Saturday, August 28, 2010

USING PLAY TO BOND WITH YOUR CHILD

http://www.youtube.com/watch?v=9MDnouUu7cU

http://www.youtube.com/watch?v=0hqYt1Ydl_4

http://www.youtube.com/watch?v=m1OLLUZJIf4

http://www.youtube.com/watch?v=bSEVTo7duz4

http://www.youtube.com/watch?v=LVx75xOwqM0

Saturday, August 21, 2010

USING PLAY THERAPY AS A TREATMENT FOR AN AUTISTIC CHILD


Rima was a 5.5 year old ASD child when on gentle persuasion by a day care teacher her parents approached us for play therapy. Rima’s parents although both were paramedics, struggled to accept that their child was not normal. Initially they blamed themselves for the lack of time and hoped that their love and attention would reverse her ‘odd’ behaviours. The mother especially blamed her work hours or their decision to have another child (a normal 3 year old son) so soon for Rimas developmental issues.
When they first came to discuss Rima, they thought that the only issue with the child was that she was not very verbal. They claimed that although she was better than before after the day care center teacher spent extra time with her, they were worried how she would react to the big school which she would join in the 1st grade, next year. But as they talked they realized that the problem was far more complex and interlinked. They were able to identify other issues such as her hyperactivity, non communicative behaviour, usually preferring to play on her own, petrified of loud noises and animals, asocial by nature and find it difficult to share things. She also was easily irritated and was often teased and bullied by her cousins to whom she reacted by either crying or reacting violently. She loved to play in sand and go to the beach but didn’t much play with other toys. She was also at times mean and violent with the younger brother. She didn’t demand much, even in food and would be quite passive most of the times. She enjoyed watching television ads, and listened to religious mantras. She seemed to have an unusually bright memory in remembering lyrics of the songs / advertisement / mantras. Her favourite game with her father was to climb on him holding his hand and then throw herself backward head down. Although she does this regularly, the parents were very worried about this as she could seriously injure herself. They had tried to change this behaviour a number of times, but she would not pay heed to their warnings. Infact they thought that her risky behaviours such as this had increased and now she would take every opportunity to jump of the table or even fling herself suddenly at the opposite person, uncaring of how badly she might get hurt or hurt the other person. If shouted at or stopped, she showed an unusually strong temper and become very obstinate. Thus discipline and obedience or boundary setting were major issues with her. She would still wet the bed in the night although not regularly and at times soil her panties. The mother mentioned that Rima was very fond of sand; therefore they had made a sand pit in the balcony for her to play in. But her play in sand was pretty unusual. Instead of making something out of sand, she spent hours just sifting through sand humming to herself a tune. As we talked, the mother recognized other behaviours which although she had noticed, never paid much attention to it. Rima’s inability to generalize learnt behaviours to other similar situations, her inability to focus on two or more things at a time, her insistence of ritualistic actions, her inability to substitute one toy for another similar toy. She also realized that all these behaviours together indicated Autism, a neurologically based life long and severe condition and not merely a late developmental issue or an emotional problem.
The therapist helped them understand how play therapy can benefit an autistic child and how an autistic child’s play differs from that of other children. She also went on to explain how play is a complex phenomenon that occurs naturally for most children and how they move through the various stages of play development and are able to add complexity, imagination, and creativity to their thought processes and actions. However, for many children with Autistic Spectrum Disorder (ASD) various stages of play never truly develop or develop in a fragmented fashion. These skills which a ‘normal’ person takes so much for granted is actually an uphill task for an ASD child. An ASD child suffers at all three levels of understanding and mastering the skills, cognitive social and behavioural.
Initially it was believed that play therapy is not effective treatment for ASD, recent research has convincingly proved that it is one of the most effective forms of treatment when used at times in a structured manner and especially if it is taught to parents and incorporated in the daily routine by the parents. Extensive opportunities in play therapy for social skills and emotional development help the child by increasing his awareness of other people’s mental states and their intentions. Play therapy then becomes a safe practice zone for the development of these skills.
These play therapy skills can also be taught to the parent / care taker who can incorporate it as a part of the daily routine. Treatment of ASD is highly specialized and a life time task, therefore often very expensive. Play way parenting equips parents to incorporate these play sessions in daily routine of the child and drastically reduces the cost. Parents are also encouraged to introduce it to the rest of the family so that it becomes another support for the ASD child to learn and master the skills. It also indirectly helps the other family members cope with their emotions with regards to the ASD child in a constructive manner.
