Tagged Psychology and Psychologists

Pretty Girls Are Supposed to Smile

Jon Krause

“There is no one who has not smiled at least once,” writes Marianne LaFrance, a Yale University psychology professor, in her 2011 book “Lip Service: Smiles in Life, Death, Trust, Lies, Work, Memory, Sex and Politics.” Her book explores how smiling unifies us. Like breath, the smile is universal. We smile to connect, to forgive, to love. A smile is beauty, human.

But I have never smiled. Not once.

I was born with Moebius syndrome — a rare form of facial paralysis that results from damage in the womb to the sixth and seventh cranial nerves, which control the muscles of the face. I was born in Britain, on the same day in 1982 the country’s first test-tube twins were born. But while science has created medical miracles like test-tube babies, there’s little that doctors can do for someone with Moebius syndrome.

Decades later, I still cannot smile. Or frown. Or do any of the infinite subtle and not-so-subtle things with my face that I see others in the world around me doing every day.

Doctors describe people with Moebius as having a “mask-like expression.” And that is what strangers must see. A frozen face, eyes unblinking. My mouth always open, motionless, the left corner of my lips slightly lower than the right. Walking down the street, I can feel the touch of casual observers’ eyes.

A child’s very first “social smile” usually occurs six to eight weeks after birth, eagerly awaited by new parents. Because, as an infant, my face remained so expressionless, when I began laughing it took my mother a while to realize that the sound I was making was laughter. At what point, I wonder, did I begin to compensate for the absence of my smile.

I am constantly touching my own face, making it move with my hands. I like the sensation of my fingertips shifting my otherwise motionless lips. It’s something I’ve done since I was very young.

I remember, age 5, kneeling at my grandmother’s dressing table, while my grandmother, without my noticing her, watched from around the doorjamb. Very quietly, I leaned toward her mirror, my elbows pressing into the cool granite top and, with two fingers, lifted the corners of my mouth into a tiny smile — a smile I only dared to share with my reflection.

This was the beginning of my understanding that I was different.

Not until I was 16 did Granny tell me that she had been watching me that day, saying, “It broke my heart.”

Through childhood and adolescence, I continued secretly “smiling” at myself in the mirror. Seeing the appearance, however awkward, of a smile on my own face helped me feel better about the day-to-day missed connections with others — schoolmates, girls in my ballet class, or adults on queue in the supermarket — who perhaps wanted to see me smile back at them.

Not smiling is about much more than surface image, though. It takes real stamina. To swallow a mouthful of food, for example, I use a few delicately placed fingers to press my lips closed. After swallowing, I try to lower the helping hand so that it looks as though I am merely brushing a stray crumb from my mouth, hoping no one notices that I do this many, many times more than a normal person would.

Going to sleep is another challenge. Because I can’t voluntarily close my eyelids fully, I have to either hold my eyelids closed with my right forefinger and thumb until they stay shut, or lie on my back with a cotton tank top laid over my eyes in such a way that their lids are sealed. Sometimes this gets exhausting. Sometimes I shed tears, and that speeds up the process.

I try to act around my disability. To pass. The one missing gesture I can never fully compensate for, though, is smiling. My body feels the smiles my face has never shown. When I explain to new friends why I don’t — can’t — smile, they say, Wow, that must be really hard. Not really, I lie, by now I’m used to it.

Still, there are moments when I feel the smile my face cannot physically make. It might be while I’m laughing over a shared joke with a friend, or when a child passing on the street smiles up at me. It translates as instantaneous pleasure throughout my whole body — a kind of minute awakening, both within and without. For a long time I wondered whether it showed. But close friends tell me my smile does come through, that they can see my smile.

Yet, recently, an elderly man passing me at a bus stop looked me up and down, caught my eye, and said, “Pretty girls are supposed to smile.”

I was speechless. I shook my head and laughed uncomfortably, hoping he wouldn’t pursue the subject. As he walked away, I remembered a high school photographer cheerily calling “Smile!” just before the blinding white flash. “Smile,” someone says, and again I’m 5 in the mirror, or 16, cringing, trying to do something I cannot do, and waiting for the uncomfortable moment to pass.

Effy Redman, a graduate of Hunter College’s creative writing M.F.A. program, lives in Saratoga Springs, N.Y.

