power, they have responded powerfully to male looks. Freed from economic worries, Queen Elizabeth I flirted shamelessly with the handsome Raleigh; Catherine the Great took a long list of comely, but otherwise ordinary, lovers."

That may be happening in record numbers today. Attractive, self-sufficient women may place higher value on physical features because they have been reinforced for these attributes. Traditionally, beautiful women have been able to leverage their looks to snare a wealthy and powerful man. Now that some women have greater financial independence, they may use that power to seek a stunning mate.

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Twin Peaks -- Hair and Height

"In America," writes Gilmore an essay called, "The Beauty of the Beast" (in The Good Body, Yale University Press, 1994), "male concern focuses on two main issues: height and hair." What do height and hair symbolize? Raw maleness. Philosophers like Edmund Burke and art historians like Johann Wincklemann conflate the sublime and the masculine--and associate both with greatness, strength, and majesty. "What are height and musculature, after all," Gilmore asks, "but male equivalents of voluptuousness in females? How is height in a male different from bust size in a female? Short men can have terrible problems." And in a culture that eroticizes differences between the sexes, the potent masculinity of a tall male can be appealing.

Though many studies indicate that women love a tall man--Hatfield and Sprecher found that women prefer a man at least six inches taller than themselves--male concern with height seems linked to competition with other males as well. "Men are worried about how they appear to other men," notes Gilmore. "I remember boys being mercilessly ridiculed and beaten up for looking effeminate. Size and power were of absolute importance. I knew a fat boy who had a kind of bosom, who was persecuted so relentlessly that he had a nervous breakdown at age 13."

No wonder, then, that both men and women in the survey rated a trimmer, taller male as more attractive. However, a striking finding emerged from the data: There was a discrepancy between what women desired and what they would accept in a mate. Women adapt to their own partner's height--in fact, their preferences seem strongly linked to their mate's actual height. As Michael Pertschuk points out, this ability to adapt, to adjust abstract ideals in favor of the real man, showed up again and again among the women in the survey. It seemed to cut across all variables--from height to weight to penis size. It seems that "negative" appearance factors become lost within the greater gestalt of the partner. The woman sees past or through a less-than-ideal feature.

Hair, in turn, is another highly valued masculine signpost. Hair is a traditional signal of youth and power, an index of male virility. Hair signals man in his natural, wild state--uncivilized, and somehow more primal and sexual. Not only is hair a potent symbol, it is one that can be easily manipulated--and has been throughout history. As Pertschuk says, "In the early to mid 1800s, men went to jail for wearing beards. By the Civil War era you would be hard-pressed to find a general who was not sporting a beard. This fashion lasted until the turn of the century, when it was replaced by militant 'clean shavenism.' In some Protestant sects, long hair and beards are suspect. Other sects, such as the Jewish Hasidim, are expressly forbidden to cut their beards. In England the antimonarchists wore their hair short, in protest to the long, flowing locks that were approved of by the monarchy."

Though it's tempting to look at hair as a concrete reflection of the role of males in society, Pertschuk feels it may be more indicative of rebellion, of setting oneself apart from an existing social order. Boys coming of age in the rebellious 1960s wore their hair long and grew beards in a gesture. The next generation was clean shaven. The punks dyed their hair fluorescent pinks and greens, spiked it, and shaved their heads in Mohawk designs--a veiled threat, an attempt to upset and defy the existing order.

Body Build: The Muscular Male

The showy, muscle-bound heroes of today are a far cry from yesteryear's aristocratic heartthrobs--Cary Grant, John Barrymore. And although Charles Atlas body-building ads pumped up the back pages of magazines and comic books as far back as the 1920s, we are witnessing a new fascination with the perfectly proportioned, tautly muscled male god. "When women swoon over these men," notes Gilmore, "it's not unlike the response men have when they see a beautiful woman. Men like to be sex objects, too. It's never been acknowledged, because that desire is not considered manly, and the more urgent need is to appear masculine. But studies have shown that men envy women their ability to attract and command the attention based simply on their appearance."

This cultural emphasis on a specific male type has a definite dark side--the growing number of men suffering from body image disorders. According to Steven Romano, M.D., Director of the Outpatient Eating Disorders Clinic at New York Hospital/Cornell Medical Center's Westchester Division, "I'm seeing more and more males who have body image disturbances. They are compulsive exercisers, and there are a number of steroid abuses." Another expert calls it "reverse anorexia."

"Psychologically, this group is very tied to female anorexics," says Romano. "Just as the anorexic continues to see herself as fat even though she's thin, these males are well muscled but they look in the mirror and see themselves as too thin. They are judging themselves by the ideal projected in the media. I had a 19-year-old walk in who said he had to look like Marky Mark. He would only eat a diet that allowed him to build muscle. These men tend to be straight males who think a well-muscled physique is what women are interested in."

Gilmore concurs. In interviewing men about body image, he found "body anxiety is related to appearing unmasculine or effeminate. This obsession especially attaches to body hair, chest development, waist, and hips. Our culture lays considerable stress on a manly physique."

No wonder, then, that the male PT readers who responded to the survey indicated that they value muscle mass. Yet male fascination with muscles may have more to do with other men than with women. "Women don't know what goes on in the playing field among boys," insists Gilmore. "It's very cruel. Boys are beaten up if they don't measure up. To be masculine requires a certain musculature."

The new male fascination with muscle may indeed hold destructive potential for men--though perhaps less so than the female ideal does for women. Women who starve themselves to reach a cultural ideal of feminine beauty are damaging their physical health; men who exercise and work out at the gym to build muscle may still eat well. Yet if men feel compelled to make over their bodies to achieve difficult aesthetic goals, they may be opening themselves to problems with steroid abuse, musculoskeletal injury, and eating disorders. If weight is a male concern, it has more to do with looking effeminate, puny, and thin than carrying a few excess pounds.

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The Penis

Where is the essence of masculine power distilled, if not in the penis? The penis is the visible badge of masculinity. If the ideal of the sublime, the majestic, the truly masculine resides in power, size, and the ability to attract women and make one's mark on the world, no body part is more symbolic than the phallus. Popular culture, and pornography in particular, link penis size with male appeal. Yet there is an opposing thread in our culture that says size doesn't matter. The origin of this belief is the work of Masters and Johnson, who reported that smaller, flaccid penises become larger upon erection than do larger flaccid penis. This is not entirely true, but most sex manuals indicate that size does not matter.

"Not surprisingly," reports Pertschuk, "feelings and attitudes about penis size reflected the general upheaval in our culture where male body image is concerned. Questions about male genitals elicited many passionate comments--but the one constant was that women were evenly divided about the importance of organ size. Fully half preferred it large--the other half was unconcerned or disliked a big penis."

Male Body As Cultural Crucible

Our culture has never openly addressed the reason masculine beauty matters so much. There is a long Western tradition merging aesthetics and ethics, stretching back to Plato's belief that the beautiful is good--and in particular, that masculine power is the ideal emblem of our culture. "This moral primacy of male beauty," muses David Gilmore, "this exaltation of maleness as both heroic and beautiful places a powerful stress on males. Masculinity becomes an apotheosis of national identity. The erotic and social appeal of a virile, handsome, muscular man successfully accomplishing some task is very strong. It's what our culture prizes above all. Men experience deep psychic terror of failing literally to embody national ideals."

The pressure on males to measure up to such iconic images has never been adequately examined by anthropologists or by social psychologists. Why? Ironically, says Gilmore, because "men don't talk about it. It would seem narcissistic, and that would seem feminine. It's an old male code--never complain." Yet studies have long shown that the height of males is linked to the attractiveness of their female partners, that handsome men are more successful than short or plain men, and that taller men earn more than short men.

Even more important, this male silence has helped drive the sexes apart. "If we could talk about it openly," comments Gilmore, "we could mutually experience the agony of the visual tyranny in our culture. Both men and women experience it in different ways. My own interviews with men between the ages of 30 and 50 have revealed deep-seated concerns about appearance, many in terms that rival the feminine 'beauty trap.' Men's passionate worries struck me as no less poignant than those expressed by women. The male body, like the female's, has become a punishing crucible painfully subjected to the tyranny of a cultural ideal."

That ideal has helped shape our political history. For seven straight decades America elected the taller of two presidential candidates. Richard Nixon was the one to finally break the pattern. When Carter and Ford debated, according to Ralph Keyes, "Carter's camp was jittery at the thought of their candidate standing right next to the 6'1" President." They asked that both debates be seated but were refused. Finally, they settled for lecterns placed far apart and, in payment for that concession, changed the background to camouflage Ford's encroaching baldness.

What can we learn from the new emphasis on male body image? Similar cycles of obsession among men have characteristically occurred at times when male social roles were ill defined. The dandies and aesthetes of the late 19th century, who whittled away the hours on their lace cuffs and silk vests, had no other function in society.