Play therapy provides ample of opportunities to develop following skills in ASD children, necessary for their learning:
1. Imitation: imitation is a skill that is learnt very early in childhood. But the most crucial aspect of imitation is the ability to generalize these imitative behaviours to other situations. For example a child through imitation learns to smile and then uses cognitive and social skills to generalize smiling behaviour to situations requiring it. But ASD child find it difficult to generalize this to other situations. During play therapy, puppets, role enactment, make believe situations etc are used to increase the generalizations of these imitative responses.
2. Object exploration: children suffering from ASD find it difficult to initiate an exploratory play. This is because they get over whelmed with multiple stimuli and over a period of time, due to past experiences they learn to be socially reserved. In play therapy, the sensitive manner in which the therapist approaches the child establishes a safe and trusting environment for the child to attempt to explore. Then when the therapist incorporates some specific techniques such as restricting the space during play and giving them toy one by one the child finds it easier to learn them. A combination of skills and emotional support substantially increases these initiative responses in the child. It also helps to increase the child’s self confidence and self esteem.
3. Exploratory and Experimentation with play: Play therapy is often one of the first experiences of play without any target response goals for an ASD child. Being socially withdrawn they rarely take any initiatives to play on their own. Since play sessions are directed towards play only, it provides them with an opportunity to experiment and explore with play in a safe and trusting environment. Manipulation of toys in play session helps them to practice varying characteristics of toys, classification of toys such as sorting and matching, establish causal relationship between events and how to influence the world around them.
4. Communication skill: Communication skills such as expressing emotions, expressing specific needs, using gestures and joint attention are mastered during play sessions. Play therapists create surprise events during play sessions, using visual information to communicate verbally something that the child wants. This provides the child with ample opportunities to practice putting their emotions into gestures and words and thus reduces their frustration about not being able to get their needs met. It also reminds ASD children that communication and play involves another person and acts as a bridge toward more complicated or symbolic communication using words assessing not only their emotions and needs but also to match it with the other person. This is especially a difficult area for an ASD child as these skills are highly dependent also on social skills, both a problem area for the child. This skill can be taught using substitution of the play object (such as dolls), role enactment using various toys (puppets), recreating real life situations with numerous alternatives, helping the child to elaborate on intentions (involving verbal communication), helping the child to master ideas / themes, discussing with the child abstract themes and using obstacles to generate alternative solutions.
5. Signing or acting: Play sessions provide ample of opportunities to use a combination of gestures supported by verbal communication. This helps in the transition from no communication to gestures and then to verbal communication. This also helps to reduce the child’s frustration with people, usually strangers who are unable to understand their sign language. It thus increases their confidence socially and also boosts their self esteem. We often find a simultaneous reduction in anger in the child.
6. Peer Play: Peer play also relies on social cues which ASD child finds extremely difficult. Therefore we often find and autistic child unable to share, wait for turns, negotiate with another child, imitate other role models, ask for help, request for events / objects, initiate inviting another child for spontaneous play, all of which a necessity for any school going child. Through structured play sessions dealing with each of these skills and then slowly moving on to group play sessions or introducing it amongst the siblings the child gains enough confidence in these skills to be able to practice them at school or with other peers.
7. Increasing attention and concentration: also requires the child to comprehend the object and hold it in his thought symbolically. Play sessions intrinsically provide these opportunities to the child. It then becomes a practice field where the child learns to master these skills and then be able to use them outside.
8. Motor coordination also increases tremendously using play toys. The child learns to explore and experiment with different shapes, sizes textures and colours of toys in a non threatening, goal less, safe environment where the only goal is pleasure.
9. Parenting skills are also improved. Very often without realizing parents facilitate the learned helplessness in the child as he is unable to communicate. We often find the parent not being able to push the child to learn the above mentioned skills or become too harsh and frustrated. Neither of these behaviours are conducive for further development. During play sessions parents get an opportunity to examine their play deficits as well as express their own emotions and frustrations with the therapist. This kind of self exploration helps in dealing with parental anxiety of their child and his future in a manner which will help the child become independent.