Dementia Patients Hold On to Love Through Shared Stories

Paul Rogers

Can you keep the love light shining after your partner’s brain has begun to dim? Just ask Denise Tompkins of Naperville, Ill., married 36 years to John, now 69, who has Alzheimer’s disease.

The Tompkinses participated in an unusual eight-week storytelling workshop at Northwestern University that is helping to keep the spark of love alive in couples coping with the challenges of encroaching dementia.

Every week participants are given a specific assignment to write a brief story about events in their lives that they then share with others in the group. The program culminates with a moving, often funny, 20-minute written story read alternately by the partners in each couple in front of an audience.

Each couple’s story serves as a reminder of both the good and challenging times they have shared, experiences both poignant and humorous that reveal inner strength, resilience and love and appreciation for one another that can be easily forgotten when confronted by a frightening, progressive neurological disease like Alzheimer’s.

“It’s been an amazing experience for us,” Mrs. Tompkins said of the program. “Creating our story revealed such a richness in our life together and is helping us keep that front and center going forward.”

She added that the program provides “an opportunity to process what you’re going through and your relationship to each other. It helped me digest all the wonderful things about John and how well we relate as a couple, things that don’t go away with Alzheimer’s disease. John is so much more than his disease.”

Ditto for Robyn and Ben Ferguson of Chicago, married 42 years in 2012 when they learned that Ben, a psychologist, had Alzheimer’s disease. “The diagnosis was crushing,” said his wife, who is also a psychologist. “Telling people in the program about it helped us recognize the impact on our lives and relationship and really face that. It made things feel not quite so bad.”

The Fergusons have publicly presented their 20-minute story together 19 times so far, helping to enlighten medical students and those training in social work and pastoral care, as well as researchers and members of the general public. “It reinforces our relationship as a couple, rather than caregiver and patient, even though he is 85 percent dependent on me for the activities of daily living.”

Dr. Ben Ferguson, now 69, said, “I feel we’re giving people information that could be very valuable in their future. It’s helpful to them to see us smile, have a good time and give a good report – as well as a bad report – about what goes on with this disease. It’s helpful for people to hear it from someone who has it, and it’s helped us avoid getting so morose.”

As for their presentations, which they now give almost monthly, his wife said, “They help us stay positive and give us a sense of purpose. We both feel a real need to do advocacy work, and this is the best thing we can do right now. We know there’s a sell-by date on this – we won’t be able to do it forever. But we don’t think about that now. Now we’re focused on helping people understand that your life doesn’t stop with the diagnosis. We want people to hear that you go on with your life, even though you may need a lot of help.”

Another workshop participant, Sheila Nicholes, 76, of Chicago, said of her husband, Luther, who has vascular dementia, that the storytelling “brings him back to being funny again. Writing our story together gave us a way to talk about these things, to think about where we were then and where we are now.”

Noting that dementia is “a very hush-hush illness in our black community,” Ms. Nicholes said she hoped that telling their story would help others speak more openly about it and learn to “just roll with the flow.”

The storytelling workshop, which started in January of 2014, was the brainchild of Lauren Dowden, then an intern in social work at Northwestern’s Cognitive, Neurological and Alzheimer’s Disease Center. She quickly learned from family members in a support group that “their concerns were not being addressed about dealing with loss, not just of memory, jobs and independence, but also what they shared as a couple.”

During the group sessions, Ms. Dowden said, “there’s so much laughter in the room, so much joy and love of life as well as poignancy and tears. As they move forward, as the disease progresses, they can be reminded of who they are, their strength and resilience, what has made their relationship strong, what they loved about the person, as opposed to just being patient and caregiver.”

As the program moves week to week, Ms. Dowden said, “there’s more touching, affection, looking at one another and laughing. There are delightful moments of connection when one member of a couple reveals something the other didn’t know.”

The weekly story assignments require that the couple collaborates, “and they learn how to work together in new ways, how to make adjustments, because they’ll have to make thousands and thousands of adjustments throughout the course of the disease.”

In executing the workshop assignments, Dr. Ferguson said she would ask her husband questions, he would answer and she would write down what he said. “The workshop was really transformative,” she said. “It gave us hope for our future together in dealing with this disease.”