Contemporary men are experiencing an upheaval in their social role. It is unclear just what it means to be male anymore. The physical limits of the body provide a tangible arena of control and purpose. And so the ideal male body has become more rigidly masculine than ever.

At the same time, our willingness to gaze almost brazenly at male flesh, to pursue it as an object of pleasure, is a stark sign that men are joining the ranks of women. They are being looked at. That is inevitable in a culture where a staggering amount of visual information shapes our very existence--from cinema to advertising to television, from children dying in war zones to world leaders showing up on "Larry King Live," to Madonna kissing the crack in a man's buttocks in her book Sex. This is truly a culture where a picture is worth a thousand words. Men are no longer exempt.

Cosmetic Surgery

There seems to have been an explosion in cosmetic surgery of late. In 1992, over 350,000 Americans went under the knife--and 13 percent were men. Though there is still a stigma about plastic surgery for men, that is changing, according to Manhattan plastic surgeon Joseph Pober, M.D. "About 20-25 percent of my practice is men, and contrary to the myth, most of the men are heterosexual.

"These men tend to be basically successful and secure, and they usually look good already. They tend to worry most about being disproportionate--not whether they are fat or thin, but whether their calves and waistlines and chests are proportional."

Respondents' feelings about cosmetic surgery were surprising. Though both men and women were more accepting of cosmetic surgery for women, men were overwhelmingly more accepting of surgery for both sexes. Among women, those who approved of cosmetic surgery for women or for men tended to be older and to rate themselves as more attractive. In addition, they tended to be more pro feminist.

People who approved of one procedure tended to approve of them all, and those who approved them for women were very likely to approve them for men. Among men, approval of cosmetic surgery was unrelated to any specific demographic factor.

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While the role that the body plays in the realm of emotions has been recognized in the West as far back as the time of Freud, touching our client's bodies is strongly cautioned against by many experts and strictly forbidden by others.

Why explore Bodywork? Perhaps it is the rebel in me, a quest to learn of areas not deemed important enough or credible enough to teach me in graduate school. Perhaps this interest stems from the very same source that led me to experiment with drugs as an adolescent. Maybe it originates from my need for continuous expansion, exploration and growth.

In thinking back on my youth, I am reminded of a card that a father sent to his grown daughter years ago. On the front, the card depicts on the front, Santa Claus standing around a pole with his reindeer. Santa points at the pole and warns the reindeer not to stick their tongues on the pole. When you open the card, you see all the reindeer huddled around the pole, glued to it by their tongues. Santa is standing by with an all too recognizable and yet indescribable look on his face. The father signed the card, "Now I finally realize I have been blessed with reindeer children." I have never forgotten that card or this father who I've never met. Perhaps it is my own reindeer soul that calls me to areas beyond traditional boundaries. Whatever my motivation, it is my belief that we must be open to learn as much as we can in order to fully assist our clients. In rejecting only what I possess some understanding of first, and recognizing that what works for one individual can all too often fail another, I must then be prepared to reach out in as many forms as I can to reach where I at times must journey to. "Body work" may very well be one such form.

Recently, my daughter pulled some muscles in her neck while ice-skating. She was lying in bed the next day with a heating pad and asked, "Mommy, why does my neck hurt?" I was busy putting away clothes and answered her somewhat distractedly. "Because you hurt it, honey. When you fell down, you sprained muscles in your neck." "But why does it hurt, mommy" she asked again. I stopped what I was doing and sat down beside her. "Remember how I've told you that it is important to take care of your body? Well, when something happens that isn't good for your body, it tells you by hurting. It's like your body's way of talking to you, of crying for help and asking to be taken care of." She looked up at me with pained eyes that contained just a glimmer of hope and said, "If I take care of it right this minute, does that mean it will stop hurting?"

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A client shared with me that a friend and her 15-year-old daughter, Lindsay, were visiting one day. They were sitting at the table catching up as they had not seen one another since her friend's daughter was three years-old. Her daughter got up from the table and was walking towards the bathroom, when all of the sudden her body jerked violently, and she grabbed the radiator, startling them all. My client asked what had happened, and she said that she wasn't sure; she just felt as though she was going to fall. Her mother then reminded them that when Lindsay was about 18 months old; she had tripped over a toy and fallen headfirst into the radiator. Her nose had been bloodied and her head badly bruised. Lindsay had not been to my client's house since that time, as the family had moved away, and she had no conscious memory of this.

Within the past few years, I have begun to utilize bodywork when there seem to be no words or images available to explain a client's feelings. I have been astounded on more then one occasion by the information stored within the body. I have no doubt that not only does the body send us messages, but that it also remembers what we often consciously do not.

Anne Wilson Schaef, in Women's Reality (1981), remarks that it is her belief that all therapists working with women should either be skilled in bodywork (work with breathing and tension in the body) or should work conjointly with someone who does. She contends that we must learn how to facilitate the removal of "body blocks" (tenseness, numbness, deadness, etc.) in order to assist our clients to experience their feelings and work with them constructively. Schaef found that in working with the body's breathing and tension, the length of therapy could shorten.

MASSAGE

Joan Turner, in a chapter entitled, "Let My Spirit Soar," from Healing Voices: Feminist Approaches to Therapy with Women (1990), describes how she integrates "body work" into psychotherapy focusing on the body while involving the mind, spirit, and soul.

Turner believes that the entry point to the body space and inner child is through the muscles. She uses a technique of deep tissue therapeutic massage. With her hands, thumbs and fingers, she focuses on the muscles that she describes as "needful" (tight, sore, knotted, and numb). The muscles respond by softening and relaxing, while the breath slows and deepens. The body begins to feel lighter. It is at this point that Turner believes awareness deepens. Turner proceeds to engage in psychotherapy while continuing to work on her client's body. She watches for signs from the body, responding to them, using them as cues to explore a particular issue or utilize a specific technique. She also calls the changes in the client's body to the client's attention, and they discuss the meaning of these changes, what the body is saying, what it needs, etc. Turner also utilizes journaling, homework assignments, etc. in her work with clients.

A client of Turner's, in writing about her experience, reported that she has learned to perceive her body as a messenger of "transformational images" that serve to facilitate awareness and growth. She adds that she became aware of her body as a teacher, as sacred, to be cared for, listened to, and nurtured.

"Sensitive Massage" is a personalized approach to healing which utilizes deep-breathing techniques and internally directed body imagery. This technique is very similar to Taylor's work although it is not necessarily used in conjunction with psychotherapy.

Margaret Elke and Mel Risman (The Holistic Health Handbook, edited by Berkeley Holistic Health Center, 1978) describe the practitioner and client as functioning as a "meditative duet" during a sensitive massage session. Clients are urged to give over to what very often is a very sensual, nurturing experience. Elke and Risman believe that, during this process, clients may discover unconscious tensions, repressed emotions, and memory recalls, in addition to new pleasurable sensations. "Sensitive massage" often assists clients to become more aware, grounded and appreciative of their bodies.

"Sensitive Massage" is recommended for individuals who are in need of nurturing touch, who need to learn how to relax, who need to accept their sensuality, and who need to learn from their body language.

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REFLEXOLOGY

Reflexology refers for the most part, to the stimulation of reflex points on the feet and hands, although there are many other usable reflex points throughout the body.

There are many theories as to how Reflexology works. Explanations range from: energy points along the meridian lines are activated by reflexology; to each of the 72,000 nerve endings on each foot connects to a different body area. When the particular zone of the foot that is connected to it gets stimulated, the corresponding body area responds.

Lew Connor and Linda Mckim (The Holistic Health Handbook, edited by Berkeley Holistic Health Center, 1978) propose that Reflexology can assist the body by relaxing it and stimulating the blocked nerve endings, thus stimulating sluggish glands and organs to regain their normal functioning. Used frequently, maintain the authors, Reflexology can provide the body with a general toning to enhance vitality and one's sense of well being.

While I have a minimal understanding of Reflexology, I have found that providing foot massages while doing relaxation, hypnotherapy, and visualization have often been very helpful in my work. I believe the benefits stem from a number of sources, such as: (1) Foot massage enhances my client's ability to relax and serves very often to deepen the trance state; (2) It provides clients with an opportunity to be nurtured, thus increasing feelings of well-being, trust, and feeling cared for; (3) It is less invasive than massaging other areas of the body of which victims of sexual abuse in particular, are more protective; (4) It is less time consuming than doing a total body massage, and yet produces the desired effect of promoting relaxation; (5) feet are one of the most abused and neglected parts of the body; and (6) women often carry a lot of shame and embarrassment about their feet. Thus, it is a part of the body that particularly benefits from being cared for, caressed, and attended to.