Wednesday, August 18, 2010

CHILDREN OF DIVORCED / SINGLE PARENTS


Vineeta lost her mother when she was a young adult; she pined for years, unable to overcome her grief over the loss of her parent. But when she underwent divorce, she was unable to understand her own 8 year old son, who was grieving the loss of his father. She struggled to understand why suddenly he was getting into trouble at home and at school, why were his grades falling although he was an intelligent child, why was he back answering and blaming her. Nothing made sense, but a sense that everything falling apart for them both was experienced. Maybe that is what a child feels when parents divorce/ separate. His entire world seems to come crashing down.

The movie Bal Ganesha which got everyone in the theatre to tears of joy when Ganesha showed his superior intelligence and circled his parents three times instead of taking three rounds around the world, winning the race against his younger brother. Little do we realize that this mythology is not about superior intelligence, rather it portrays the child’s perception of his parents, his world. For him, parents are at the center of his existence and therefore separation from one or both is experienced like death and a threat to his own survival.

Like any one who is fighting for their survival, children try out various options to survive this trauma, and attempt to reunite their parents. Like the Vineeta, who grieved for years over the loss of her mother, children do not give up hope of reuniting their parents for years after the separation. Parents who are anyways struggling to deal with their own emotions find it extremely difficult to deal with the emotions of the children. Children ask questions which seem impeccably correct putting the parents in a spot. “But why does he not like you? Maybe if you work hard and become smarter and thin, the way he wants you to, we can be together,” says a 7 year old boy to his mother. Or a 10 year old girl to her father “Why can’t you forgive her, maybe she did not mean the things she said to you. You forgive me every time I have lied, can’t you forgive her? For my sake please?”

In most cases the children tend to feel responsible for the divorce and try to change the behaviour and actions to please the other parent, like this 6 year old boy pleads to his mother, “lets go back home, I promise I will not make him angry and bother him for toys ever again or change the TV channels.” At times, in their attempt to get back the parents together, they may even get into negative behaviours such as lying, running away from home, cooking up stories, poor academic performance, and bedwetting, being irresponsible and stubborn etc. This problem is exaggerated if the child is very young and unable to communicate; or if he is entering his teens and feels confused and threatened about the volatile emotions characteristic of this age. Unable to deal with this confusion and inability to express their distress, children learn to bottle up emotions and thoughts, making communication all the more difficult. There seems to be a glass wall around them where you cannot hear what they are saying nor can they seem to understand what you are trying to communicate. Nothing seems to penetrate and touch them through this wall.

But there is a non threatening way to communicate to them, through the language of play. Play is a natural mode of communication of children. They can better emote their feelings unconsciously through play and therefore play becomes a powerful cathartic medium. It also provides an emotional distance to the children necessary to express threatening and negative emotions and thoughts. They cannot say that I don’t hate you mom for getting divorce but they can definitely express the same using a doll set or by beating at clay incessantly. Thus through the use of play, we can reach out to both the younger children and the teenagers alike.
This play way is used by a specially trained therapist to help children and parents better understand and deal with each others thoughts, feelings and behaviours. Unfortunately this is a language that we as parents, have long forgotten and need to relearn it in order to understand what our child is feeling to help them. Sometimes the Play Therapist also involves the parent to some of the structured play techniques which can help them bond better. This is what we did with Vineeta and her son. Through play materials we helped the child emote his anger and frustration. Once he had a name for the feelings, he was able to express it verbally. Vineeta on the other hand, when she was involved in the Play Therapy sessions, learned to better understand his emotions and respond appropriately to his needs.
The drawing in the picture was drawn by the child demonstrating his pain at the divorce as is seen by the heavy clouds, scratched sun and the two rivers which run parallel to each other like tears from the eyes. A Play therapist uses numerous play materials such as this to make such interpretations and convey it to the child, equipping the child with the ability to choose his reactions appropriately. It aims to increase resilience and self esteem within each child. Making him confident to face the future and challenges in life.

Monday, July 26, 2010

MANAGE YOUR CHILD’S HYPERACTIVITY USING PLAY THERAPY

It’s normal for children to occasionally forget their homework, daydream during class, act without thinking, or get fidgety at the dinner table. But inattention, impulsivity, and hyperactivity are also signs of attention deficit disorder ADD. ADD/ADHD makes it difficult for people to inhibit their spontaneous responses—responses that can involve everything from movement to speech and attentiveness. Having ADD/ADHD (for the child) can be just as frustrating as dealing with someone who has it. Kids with ADD/ADHD want to sit quietly; they want to make their rooms tidy and organized; they want to do everything Mom says to do, but they don’t know how to make it happen. They do not intentionally want to annoy you. If you keep this in mind, it will be a lot easier to respond to you child in positive, supportive ways. Like all kids, children with attention deficit disorder (ADD ADHD) sometimes make bad choices regarding their own behaviour.
Rima was getting ready to go for a swim with Akshay, her 10 year old son. Saturday morning is a planned outing with him and some of his school friends and their mothers and a special time for Akshay, something that he looks forward to the entire week. Rima asked Akshay to finish his breakfast, take a bath and pack his swimming bag while she went on hurriedly going about doing her household chores. Expecting Akshay to have finished at least with his breakfast and bath in the past half an hour, Rima went to check whether he needed anything. She found him sitting on the dinning table with the breakfast untouched and watching his favourite cartoon show. What is his problem? Yes, he has ADHD, but how hard is it to do three simple things? He loves to go to for the swim with his friends. Why is it such a struggle to get him to listen? As Rima hurries Akshay around, she is thinking of what her husband would say if he were around. ‘You are spoiling him by not being stricter with him and doing his work for him. He pays attention when he is playing with his video game, but not when we ask him to do his chores.’ Rima thinks that Akshay’s failure to comply is due to a lack of motivation – if he wanted to do it, he could. But Rima isn’t so sure. She’s been consistent with discipline. Rima also knows that Akshay feels bad about himself when he doesn’t succeed at school or when she constantly fusses at him at home. She knows that he has begun to compare himself to his peers. He seems frustrated with his inability to accomplish simple things that seem effortless for his friends. She has heard him refer to himself as “dumb.” She can’t understand why Akshay doesn’t comply with the instructions he receives from adults, but she doesn’t think it’s a lack of motivation. She knows in her heart that he would comply if he could. Rima has recently attended a talk by the school counselor on Executive Functions of ADHD. Equipped with this information she tries to understand what actually must be Akshay’s mental process.
Executive functions are mental processes that give organization and order to our behavior, allowing us to direct our actions through time toward a goal. Let us take Rima’s working of a single evening as an example of executive function. The previous evening, Rima left office for the weekend. She was tired and would have loved to go straight home especially with the heavy down pour since late afternoon. But she recalls that she needs to fill in some grocery first for dinner (working memory) and heads for the super market. She decides to pick up the lap top adaptor on the way to the grocery store (strategic thinking) so that she can work over the weekend and does not have to make another round this side of the town for the adaptor. She thinks of how comfortable her Sunday morning will be if she could in between the cooking do her work and then relax the entire day (internalized language). She begins to feel more energized as she weaves herself through the evening traffic (regulating motivation). As she reaches the grocery shop after picking up the adaptor, she makes a list of things that she would require to buy for the dinner (initialization action). Just as she gets her pen out, her cell phone rings, she checks the display and sees it is a friend who was returning her call. She makes a mental note of calling her later after dinner (strategic thinking) and chooses not to respond to the call right now (interference control). While entering the grocery store she sees that there are some attractive schemes on the 15 litre oil cans but decides to check on it the next week (interference control) as she is running late (a sense of time). As she heads for the vegetable section, she takes a quick look at her wrist watch. She has time to stock in the fruits and makes a bee line for section (self-monitoring). She decides to check on Akshay as she waits in the billing queue (shifting between tasks) so that his work is done by the time she reaches home. In the night before retiring in front of the television, Rima remembers to make the call to her friend (working memory) and calls her.
Rima’s executive functions work smoothly and efficiently. Because this functioning occurs without her conscious awareness, she takes it for granted. But the development of these functions took place over time. Imagine Rima at the age of 10, would she be able to do all this planning simultaneously? She would probably be able to only concentrate on her chore of buying chocolate at the super market. It was a gradual process for her actions and sense of time to become internally directed. Researchers believe that this capacity for self-direction is neurologically based and concentrated in the pre-frontal region of the brain. Rima learns that current research regarding ADHD is moving away from an emphasis on impulsivity and inattentiveness and toward an emphasis on executive functions. Many experts in the field recommend that individuals with ADHD compensate by using tools that “externalize” the executive functions. is a natural form of integrating these skills and Play therapists are specially trained counselors who use play appropriately to help children regulate their behaviour. The school counselor suggested Play therapy for Akshay. In many children’s games –Froggie May I, Statues, Simon Says, Freeze, mountain and river, saakli–while fun, also provide an engaging external framework for children to practice behaviors that are central to executive functioning. The therapist lets both Akshay and Rima know that a large part of each session will be devoted to play, and that she will even give some home assignments that involve play. Rima relates the history of Akshay’s diagnosis and treatment over the past three years her own attempts to firm up discipline and provide extra structure and support in Akshay’s day to day life. Both Rima and Akshay are tearful as they describe their frustrations and guilt and an overwhelming sense that they are not good enough. The therapist comments that they might want to add to their treatment plan is for Akshay to become a working member of the “treatment team.” The following weekend Akshay has an assignment from his therapist. Chores are a sore point in their household. Rima has always been frustrated that she has to remind Akshay each and every step of the way. Akshay’s assignment is to use the time honored habit of making a list to supplement his working memory and free him from dependence on his mother’s reminders. To engage Akshay’s interest and sense of fun, the therapist has given this tool a playful spin. An hour later, chores done, Rima and Akshay are on their way to the swim. “That was fun,” Akshay says to his mother. “And I got all my chores done by myself! Let’s do that again next week.” Rima reflects that it doesn’t matter whether Akshay relies on his working memory or uses a list. The results are what she cares about. She is pleased that the chores got done but is even more pleased to see that Akshay himself is so pleased. She was right; Akshay is motivated to succeed. But she had been expecting him to succeed in ways that were not in line with his development. She has now seen that, with the right external support, Akshay can experience the success that he so much wants for himself.