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When performing a foot massage, the office is scented, soft music is playing, in addition to the sound of my water fountain trickling in the background. I provide the client with a comfortable eye pillow, if she wishes to use one, and a soft blanket. Then I make sure her spine is straight and a pillow supports her knees so that her legs are not locked straight. I use massage oil or lavender-scented lotion, providing my client is not allergic to either, and place her feet on a very soft furry piece of material. I ask her to begin by breathing deeply, in through her nose and out through her mouth, imagining that as she breathes in, she is breathing in peace, and as she breathes out she is breathing away all worries, tensions and cares. I also ask her once she is settled into her breathing to imagine a safe and peaceful place. I inform her that the place can be real or she can create one -or she can modify an existing place to more perfectly meet her needs. Next, I begin with one foot at a time by rubbing, stroking, massaging and kneading it. Once I have massaged each foot each for a minute or two, I proceed into visualization or hypnotherapy work while continuing the massage. I suggest that the client direct her breathing into the areas I am massaging first, and then instruct her to direct her breathing progressively into other parts of her body.

As I begin to request her to direct her breathing into the areas I am massaging, I start just below the ball of her foot, about in the center. I take each of her feet in both hands, place my thumbs in the crevice-like area and slowly begin to apply pressure. Most of my massage movements are done with my thumbs moving them in a forward motion. The next area I concentrate on is the toe area, going from the toes down the foot from the outside to the inside. I switch from one foot to the other here, massaging the same area on both feet before moving to the next. I shift to the top of the feet, working again between the toes and finish by gently stroking the undersides of feet. Once I have completed the foot massage, if I am continuing with the hypnotherapy or visualization, I place a heated pad under the feet in order to continue providing the feet with a feeling of comfort while I complete my work.

REICHIAN THERAPY

Reichian therapy is based on the work of Wilhelm Reich who I feel compelled to add died in prison as a result of his highly controversial work with an invention he described as an "orgone accumulator." While many thought him mad by the time of his death, others were inspired to continue certain aspects of his work. Reich proposed among other things that neurotic character structure and repressed emotions are actually physiologically rooted in chronic muscle spasms. Each emotion involves an impulse to action. For example, sadness is a feeling that involves an impulse to cry, which is a physical event involving a certain kind of convulsive breathing, vocalizations, tearing, and facial expressions in addition to effecting the limbs. If the urge to cry is suppressed, the convulsive muscular impulses have to be suppressed by means of a conscious effort of holding or stiffening. One must also hold one's breath thus not only suppressing the sobs but also lowering the energy level by decreasing oxygen intake.

If the muscular holding becomes habitual points out Richard Hoff, (The Holistic Health Handbook, 1978) it turns into chronic spastic contractions of the musculature. These spasms become automatic and unconscious and cannot be voluntarily relaxed even in sleep. The long forgotten memories and feelings, while lying dormant, remain intact in the form of frozen impulses to action in the muscles. The totality of these chronic muscle spasms constitute what Reich termed "muscular armoring". "Muscular armoring" serves to defend individuals against both external and internal impulses. "Muscular armoring" is the physical aspect of our defenses, while character armoring is the psychical. These two defense mechanisms are inseparable.

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Reich developed a variety of techniques for dissolving the muscular armoring, including:

1) Deep massage of spastic areas, especially while having the client breath deeply and expressing the pain with his or her voice, facial expression, and when appropriate, his or her body. Reich believed this to be a powerful route to the unconscious. Occasionally, maintains Hoffman, pressure on a single muscle spasm will produce a spontaneous outburst of repressed emotion, with a specific memory of a forgotten traumatic event.

2) Deep breathing, which according to Hoffman, may produce energy streamings, prickling or tingling sensations, spasms, tremors or spontaneous emotional releases.

3) Pushing down on the chest while the client exhales or screams is thought by Reichians to assist in loosening up energy blocks.

4) Work with facial expressions in order to assist in unblocking emotions since the face is a major organ of emotional expression.

5) Work with the gag reflex, yawning, the cough reflex and other convulsive reflexes tends to break down rigid armoring, according to Hoffman.

6) Maintaining "stress positions", particularly while engaging in deep breathing and expressing pain with one's voice and face, are said to loosen armor by stretching it, inducing tremors, irritating it and tiring it.

7) Active "bioenergetic" movements, such as stamping, pounding, kicking, tantrums, reaching out, shaking the head, shoulders, or other body parts. It is stressed that these movements should be accompanied by full breathing and appropriate sounds and facial expressions. Done over a period of time, Hoffman states that these movements tend to break down inhibitions and liberate genuine feeling.

Reichian bodywork is methodical; there is a definite order to it. Its fundamental law is to start with the most superficial defenses and work gradually into the deeper layers at a rate that the client can tolerate.

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ROLFING

In his book, Hymns to An Unknown God, (1994), Sam Keen describes his experiences with bodywork. During his days as a reporter for Psychology Today, Keen submitted himself as a guinea pig in order to investigate Rolfing (structural integration) at the Esalen Institute. Rolfing involves manipulation of the connective tissue of all the major muscle groups in the body and is often very uncomfortable in the beginning.

When Ida Rolf began working on Keen's chest with her fingers, fists, and elbows, Keen reports that he felt himself begin to panic as it "hurt like hell." He later learned that the chronic tension in the muscles of his chest had formed a defensive armor that was physically, emotionally, and spiritually limiting. However, as he was not aware of this at the time, the first hour was an ordeal that led him to curse, moan, and wish for salvation. Once the trauma of the first hour gave way, Keen recalls that slight and yet unmistakable changes began to appear in his posture and stance in life. He noted that his leg muscles seemed freshly lubricated, allowing him freer movement and that his feet made more substantial contact with the ground. Encouraged by these observations he opted to continue with the process.

"...With my release from this and other long-held psychosomatic-spiritual defense systems, I experienced a new openness, ease, and expansiveness. My body became looser, as did my mind...There were other changes...Most important, I gained a direct sensuous and kinesthetic awareness of my total body."

YOGA

Yoga is an ancient Indian practice that is a way of life versus a series of body postures. The literal meaning of the term yoga is "union". Renee Taylor, in his book, The Hunza-Yoga Way to Health And Longer Life, (1969), maintains that Yoga is a means of controlling one's thinking and moods, stating that:

"Yoga is an ancient yet still unsurpassed science of living. In Yoga, relaxation is an art, breathing a science, and mental control a means of harmonizing body, mind, and spirit."

Yoga utilizes such methods as deep rhythmic breathing, physical postures that serve to tone and strengthen various body parts, promote calmness, increase circulation, and includes relaxation methods and vocal and concentration exercises.

While my knowledge of Yoga is limited, I often suggest that clients consider attending a Yoga class. It has been my experience that our progress is enhanced by their participation in Yoga. I have been particularly impressed by the positive impact of Yoga on clients whom I have worked with in the past suffering from anxiety, depression, and eating disorders.

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THE RUBENFELD METHOD

Ilana Rubenfeld, a former professional musician turned bodywork counselor/teacher, has led over 800 workshops, presented at hundreds of conferences, and has established a center in New York where she offers a three year training program. She also serves on the faculties of New York University Continuing Education and the Graduate School of Social Work, the Open Center in New York, the Omega Institute, and has served on the faculty of the Eslan Institute for over 20 years.

Rubenfeld perceives every human being as a unique psychophysical pattern, possessing a distinct emotional agenda with an expression of its very own. According to Rubenfeld, the body serves as a functional metaphor and practical tool for reaching hidden levels of discord and revealing them to the client's awareness. The Rubenfeld practitioner assists the client to re-enter the original experience of an intense emotional event, rather than search out reasons for stress and disease. This is accomplished through subtle touch and nonintrusive collaboration with the client, where the practitioner intuitively helps to unleash negative emotions and guides the individual's inborn self-healing abilities. "Disease is but a message revealing a more subtle, inner message," claims Rubenfeld.

It is by using both real and imagined movement, in addition to intentional touch of the practitioner with the client's consent, that subtle changes take place in the nervous system, whereby deeper levels of meaning and emotion become more accessible over time.

Rubenfeld stresses the importance of the client taking the physical aspects of life into account by caring for the body. Her primary goal is to help individuals become their own therapists by assisting them to learn how to more effectively release and resolve emotions in everyday life. Rubenfeld maintains that once we learn to focus our awareness, we are able to more spontaneously modify habitual behaviors, as well as release and access stored memories.