Monday, July 12, 2010

CREATING AND INCLUSIVE ENVIRONMENT IN THE COMPANY

You are at a senior managerial post in an innovative technical company. By enlarge the company environment is that of commaradie and the competition is healthy. You had employed Rita at a managerial post few months ago. You value her talent and her input to the company is crucial. She is an amicable personality and excellent with her work. One day she steps into your office with a grim expression on her face and informs you that she has decided to look for a new job and would appreciate a reference from you. After briefly discussing with her you realize that she likes her work and she is leaving because she feels marginalized and isolated by the other office colleagues. You have been aware of socializing of office staff, mainly male staff, at a beer joint over the weekends for quite some time, and have encouraged it by going there yourself along with them occasionally as it seemed to increase their commaradie. You did not pay much attention to a few who seemed to avoid going there for example Ramesh who has two elder sisters who are to be married and an ailing mother. He chooses not to go for his family responsibilities. Harsh too who is a single parent does not visit the joint as he has to pick up his child from the day care, nor does Ritesh who does not drink. Rita too does not visit the joint as she is the only woman in the office.
Many a times office information is informally circulated amongst the staff members at this joint and it also seems to encourage mentoring of rookies. Govind who visits the joint regularly learnt of one such possible opening in the organization a few months prior to its announcement at the joint. He then strategically placed himself in such a manner that he would be the most eligible person fitting the profile for the position by the time it was announced. Rita who is technically sound would have been better suited for the post were she aware of the information before hand like Govind or if the information was released simultaneously to all.
Rita hit her limit when she found this out and feels left out of the crucial information which could have been a crucial promotional move upwards for her career. She believes this will be an ongoing phenomenon in the company politics as she is excluded from the group and therefore wants to move. You value her talents and skills and do not want to lose her. You now realize that those who are not in the beer joint clique feel isolated and left out although the clique does not intentionally sets themselves out to be exclusive. You also know that such cliques are a part of regular office politics but cannot deny that they provide few with benefits that give them a head start to many promotions. You wonder whether you have been complicit in this matter and how you could promote an atmosphere of inclusiveness or even how you could help Rita.
This incidence has opened your eyes to the following facts:
• These socializing outside of office colleagues having similar interests like sports, gym, hobby classes, bars, prayer places etc is natural and unavoidable. The inclusion of those based on the commonalities of gender or religion or lifestyle, although unintentional, provides them with opportunities to pass on crucial company information as a privilege of being a part of the ‘haves’ clique.
• The loyalty and intimacy amongst the ‘haves’ community which allows these special privileges is obvious to them. While they enjoy the benefits it also creates a self doubt and they are bound to worry about securing the same based on purely their merits and abilities, especially since they may not receive specific and honest feedback on their shortcomings.
• On the other hand, the ‘have nots’ are undeniably going to feel that such favoritism is unfair and will be demoralized. Tying opportunity and promotion to anything other than performance hurts the morale of the workers leading to poor performance, mistrust and reluctance to seek guidance when necessary.
• A leader who is aware of these dynamics but tolerates such inequalities is unlikely to be respected both by the haves and the have nots because at some level both the cliques know the practices are unfair. Given these facts t0 transform this atmosphere into an all inclusive environment is not possible.