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BIOENERGETICS

Edward W. L. Smith, who was influenced greatly by the work of Wilhelm Reich and Frederick Perls, wrote, The Body in Psychotherapy (1985). In his book, Smith describes techniques he believes facilitates body awareness in his clients. In utilizing these techniques, the therapist offers some relatively simple instructions, while the client's task is to direct attention and allow awareness to develop. This awareness provides the client and therapist with information regarding areas of the client's body of "diminished aliveness" or "blocks in the flow of that aliveness." Body awareness exercises also assist the client in taking a more active role in therapy, according to Smith, as it mobilizes him or her to take responsibility as the client is the ultimate source of information on him or herself in the therapy. The most important advantage perhaps to body awareness work says Smith, is that it can locate the precise locus for a body technique. The spot of tension or zone of heat provides the therapist with a map of the client's energy blocks and status.

There are several body phenomena which are looked for in body awareness work. Among such phenomena are hot spots, cold spots, tension, pain, numbness, paresthesias (prickling or tingling of the skin), vibrations and energy streamings.

Hot spots are areas on the surface of the skin which feel hot relative to surrounding areas. These "spots," according to Smith, may represent an area where energy has accumulated because of the individual's charging then holding energy in the hot area of the body, and thus not allowing it to be processed or discharged. Cold spots, on the other hand, Smith suggests, are areas on the body from which energy has been withdrawn, resulting in these areas being "deadened". Smith hypothesizes that these cold spots result from an individual's withdrawal of energy from an area which is held from full aliveness in order to protect the individual from some threat. "Going dead", says Smith, is a means of avoiding the aliveness which is forbidden by the unhealthy "introject" operating in the individual's dynamics. Smith asserts that this interpretation of hot spots appears to be clinically supported in the case, even of Raynaud's disease, a disease involving the constriction of blood vessels causing impaired circulation in the hands, feet, nose and ears.

Smith cites biofeedback literature providing evidence of the ability of individuals to learn voluntary control of skin temperature, pointing out that this very mechanism could operate on an unconscious level. Further, he refers to our "lived language" in support for attributing psychobiological meaning to hot and cold spots. For instance, when explaining a potential bride or groom's emerging hesitancy to go through with the wedding, the term, "cold feet" is often used. Other such terms are "the cold shoulder", hot headed", "hot under the collar", etc.

Smith views tension as the direct subjective experience of body armor.

"Where one feels tense is where one is contracting a muscle or group of muscles to avoid the flow of a contact/withdrawal cycle.

If tension is strong enough and long enough in duration, pain is experienced; often, tension and pain are experienced together.

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Numbness follows from nerve pressure which results from tension. With muscle tension in certain areas, pressure is put on nerves resulting in a numbing or "going dead." Numbness is often accompanied by cold, since the tension may also be interfering with blood flow.

When a "deadened" area (cold and/or numb) begins to come back to life, there may be prickly feelings, tingling, or a creeping on the skin. These paresthesias are a note of optimism, in a sense. They indicate that the immediate crisis with the toxic introject is passed.

Reich used the term "streamings" to describe the deep current-like sensations which run up and down the body shortly before orgasm. To a lesser degree streamings may be experienced by relatively unarmored persons during very deep breathing. Streamings, then, can be taken as an indication that the body armor has largely dissolved and that the orgone (energy produced and expanded in homeostatic cycles) has begun flowing freely.

Before streaming of orgone is possible, there must be an increasing of the vibratory state of the body. As Lowen and Lowen (1977) have written, vibration is the key to aliveness. The healthy body is in a constant state of vibration, due to the energetic charge in the musculature. A lack of vibration can be taken to mean that the bioenergetic charge is greatly reduced or even absent. The quality of vibration gives some indication of the degree of musculature armoring.

Inviting clients to spend time, look inside, and note happenings in his or her body, is a step toward ending client's body alienation according to Smith. In offering the invitation of awareness, Smith advises that the therapist take his or her time in order to find appropriate pace and phrasing for the client. It is very important not to rush the client in this process.

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Smith also uses the exaggeration of a body action in order to facilitate body awareness, and points out that clients frequently make mini-movements or partial movements which suggests the action that follows from a present emotion. When Smith calls attention to the diminished movement, it is his experience that clients tend to report they are either unaware of the action or unclear about its meaning. It is Smith's opinion that in these situations, this "slip of the body" is an extended expression of the prohibited or repressed emotion. Smith contends that in inviting the client to repeat the diminished action in exaggerated form, the meaning often becomes obvious.

The information obtained via body awareness exercises is thought by Smith to be valuable to the therapist by identifying access points for therapeutic interventions, as well as to the client by contributing to his or her self-awareness.

Smith describes techniques of psychotherapeutic body interventions that are gentle and allow experiences to happen rather than being forceful as "soft" techniques.

One such very gentle technique involves inviting the client to assume a particular body posture which is paradigmatic of a particular emotion. By assuming this posture, the client may be able to recognize a blocked emotion. Postures generally stem from the therapist's intuition and vary from one client and emotion to another. However, there are certain common postures that Smith frequently uses, including: (1) The fetal posture, (2) the reaching posture, and (3) the spread eagle posture.

The fetal posture involves having the client lie down or sit and assume a fetal position. This posture is often associated with feeling safe and alone. The reaching posture requires that the individual lie down on his or her back with arms extended up, reaching out towards someone. This posture, says Smith, may induce a feeling of neediness; if held for a time, a feeling of abandonment or of a hopelessness may result. When utilizing the spread eagle posture, the client is asked to lie down with legs and arms spread out. This posture typically evokes feelings of vulnerability and insecurity and can be particularly effective with individuals who feel vulnerable and threatened and who may become aware of these feelings when in this posture.

If Smith observes that a client is holding a body part in a particular way, he sometimes rearranges the holding pattern and asks the client what the new position feels like. To facilitate this awareness, Smith may request that the client go back and forth between the two postures in order to more readily compare the two. An example of the use of this method in my own practice comes to mind. In working with a young woman who had a very difficult time talking about her abuse, I noticed that she frequently kept her arms close to her chest and fingers closed as if she were holding on very tightly to something. I asked her to open her hands and extend her arms out and away from her body. I then asked her to go back and forth between these two postures and compare the two. The client was able to talk about the feelings associated with both postures more fully.

Another "soft" technique utilized by Smith involves utilizing postures to evoke desired ego states. Smith believes that the desired ego state can be supported and facilitated by the posture assumed. For instance, Smith correlates the standing position with the parent ego state, the sitting position with the adult, and lying down with the child ego state. From time to time Smith has suggested a particular posture to a client who may be having difficulty staying in or entering a particular ego state.

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Touching can be a form of bodywork. For instance, the therapist might touch a client to indicate caring and support. A therapist may also deliberately place his or her hands on the part of the client's body where some feeling is being inhibited or blocked. Smith reports that he might touch a client where an unusual body phenomenon is occurring and then say something such as "Just let go and breathe. Just feel my touch and allow whatever needs to happen, happen. Just notice your body sensations." Smith finds that skin to skin contact tends to be much more effective, although he maintains a respect for individual comfort level with such contact. I think it is important to note that survivors of sexual abuse may find skin to skin contact highly threatening and I myself approach the touching of clients with extreme caution.

Light and immobile touch is also often utilized in bodywork. When using such touch, the client is often asked to lie down and the therapist gently places his or her hands on areas of the body which may be armored or blocked. Places on the body where such contact is often made by Smith include: (1) lower abdomen; (2) upper abdomen; (3) back of the neck; and (4) center of the chest. Such touch is held until some response occurs. Smith often touches more than one area simultaneously. I have found the throat to be an important body area to touch when working with repressed or "silenced" material.

Utilizing breathing is a common technique of bodywork. Smith points out that because breathing provides the source of oxygen for metabolism, inadequate or insufficient breathing reduces vitality leading to such complaints as exhaustion, fatigue, tension, irritability, coldness, depression and lethargy. If such a breathing style becomes chronic, then arterioles may become constricted and the red blood cell count can drop, cautions Smith.

It is the task of the therapist, states Smith in addressing a client's breathing pattern, to teach the client to breathe deeply and fully with their whole body. Normally, this begins with calling the client's attention to the times that he or she is holding his or her breath or has decreased the rate and depth of his or her breathing significantly. It is not uncommon for a client to need to be reminded to "breathe" repeatedly during a single session.

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One method of instructing a client to breathe fully involves placing one hand upon the client's midchest and the other upon the client's upper abdomen. The client is then instructed to lift the therapist's hands while breathing and then let them fall, thus contracting and expanding both the chest and abdomen. I ask that the client use his or her own hands vs. placing mine on the client's abdomen. Once again, I feel it necessary to caution against violating the client's personal boundaries.

According to Smith, stretching of tight places in the body helps to induce aliveness. While the client is stretching one body part and then the other, the therapist invites the client to share any memories or emotional reactions while stretching.

Smith defines "Hard" techniques as those interventions which are neither gentle nor subtle, but instead are uncomfortable, at times painful, and often dramatic. Smith cautions that these techniques require considerable judgment and care, otherwise they may induce highly traumatic experiences for the client.

Often, preliminary work engaged in before utilizing "hard" techniques involves grounding the client (developing the ability to be self-supported or self-contained). The use of such stress postures as the bow, the one-legged stance, lying with the legs in the air, and wall sitting can be useful first steps in facilitating grounding. The client shifts all his or her weight to one leg, bends the knee, and extends the other leg with the heel only slightly touching the floor when assuming the one legged stance. The straight leg is used only for balance in this stance. When the client experiences vibrations in the stressed leg, the client reverses the position. When engaged in the wall-sitting stance, the client takes a seated position with his or her back against the wall, with thighs parallel to the floor, without benefit of a chair. The client is instructed not to brace his or her arms against the thighs for support. The client remains in this stance until the vibrations in the legs can be felt. With all of the stress postures, deep breathing through the mouth and vocalized exhalations are encouraged. Each of these stances assists the client in experiencing him or herself in contact with the ground.

Using deep pressure on spastic muscles is a common technique used by many therapists who engage in bodywork. Typically, the therapist mobilizes the client's breathing and then works on the armored muscles by applying deep pressure or deep muscle massage.

Alexander Lowen, author of Pleasure: A Creative Approach to Life, describes the principles and practices of bioenergetic therapy as based on "...the functional identity of the mind and the body. This means that any real change in a person's thinking and, therefore, in his behavior and feeling, is conditioned upon a change in the functioning of his body."

RELEASING THE ENERGY OF THE BODY'S STORED PAIN

For centuries healers around the world have been aware of the human body's energy field. Because most of us are unable to see this energy field with our eyes, we have tended to ignore it. Yet each of us have experienced it. Whenever you have entered a room and sensed the tension between individuals who are in distress or who have been arguing, you have experienced their energy field. When you sense the presence of another before seeing them, you have tapped into his/her energy field. We are constantly emitting and receiving energy. Wayne Kristberg, author of The Invisible Wound: A New Approach To Healing Childhood Sexual Abuse, provides an example of how this energy field can be demonstrated. He suggests that an individual close his/her eyes and hold their hands over their ears; while a friend slowly begins to approach from approximately ten feet away. Typically, the individual will sense the energy of the friend before the friend is standing within a foot away. This is because the friend has entered the individual's energy field. The energy field extends not only outward from one's body, but also permeates the body completely; absorbed in each atom and cell. It is within the bodies' energy system, that the body holds the memories of one's past experiences, including the memory of sexual and physical abuse.

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According to Kristberg, the trauma and pain of sexual abuse is centralized and stored in the pelvic area. When an individual undergoes recovery work to externalize or release the stored pain, a sensation of emptiness in the pelvic region may be experienced as a tingling sensation, a sense of relaxation or of lightness in this area. After undergoing intense emotional release work, most survivors feel significant relief. Kristberg contends that it is important to then focus awareness and direct healing energy into the now "empty place" in order to maximize healing. If one does not guide healing energy into the wound, once emotional release work is completed, Kristberg warns that the "energy hole" will reestablish the previous pattern of held pain. This is due to the fact that the body has become accustomed to carrying the energy pattern associated with the held pain. If a new energy pattern is not introduced after the pain is released, the original pattern of pain will reemerge.

Held pain can be externalized by a number of means, including bodywork, shouting, screaming, etc. While this release is occurring, the held energy is being pushed out and away from the body. During this process, Kristberg recommends that the individual doing the work should find a position that is most effective for letting out the emotional energy. As the emotions related to the trauma begin to be released, initial feelings of terror, intense fear, grief, or anger may be experienced. The body may begin to tremble or shake, or one might begin to yell or scream.

Energy tends to be manifested in two primary forms reports Kristberg: toxic energy and healing energy. Toxic energy consists of energy that has been held in or repressed, and often includes unexpressed anger, terror, grief, loss, rage, guilt, shame, etc. Once this energy is released it becomes "nontoxic." Healing energy, on the other hand, flows freely and is unrepressed. It is often experienced as feelings of peace, contentment, happiness, joy, etc. When healing energy is directed into the wound, Kristberg advises his clients to visualize the energy in the form of a color or image that represents healing to them.

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BIOFEEDBACK

Biofeedback provides us with an opportunity to demonstrate the connections between an individual's psychological and physiological activity. Biofeedback instruments offer an immediate and objective source of information to the client and practitioner regarding the client's mind/body interaction. The physiological effects of such emotions as fear, anger, etc. can be demonstrated to the client, and psychosomatic disorders can be more concretely explained.

Biofeedback, as well as meditative practices, emphasizes the importance of attaining a state of relaxation in order to facilitate the achievement of insight and growth. It is also the goal of both practices to develop a state of harmony between the mind and body.

Biofeedback as explained by Kenneth Pelletier is based on three basic principles:

1) An individual can regulate any neurophysiological or biological function which can be monitored and amplified by electronic instrumentation, and then fed back to the individual through any one of the five senses.

2) Every change in an individual's physiological state is accompanied by a corresponding change in the mental emotional state, whether it be conscious or unconscious. Every change in the mental emotional state, conscious or unconscious produces a change in the physiological state.

3) A deep state of relaxation is conducive to the establishment of voluntary control of many autonomic or involuntarily nervous system functions, such as heart rate, brain waves, muscle tension, body temperature, white blood cell levels and stomach-acidity.

Biofeedback is described by Pelletier as one of the many approaches which places responsibility for health, well being and even personal growth upon the individual. When utilizing biofeedback with a client, the therapist can demonstrate the tremendous influence one can have over one's body processes, thus empowering the individual.

In working with individual's suffering from anxiety, phobias and panic disorder, I often now use a small hand held biofeedback monitor which measures galvanic skin resistance, which is a reflection of sweat gland activity and pore size. When an individual becomes disturbed or aroused to any extent, the monitor emits a high pitched buzz tone; when calm and relaxed, the tone is transformed into a slow popping sound. This is an extremely primitive machine and tremendously inferior to the more advanced instruments utilized in biofeedback. It does, however, demonstrate to clients how their emotions and thoughts impact their body functioning. I have found it to be extremely useful in instructing clients in the importance of utilizing relaxation techniques in order to alleviate anxiety, as well as other stress related disturbances. I am finding biofeedback particularly helpful in my work with victims of Post Traumatic Stress Syndrome.

While bodywork remains an area that I am just now beginning to learn about and utilize, I am convinced that one must not neglect the body in endeavors to reach matters of the mind, for they are too often interwoven.

next:To Those who Provide Support to Parents who are Survivors

Antidepressant medications now come with a medication guide written by the FDA. The guide lays out the antidepressant warning about a possible increase in suicidal thoughts and behaviors in plain English. Read the guide below.

Medication Guide About Using Antidepressants in Children and Teenagers

What is the most important information I should know if my child is being prescribed an antidepressant?

Parents or guardians need to know about four important things to help them decide whether their child or teenager should take an antidepressant:

• The risks of self-injury or suicide
• How to try to prevent self-injury or suicide
• What to watch for in children or teens taking antidepressants
• The benefits and risks of antidepressants

1. Risk of Injury to Self or Suicide

Children or teenagers with depression sometimes think about suicide and many report trying to kill themselves. Antidepressants increase suicidal thoughts or actions in some children and teens. Antidepressants increase suicidal thoughts and actions in some children and teenagers. But suicidal thoughts and actions can also be caused by depression, a serious medical condition that is commonly treated with antidepressants. Thinking about killing yourself or trying to kill yourself is called suicidality or being suicidal.

A large study combined the results of 24 different studies of teenagers and children with depression or other illnesses. In these studies, patients took either a placebo (sugar pill) or an antidepressant for 1 to 4 months. No one committed suicide in these studies, but some patients became suicidal. On sugar pills, 2 out of every 100 became suicidal. On the antidepressants, 4 out of every 100 patients became suicidal.

For some children and teenagers, the risks of suicidal actions may be especially high. These include patients with

• Bipolar illness (sometimes called manic-depressive illness)
• A family history of bipolar illness
• A personal or family history of attempting suicide

If any of these are present, make sure you tell your healthcare provider before your child takes an antidepressant.

2. How to Try to Prevent Suicidal Thoughts and Actions

To try to prevent suicidal thoughts and actions in your child, pay close attention to changes in her or his moods or actions, especially if the changes occur suddenly. Other important people in your child's life can help by paying attention as well (e.g., your child, brothers and sisters, teachers, and other important people). The changes to look out for are listed in Section 3, on what to watch for.

Whenever an antidepressant is started or its dose is changed, pay close attention to your child.