The leaders could deal with such situation the following ways:
• Explicit information about the expectations and performance evaluations must be given to the staff. Feedback must be timely, specific and direct.
• You could introduce the inclusive policy while formulating project teams to promote collaboration and opportunities for staff from diverse backgrounds to interact and bond with each other in an mentorless environment.
• If the managers don’t have the skills to mentor people different from themselves, companies could provide training and coaching to the managers. Such training when done on a regular basis reflects company’s policies to be fair and caring.
• Special socializing work- based opportunities could be provided by the company for all. Many companies have now introduced sports based activities for the same.
• Leaders should be prepared to face resistance by the haves as they may perceive it as a loss of a status or privilege as they can be frightening and disorienting. This could lead to targeting the have-nots as scapegoat or sheer rage towards the have nots. Leaders have to be firm in setting limits and consequences of such behaviour.
• Rita’s situation is not irreversible but will require sensitive understanding and communication to her about many such past hurts and upsets. Talk to her about how things could be changed and what kind of a support would she like from the company to make her feel comfortable.
• Help her identify mentors and supportive co workers, encourage them to include her professionally both in office and outside the office.
• Insist and encourage Rita to include herself in social activities and accept invitations for the same although she may not enjoy it initially.
• Help her to gain insight that awareness of emotions could help her to make free and powerful decisions rather than limit her. Most wise decisions are not solely based on how a person feels rather takes both the emotions and thoughts into consideration. That she could still go ahead and socialize based on logical choices and decisions if she wants to move up the corporate ladder and that handling her own momentary uncomfortable feelings is not that difficult.
An inclusive and welcoming workplace will improve not only company morale but also the company's bottom line, too.

Monday, June 21, 2010

RAAVNA… Mystery of loving your captivator?

The last emotionally packed and paradoxical sequel of the film Raavana wherein Rajini, disillusioned and suspicions of her husband goes onto meet Veera, her captivator was quite baffling. Why would Rageeni need to confirm the truth with Veera, her abuser, whom she knew barely for 14 days as against her husband who loved her for so long? How will Rageeni deal with her conflicting emotions now if she decides to go back to her marriage? Although most of us who have seen the movie ‘understand’ Rageeni’s emotions; if we try and socially or logically analyze it, we will be at a dead end. While the situation doesn't make sense from a social standpoint, does it make sense from a psychological viewpoint? The answer is – Yes…its called the Stockholm Syndrome!

Stockholm syndrome is a psychological shift that occurs in captives when they are threatened gravely but are shown acts of kindness by their captors. Captives who exhibit the syndrome tend to sympathize with and think highly of their captors. When subjected to prolonged captivity, these captives can develop a strong bond with their captors, in some cases including a sexual interest. Psychiatrist Frank Ochberg, widely credited with Stockholm Syndrome's psychiatric definition, describes it as "a primitive gratitude for the gift of life," not unlike that felt by an infant.

Is Stockholm Syndrome limited only to dramatic situations like kidnapping and hostage? Surprisingly, it is more common than people realize it to be. We all know it under the name of “Domestic Violence”. People are often amazed at their own psychological conditions and reactions. Having worked with couples for a number of years I come across many such cases in my clinical practice. Some of the most surprised and shocked individuals are those who have been involved in controlling and abusive relationships. When the relationship ends, they offer comments such as "I know what he's done to me, but I still love him", "I don't know why, but I want him back", or "I know it sounds crazy, but I miss her". Recently I've heard "This doesn't make sense. He's got a new girlfriend and he's abusing her too…but I'm jealous!" Friends and relatives are even more amazed and shocked when they hear these comments or witness their loved one returning to an abusive relationship.