• After starting an antidepressant, your child should generally see his or her healthcare provider:
• Once a week for the first 4 weeks
• Every 2 weeks for the next 4 weeks
• After taking the antidepressant for 12 weeks
• After 12 weeks, follow your healthcare provider's advice about how often to come back
• More often if problems or questions arise (see Section 3)

You should call your child's healthcare provider between visits if needed.

3. You Should Watch for Certain Signs If Your Child is Taking an Antidepressant

Contact your child's healthcare provider right away if your child exhibits any of the following signs for the first time, or if they seem worse, or worry you, your child, or your child's teacher:

• Thoughts about suicide or dying
• Attempts to commit suicide
• New or worse depression
• New or worse anxiety
• Feeling very agitated or restless
• Panic attacks
• Difficulty sleeping (insomnia)
• New or worse irritability
• Acting aggressive, being angry, or violent
• Acting on dangerous impulses
• An extreme increase in activity and talking
• Other unusual changes in behavior or mood

Never let your child stop taking an antidepressant without first talking to his or her healthcare provider. Stopping an antidepressant suddenly can cause other symptoms.

4. There are Benefits and Risks When Using Antidepressant

Antidepressants are used to treat depression and other illnesses. Depression and other illnesses can lead to suicide. In some children and teenagers, treatment with an antidepressant increases suicidal thinking or actions. It is important to discuss all the risks of treating depression and also the risks of not treating it. You and your child should discuss all treatment choices with your healthcare provider, not just the use of antidepressants.

Other side effects can occur with antidepressants.

Of all the antidepressants, only fluoxetine (Prozac) has been FDA approved to treat pediatric depression.

For obsessive compulsive disorder in children and teenagers, FDA has approved only fluoxetine (Prozac), (Zoloft), fluvoxamine, and clomipramine (Anafranil).

Your healthcare provider may suggest other antidepressants based on the past experience of your child or other family members.

Is this all I need to know if my child is being prescribed an antidepressant?

No. This is a warning about the risk for suicidality. Other side effects can occur with antidepressants. Be sure to ask your healthcare provider to explain all the side effects of the particular drug he or she is prescribing. Also ask about drugs to avoid when taking an antidepressant. Ask your healthcare provider or pharmacist where to find more information.

* This Medication Guide has been approved by the U.S. Food and Drug Administration for all antidepressants.

next: Suicide: A Teacher's Experience
~ depression library articles
~ all articles on depression

Comprehensive information on all aspects of alternative treatments, therapies, and remedies for mental health conditions, psychological disorders.

Be an Informed Consumer

• Understanding Complementary and Alternative Medicine
• Statistics on CAM Use
• Alternative Treatments: Get Informed
• Selecting a Complementary and Alternative Medicine (CAM) Practitioner
• Consumer Financial Issues in Complementary and Alternative Medicine
• Important Information About Herbal Treatments
• Harmful Substances in Herbal Products

Major Areas of CAM

• Major Areas of CAM
• Energy Medicine: An Overview
• Manipulative and Body-Based Practices: An Overview
• Mind-Body Medicine: An Overview
• Whole Medical Systems: An Overview

Treatment and Therapies

• Alternative Approaches to Mental Health Care
• Acupuncture
• Use and Effectiveness of Acupuncture - NIH Statement
• FDA Warning About Actra-Rx for Erectile Dysfunction
• What is Ayurvedic Medicine?
• Effective Treatment of Chronic Pain and Insomnia
• Magnets To Treat Pain
• Mind-Body Interventions for Gastrointestinal Conditions

Dietary Supplements

• Botanical Dietary Supplements: Background Information
• Dietary Supplements: Background Information
• What's in the Bottle? An Introduction to Dietary Supplements
• Dietary Supplement: Folate
• Safety of Herbal Supplements
• Ginko: Herbs
• Asian Ginseng: Herbs
• Dietary Supplement Fact Sheet: Iron
• Magnesium
• Melatonin for Sleep Disorders
• SAMe (S-Adensoly-L-Methionine)
• St. John's Wort: Overview
• St. John's Wort and the Treatment of Depression
• Valerian Root
• Vitamin B6
• Vitamin B12
• Zinc - Alternative Medicine

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Complimentary & Alternative Medicine

Complementary Therapies for Your Mental Health

• Complimentary and Alternative Medicine
  
  • Acupressure, Shiatsu, Tuina
  • Alexander Technique for Depression, Stress
  • Applied Kinesiology for Mental Health Conditions
  • Aromatherapy for Mental Health Conditions
  • Autogenic Therapy for Peace of Mind
  • Bach Flower Remedies for Mental Health Conditions
  • Bowen Therapy for Psychiatric Disorders
  • Chelation Therapy for Mental Health Conditions
  • Chiropractic, Spinal Manipulation, Spinal Manipulation
  • Colonic Irrigation for Treating Psychological Disorders
  • Color Therapy for Psychiatric Disorders
  • Craniosacral Therapy for Psychiatric Disorders
  • Crystal Therapy, Electrocrystal Therapy
  • Feldenkrais Method for Treating Psychological Conditions
  • Guided Imagery for Treating Psychological Conditions
  • Hellerwork for Psychological Conditions
  • What Is Homeopathy?
  • Homeopathic Remedies for Mental Health Problems
  • Hydrotherapy - Reduce Stress and Relax
  • Hypnotherapy, Hypnosis for Psychological Disorders
  • Magnet Therapy for Treatment of Depression, Stress
  • Massage for Treatment of Psychological Disorders
  • Meditation for Treating Psychological Disorders
  • Music Therapy for Treatment of Psychiatric Disorders
  • Osteopathy
  • Ozone Therapy
  • Polarity Therapy for Psychological Conditions
  • Prayer for Treating Psychological Disorders
  • Qi Gong for Psychological Disorders
  • Reflexology to Relieve Stress, Improve Health
  • Reiki for Psychological Disorders
  • Relaxation Therapy for Psychological Disorders
  • Rolfing Structural Integration
  • Tai Chi for Psychological Disorders
  • TENS (Transcutaneous Electrical Nerve Stimulation)
  • Therapeutic Touch for Psychological Disorders
  • Visualization for Psychological Disorders
  • Yoga for Anxiety, Stress and Depression

  Others

  • Healthy Lifestyle - Ways to Staying Well
  • Alternative Therapies Work Well for Anxiety
  • Treating Anxiety Disorders Without Medication
  • Managing Stress
  • Breathing Exercises to Reduce Stress
  • How to Relax and Cope with Stress
  • Self-Help and Alternate Therapies for Depression
  • Complimentary Therapies for Depression
  • Alternative Treatments for Depression and Anxiety
  • Meditation
  • Assessing Complementary and/or Controversial Interventions For ADHD
  • ADHD - Unproven Treatments

  Books

  • Books on Alternative and Complementary Medicine

 

next to: Understanding Complementary and Alternative Medicine

Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. Depressed mood accompanies manic activation.

Sometimes severe mania or depression is accompanied by periods of psychosis. Psychotic symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not actually there) and delusions (false fixed beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time (e.g., grandiosity during mania, worthlessness during depression).

Bipolar disorder with rapid cycling is defined as four or more episodes of illness within a 12-month period. This form of the illness tends to be more resistant to treatment than non-rapid-cycling bipolar disorder.

The particular combinations and severity of symptoms vary among people with bipolar disorder. Some people experience very severe manic episodes, during which they may feel "out of control," have major impairment in functioning, and suffer psychotic symptoms. Other people have milder hypomanic episodes, characterized by low-level, non-psychotic symptoms of mania such as increased energy, euphoria, irritability, and intrusiveness, that may cause little impairment in functioning but are noticeable to others. Some people suffer severe, incapacitating depressions, with or without psychosis, that prevent them from working, going to school, or interacting with family or friends. Others experience more moderate depressive episodes, which may feel just as painful but impair functioning to a lesser degree. Inpatient hospitalization is often necessary to treat severe episodes of mania and depression.