Stockholm Syndrome (SS) can also be found in family, romantic, and interpersonal relationships. The abuser may be a husband or wife, boyfriend or girlfriend, father or mother, or any other role in which the abuser is in a position of control or authority. In relationships with abusers, a birthday card, a gift (usually provided after a period of abuse), or a special treat are interpreted as not only positive, but evidence that the abuser is not "all bad" and may at some time correct his/her behavior. Abusers and controllers are often given positive credit for not abusing their partner, when the partner would have normally been subjected to verbal or physical abuse in a certain situation. An aggressive and jealous partner may normally become intimidating or abusive in certain social situations, as when an opposite-sex coworker waves in a crowd. After seeing the wave, the victim expects to be verbally battered and when it doesn't happen, that "small kindness" is interpreted as a positive sign.

As relatives or friends of a victim involved with a controller or abuser, our normal reaction is to consider dramatic action. We become angry, resentful, and aggressive at times. A rule of thumb is that any aggression toward the controller/abuser will result in additional difficulties for your loved one. Try to remain calm and await an opportunity to show your love and support when your loved one needs it. Remember you can not help the victim till the victim does not decide to help himself / herself.

Taking the abuser's perspective as a survival technique can become so intense that the victim actually develops anger toward those trying to help them. The abuser is already angry and resentful toward anyone who would provide the victim support, typically using multiple methods and manipulations to isolate the victim from others.

Any contact the victim has with supportive people in the community is met with accusations, threats, and/or violent outbursts. Victims then turn on their family – fearing family contact will cause additional violence and abuse in the home. At this point, victims curse their parents and friends, tell them not to call and stop interfering, and break off communication with others. Agreeing with the abuser/controller, supportive others are now viewed as "causing trouble" and must be avoided. Many victims threaten their family and friends with restraining orders if they continue to "interfere" or try to help the victim in their situation. On the surface it would appear that they have sided with the abuser/controller. In truth, they are trying to minimize contact situation that might make them a target of additional verbal abuse or intimidation. If a casual phone call from Mom prompts a two-hour temper outburst with threats and accusations – the victim quickly realizes it's safer if Mom stops calling. If simply telling Mom to stop calling doesn't work, for his or her own safety the victim may accuse Mom of attempting to ruin the relationship and demand that she stop calling.

In severe cases of Stockholm Syndrome in relationships, the victim may have difficulty leaving the abuser and may actually feel the abusive situation is their fault. Remember, the more you pressure the "victim" of the Loser/Abuser, the more you prove their point. Your loved one is being told the family is trying to ruin their wonderful relationship. Pressure in the form of contacts, comments, and communications will be used as evidence against you.

Your contacts with your loved one, no matter how routine and loving, may be met with anger and resentment. This is because each contact may prompt the Loser/Abuser to attack them verbally or emotionally. Try to maintain traditional and special contacts with your loved one - holidays, special occasions, etc. Keep your contacts short and brief, with no comments that can be used as evidence. Remember that there are many channels of communication. It's important that we keep a channel open if at all possible. Communication channels might include phone calls, letters, cards, and e-mail. Scheduled monthly shopping trips or outings are helpful if possible. The goal is to maintain contact while your loved one is involved in the controlling/abusive relationship. Remember, the goal is contact, not pressure.

Don't feel the victim's behavior is against the family or friends. It may be a form of survival or a way of lowering stress. Victims may be very resistive, angry, and even hostile due to the complexity of their relationship with the controller/abuser. They may even curse, threaten, and accuse loved ones and friends. This hostile defensiveness is actually self-protection in the relationship – an attempt to avoid "trouble".

The victim needs to know and feel they are not rejected because of their behavior. Keep in mind, they are painfully aware of their situation. They know they are being treated badly and/or controlled by their partner. Frequent reminders of this will only make them want less contact. We naturally avoid people who remind us of things or situations that are emotionally painful.

If the relationship has continued for over a year, they may require support and an exit plan before ending the relationship. Marriage and children further complicates their ability to leave the situation. When the victim decides to end the unhappy relationship, it's important that they view loved ones as supportive, loving, and understanding – not a source of pressure, guilt, or aggression. The victim and the family may also require some counseling to undo the hurt, anger and guilt.