A diagnosis of bipolar I disorder is made when a person has experienced at least one episode of severe mania; a diagnosis of bipolar II disorder is made when a person has experienced at least one hypomanic episode but has not met the criteria for a full manic episode. Cyclothymic disorder, a milder illness, is diagnosed when a person experiences, over the course of at least 2 years (1 year for adolescents and children), numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that are not severe enough to meet criteria for major manic or depressive episodes. People who meet criteria for bipolar disorder or unipolar depression and who experience chronic psychotic symptoms, which persist even with clearing of the mood symptoms, suffer from schizoaffective disorder. The diagnostic criteria for all mental disorders are described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).2

Many patients with bipolar disorder are initially misdiagnosed.3 This occurs most often either when a person with bipolar II disorder, whose hypomania is not recognized, is diagnosed with unipolar depression, or when a patient with severe psychotic mania is misjudged to have schizophrenia. However, since bipolar disorder, like other mental illnesses, cannot yet be identified physiologically (for example, by a blood test or a brain scan), diagnosis must be made on the basis of symptoms, course of illness, and, when available, family history.

next: The Illness of Vincent Van Gogh
~ bipolar disorder library
~ all bipolar disorder articles

I had a lot of grandiose, co-dependent concepts of myself that I've had to overcome. Some of these concepts were:

• I am the strong, silent type
• I am my job and my career
• I am my successes
• I am my toys (car, house, stereo, favorite sports team, etc.)
• I am master of the castle
• I am master of my destiny
• I am the provider, protector, defender, controller
• I am master of my universe

I never stopped to question whether these concepts were valid. I had no clue whether these concepts worked in real life, except to keep applying them over and over and over to the way life worked (and more often did not work). In other words, I had no self other than these concepts. I took for granted that these concepts were the sum total of who I was and how I was supposed to act and react.

In recovery, I have learned the process of self-discovery. I am a unique person, separate and apart from anyone's preconceived ideas or concepts. I accept that I am not a little god or a little general running around controlling everything and everybody.

By hitting bottom, I came to realize that there could only be one God in my life, and that I was not God (thank God!). I gave up the responsibility for running the universe. I gave up the insanity of believing that I could run my life and lives of those around me any way that suited me at the moment.

I began discovering God and God's will for my life. Once that process and that focus was in place, I began discovering my true self.

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next: The Twelve Steps: A Perspective

In a new book, Dr. Harold Koplewicz helps families sort out normal adolescent irritability from real illness

As the founder and director of the New York University Child Study Center, Dr. Harold Koplewicz has seen firsthand the pain that depression brings to families. His new book, "More Than Moody: Recognizing and Treating Adolescent Depression," describes current therapeutic approaches and new research.

How does depression manifest itself differently in teens and adults?

Depressed teenagers are more reactive to the environment than depressed adults. In addition, they act irritable. In classical depression, you are depressed all -or almost all- of the time. Depressed teens' moods are much more changeable. If an adult male gets depressed and you take him to a party, he is still depressed. In fact, he may depress others at the party. A teenage boy who is depressed and gets taken to a party might brighten, might actually want to have sex. If pursued, he might enjoy himself. But if he goes home alone, he is likely to become very depressed again. These mood changes are very hard for parents to understand.

Most teenagers are moody. When should parents start to worry?

Parents have to know their children. Adolescence is not a good time to introduce yourself. Money should have been put in the bank earlier. Then, during adolescence, it's a continuation of a close relationship. You understand what your child's sleep habits are like, what his energy level is like, what her concentration is like, so you can observe when changes in usual behavior last for a month. Then I would get an evaluation.

What would you tell parents who feel guilty when their children are depressed?

Parents want their children to be happy so much that they feel somehow responsible if their child is not. I would emphasize that depression is a real illness. Depression [is] such a misused term. We're not talking about demoralization, or about being dispirited. We're talking about a real illness that has neurobiological underpinnings and that parents have to take as seriously as diabetes.

Where should parents go for help? Do you think there are enough resources?

There are so many barriers to getting a teenager help. In our nation, it's nothing less than a tragedy that only one out of five teenagers who suffer from depression gets any help. It's even worse if you are a kid from a lower socioeconomic group. The first thing to do would be to go to your pediatrician or your school psychologist who can refer you to a child psychiatrist or a child psychologist. Diagnosis is the most important issue here. I would explore the Web site of the American Academy of Child and Adolescent Psychiatry and get the name of a board-certified child psychiatrist. I would go to a university-affiliated medical center. I would call the local medical school. I would go to the American Psychological Association and ask for a child psychologist. After the diagnosis, I would ask for a depression treatment plan, keeping in mind that more than one approach can work. There is talk therapy, specifically cognitive behavioral therapy and interpersonal therapy, which requires specialized training and has been shown to be effective. Depression medications can also work.

Are the medications normally prescribed safe for developing brains?

We've been using these drugs for many years, but there is still a question out there. I think the benefits outweigh the risks. The jury is still out, but some animal studies have even shown that taking the medication may actually prevent future episodes of depression, but this is all preliminary. Parents also need to be informed about the risk of not taking medicine. We're starting to learn that with each successive episode, patients are more at risk for another depressive episode. Each episode may affect brain development negatively. Therefore, the benefits of taking medication outweigh the risks. There are real costs to the illness which should affect how we think about the risks of treatment.

What's the biggest myth about teens and depression?

I think we still have trouble believing that children and teenagers can get depressed. Twenty years ago, the prevailing theory was that depression in teens, like moodiness, was normal and that teenagers who weren't depressed were abnormal. Now we know that's not accurate. Another myth: depression is reserved for the poor. It turns out to be an equal-opportunity disorder.

This article appeared in the Oct. 7, 2002 issue of Newsweek

next: Pediatric ECT Electroconvulsive Therapy in Adolescents and Children
~ depression library articles
~ all articles on depression

Researchers find 'trait marker' in people recovered from depression

Physicians and patients have long known that people who have a major depressive episode have a greater risk for suffering another. These people, although ostensibly recovered, also remain unusually sensitive to emotional stress.

In a November 2002 issue of the American Journal of Psychiatry, researchers reported identifying what may be a "depression trait marker" in the brain which explains why patients who have recovered nevertheless remain vulnerable to another depressive episode.

And in a second study released around the same time, another research team says it identified the first gene that leaves women vulnerable to clinical depression.

The Return of Depression

"Depression is not a single event for many people and each episode, if you're lucky, can be treated and you can be well, but depressed patients know that they are at risk for more episodes," says Dr. Helen Mayberg, lead author of the "trait marker" study and a professor of psychiatry and neurology at the University of Toronto. "The question is what about your brain seems to be the area of vulnerability."

Previous research has already demonstrated that the brains of depressed people work in different ways than healthy people. This study takes the concept further.

It "goes to a new level because it talks about people who have recovered from depression or who have been treated. Their brains are functioning differently, and it's a question of why they're functioning differently," says Dr. Kenneth Skodnek, chairman of the department of psychiatry and psychology at Nassau University Medical Center in East Meadow, N.Y. "This is special because I believe this is the first time that there has been evidence even when someone recovers that the brain is still not functioning normally."

In this study, researchers asked 25 adults to remember an extremely sad experience in their life, then scanned their brains with positron emission tomography (PET) while they recalled the event.

The participants belonged to one of three categories: 10 women who had recovered from a major depression (nine were on medication and one was not); seven women who were at that time in the throes of a major depressive episode (only one was on antidepressant medication); and eight healthy women who had no personal or family history of depression.

The scans, which measure blood flow, showed that the brains of the recovered patients and currently depressed women experienced different changes than the brains of the healthy participants.

"We saw that recovered patients looked for all intents and purposes like acutely depressed patients and that there were some very specific areas of the brain that changed uniquely in depressed patients that we don't see in healthy subjects and vice versa," Mayberg says. "Under that emotional stressor, the recovered depressed patients looked like the worst depressed patients. When we stressed healthy subjects' brains, we didn't see any decrease in brain activity."

Specifically, the subgenual cingulate and the medial frontal cortex areas of the brain were involved. The subgenual cingulate has already been identified as being involved in the experience of intense sadness even in healthy individuals. It is also a target of antidepressant medication.

"These people are different even when they're treated," Skodnek says. "It's almost like someone comes in with congestive heart failure, you treat them" and the heart appears to be doing OK. "But if you know what's going on with the heart, it's not OK."

Whether the differences in brain function are a cause or effect of a previous depressive episode remains unknown.

Nevertheless, this research and future studies it spawns will have important implications for identifying people at risk for depression and in identifying new targets for drug therapy.

Although this appears to be a trait marker for depression, Mayberg is careful not to overstate the case. "I wouldn't want anyone to think we've got the glucose tolerance test for depression," she says.

Meanwhile, researchers at the University of Pittsburgh say they've found evidence that a gene in chromosome 2q33-35 leaves women at a higher risk for depression. However, they found no such correlation in men, suggesting that vulnerability to the disease is at least in part influenced by one's gender.

next: Co-Occurrence of Depression With Heart Disease
~ depression library articles
~ all articles on depression

When I first came into contact with the word "Codependent" over a decade ago, I did not think that the word had anything to do with me personally. At that time, I heard the word used only in reference to someone who was involved with an Alcoholic - and since I was a Recovering Alcoholic, I obviously could not be Codependent.

I paid only slightly more attention to the Adult Children of Alcoholics Syndrome, not because it applied to me personally - I was not from an Alcoholic family - but because many people whom I knew obviously fit the symptoms of that syndrome. It never occurred to me to wonder if the Adult Child Syndrome and Codependence were related.

As my Recovery from Alcoholism progressed, however, I began to realize that just being clean and sober was not enough. I started to look for some other answers. By that time, the conception of the Adult Child Syndrome had expanded beyond just pertaining to Alcoholic families. I started to realize that, although my family of origin had not been Alcoholic, it had indeed been dysfunctional.

I had gone to work in the Alcoholism Recovery field by this time and was confronted daily with the symptoms of Codependence and Adult Child Syndrome. I recognized that the definition of Codependence was also expanding. As I continued my personal Recovery, and continued to be involved in helping others with their Recovery, I was constantly looking for new information. In reading the latest books and attending workshops, I could see a pattern emerging in the expansion of the terms "Codependent" and "Adult Child." I realized that these terms were describing the same phenomenon.

I was troubled, however, by the fact that every book I read, and every expert with whom I came into contact defined "Codependence" differently. I began to try to discover, for my own personal benefit, one all-encompassing definition.

This search led me to examine the phenomenon in an increasingly larger context. I began to look at the dysfunctional nature of society, and then expanded farther into looking at other societies. And finally to the human condition itself. The result of that examination is this book: Codependence: The Dance of Wounded Souls, A Cosmic Perspective on Codependence and the Human Condition.

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This book is based upon a talk that I have been giving for the last few years. I have edited and reorganized, expanded, added, and clarified information in adapting the talk to book form, but there is still the flavor and style of a talk throughout much of this book. I have not attempted to change this for several reasons, the main reason being that it works in conveying the multi-leveled message that I wish to communicate.

One of the reasons for the human dilemma, for the confusion that humans have felt about the meaning and purpose of life, is that more than one level of reality comes into play in the experience of being human. Trying to apply the Truth of one level to the experience of another has caused humans to become very confused and twisted in our perspective of the human experience. It is kind of like the difference between playing the one-dimensional chess that we are familiar with, and the three-dimensional chess played by the characters of Star Trek - they are two completely different games.

That is the human dilemma - we have been playing the game with the wrong set of rules. With rules that do not work. With rules that are dysfunctional.

I was terrified beyond description the first time I gave this talk in June of 1991. It seemed as if emotional memories of what it felt like to be stoned to death by an angry mob were assaulting my being. I went ahead with it anyway, because it is what I needed to do for myself. I needed to stand up in public and own my Truth. I needed to own the Truth that I had come to believe in, the Truth that worked for me to allow me to find some happiness, peace, and Joy in my life. I found that other people found Joy and peace in my message also.

So, now, I share this message with you, the reader of this book, in the hopes that it will help you to remember the Truth of who you are, and why you are here. This information is not meant to be absolute or the final word - it is meant as an alternative perspective for you to consider. A Cosmic Perspective that just might help to make life an easier, more enjoyable experience for you.

Robert Burney

next: About the Author, Robert Burney

a short story for children (and adults too)
by Adrian Newington

One cold Autumn day, Erin heard the sound of rustling leaves and crashing branches outside her window. She jumped onto the couch and stared out of the large lounge room window. She thought to herself, "What a blowy, windy day. Who would want to go out on a day like this?"

It was so warm inside, and so cold and grey outside. Erin felt wonderfully happy and safe in her home. The heater was on and the radio was playing lovely music; cooking smells filled the house from the cake that Mum was baking.

After looking outside for some time in a very intent manner, Erin snuggled up to her Dad and said, "Dad, why do the leaves on the trees have to die?"

Dad put down his book and gave her a cuddle as he began to speak.

"Well little one, the trees have to have a rest you know." He stood up and took her back to the window and continued to talk. "That tree out there spent all summer growing apricots for us, and the tree with the swing on it gives us all that lovely shade on those very hot summer days. They've worked very hard for us darling, they need a sleep too, and very soon, all those leaves will fall to the ground and become part of the soil once more.

When the spring comes again, the trees will find the soil to be rich and healthy from the leaves that fell to the ground. Dad looked at Erin and saw how serious she thought it all was. He looked at her and gave a little chuckle. "Besides," he said, trying to look serious too, "We need the Magic."

"Magic!" said Erin with BIG, WIDE curious eyes. "What Magic, Dad?"

"Didn't I tell you? I'm sure I did. You know. About catching an Autumn leaf?"

"You've never told me that before Dad! What happens when you catch an Autumn leaf ?"

"Why, you get a wish!", he said as if it was the greatest known fact of all time. "Are you sure I haven't told you that before? I must have."

"No you haven't, Dad. I promise. Please tell me about it".

"Well!," he said on his way back to his seat, making himself ready for his speech. "It's like this: If you're walking outside, and you see a leaf falling your way, you'll get a wish if you manage to catch it before it reaches the ground. Close your eyes and hold it near your heart and make a wish. After you've said your wish, you must keep your eyes closed and let it continue to fall to the ground".

"Can I wish for anything Dad?" "Yes, you can, but remember, some wishes are better than others."

"How Dad?"

"Well, there are different sorts of wishes you know. Firstly, there are kind wishes, and then there simple wishes, and there are thoughtless wishes."

"What's a kind wish Dad?" "A kind wish is the sort of wish that you would make for someone else."

"What sort of wish would a thoughtless wish be?"

"Well, a thoughtless wish is the kind of wish made by a person who is always thinking of themselves. They're always wanting things; they forget about people."

Erin thought deeply about this and then said, "Dad, would a kind wish be a wish to help someone stop making thoughtless wishes?"

"It sure would be. In fact, I would say that would have to be among the best sort of wishes you could ever wish for."

"And what's a simple wish?"

"Oh, that might be something like wishing to find a lost toy or doll. I wouldn't make a wish like that because sooner or later, lost things like that turn up anyway. Just a little bit of patience would do the same thing"

"Dad, I don't know what sort of wish I should make?"

"You make whatever sort of wish you want darling. Just make the wish that seems good and right in your heart." Erin came close to her Dad and said, "Oh please Dad, can we go and catch some leaves now?"

"What!? Now!? It's freezing out there!"

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She came even closer and flashed her deep brown eyes at him and said, "I know Dad, but I've got a very, very important wish to make."

"Very important?" He was surprised by her persistence. "How important?"

"Just the most important of all wishes ever made Dad!"

"Alright, we'll go to the park. Call your brother and we'll leave right away."

Erin was very excited, she could hardly wait, and ran as fast as she could down the hall to get a jacket oaom her room. On her way, she poked her head into her brother's room and cried out very excitedly: "Ryan, Ryan, get your jacket. Dad's taking us to the park to make some wishes!"

Ryan came out of his room wondering what all the fuss was about. Dad put on his coat and said to Ryan, "Coming to the park mate?" Erin came rushing out of her room and began talking to Ryan.

"Come on Ryan, get your jacket on. Don't be a slow poke. I'll tell you everything when we're in the car".

Ryan was very puzzled, but he put his jacket on as fast as he could and got into the car. Just like a wise old owl; acting as if she was an expert on wishes. Erin told Ryan the story exactly as her Dad had told it.

Soon, they arrived at the park. Dad parked the car, and the children ran out as fast as they could. There were big trees and small trees, trees with golden leaves, trees with red leaves, and the wind was blowing them everywhere. Ryan ran through a pile of dead leaves; kicking and scattering them, having a great time.

"Dad! It sounds like I'm walking through cornflakes," he shouted.

The three of them picked up handfulls of leaves and began throwing them at each other. After a time, everybody had bits of leaves in their hair and down their shirts. Suddenly, Erin remembered what she was here for. "Come on Dad!", she said excitedly. "Look over there, look at all the leaves coming down from those trees!

Ryan and his Dad followed Erin to some tall trees. Erin stretched her arms up as high as she could; running here and running there, but she found it very hard to catch any leaves at all.

"Dad, it's like the leaves don't want to be caught."

"Oh, not really love. I think they are just making you earn your wish. Don't try to catch them all. Concentrate, keep your eye on one leaf all the time. Don't be distracted, don't look away, keep reaching out."

Soon Erin, Ryan and Dad had all caught their leaves. Erin made her secret wish, Ryan made his secret wish, and even Dad had his own special wish. When everyone was ready, they all got back into the car and made their way home. It was a strange journey, no-one talked very much because they were all thinking about their secret wishes, but Erin broke the silence by being first to speak.

"Who gives us the wish Dad?"

"We do!", said Dad so very calmly. Erin and Ryan looked at each other quite confused.

"How ?", came a long stretched out reply from Erin.

Dad stopped at the traffic lights and looked around to her with a smile and said, "By believing"

Erin returned a little smile to her Dad as her breath was gently taken away by his words.

I wonder what their secret wishes were?

What would be your secret wish?

The End

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