Ms. Dowden said the feedback from those in the audience for the 20-minute joint stories has been heartening. She explained, “Students learn about the biology of neurodegenerative conditions. These stories enable them to see the human side of the disease, what it’s like to live with it, and may help them develop programs that help these families live better. In addition to the stigma, there’s a tendency to write off people with dementia.”

Ms. Dowden said she is currently refining the workshop curriculum so that it can be used as a model for other institutions to replicate. She is also expanding it to include mother-daughter and sibling pairs.

She realizes, of course, that a storytelling workshop may not be suitable for every couple. “It’s not good if there’s a lot of behavioral issues, a lot of conflict, and no insight,” she said. “But for those it does fit, it’s an opportunity to tap into the core of relationships, to still grow and learn and be delighted by one another.”

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With Coercive Control, the Abuse Is Psychological

Maggie Chiang

Lisa Fontes’s ex-boyfriend never punched her, or pulled her hair. But he hacked into her computer, and installed a spy cam in her bedroom, and subtly distanced her from her friends and family.

Still, she didn’t think she was a victim of domestic abuse. “I had no way to understand this relationship except it was a bad relationship,” said Dr. Fontes, 54, who teaches adult education at the University of Massachusetts, Amherst.

It was only after doing research on emotional abuse that she discovered a name for what she experienced: Coercive control, a pattern of behavior that some people — usually but not always men — employ to dominate their partners. Coercive control describes an ongoing and multipronged strategy, with tactics that include manipulation, humiliation, isolation, financial abuse, stalking, gaslighting and sometimes physical or sexual abuse.

“The number of abusive behaviors don’t matter so much as the degree,” said Dr. Fontes, the author of “Invisible Chains: Overcoming Coercive Control in Your Intimate Relationship.” “One woman told me her husband didn’t want her to sleep on her back. She had to pack the shopping cart a certain way, wear her clothes a certain way, wash herself in the shower in a certain order.”

While the term “coercive control” isn’t widely known in the United States, the concept of nonphysical forms of mistreatment as a kind of domestic abuse is gaining recognition. In May, the hashtag #MaybeHeDoesntHitYou took off on Twitter, with users sharing their own stories.

Last December, England and Wales expanded the definition of domestic abuse to include “coercive and controlling behavior in an intimate or family relationship,” making it a criminal offense carrying a maximum sentence of five years. To date, at least four men have been sentenced under the new law.

“In this approach, many acts that had been treated as low-level misdemeanors or not treated as offenses at all are considered as part of a single course of serious criminal conduct,” said Evan Stark, a forensic social worker and professor emeritus at Rutgers University, whose work helped shaped the new law in England and Wales.

Dr. Stark, the author of “Coercive Control,” noted that the English law pertains to a course of conduct over time. American law still does not address coercive control; it deals only with episodes of assault, and mainly protects women who have been subjected to physical attacks. But in about 20 percent of domestic violence cases there is no bodily harm, he said.

Coercive control often escalates to spousal physical violence, as a 2010 study in The Journal of Interpersonal Violence found. “Control is really the issue,” said Connie Beck, a co-author of the study and an associate professor of psychology at the University of Arizona. “If you can control a person’s basic liberties verbally — where they go, who they see, what they do — you do not necessarily have to hit them regularly, but if a person is not complying, then often physical abuse escalates.”

To a victim of coercive control, a threat might be misinterpreted as love, especially in the early stages of a relationship, or when one is feeling especially vulnerable.

Dr. Fontes, for example, was in her 40s and newly divorced when she met her ex-boyfriend. He was charming and adoring, and though he was a little obsessive, she overlooked it. Never mind that she has a Ph.D. in counseling psychology, and specializes in child abuse and violence against women.

“For a person looking for love and romance, it can feel wonderful that someone wants to monopolize your time,” she admitted.

For Rachel G., 46, a mother of three who lives outside Boston (she didn’t want her full name used to protect her privacy), the manipulation was all-consuming. Her ex-husband made them share a toothbrush, and wouldn’t let her shut the bathroom door — ever. He set up cameras around the house, and fastened a GPS in her car to track her movements. Sometimes he would show up at her work unannounced, “always framed as him needing to know where I was in case the kids needed me, or because he missed me and wanted to see me, but it was just his way of regulating my behavior.”

She was miserable, but stuck it out for 18 years. It never occurred to her to leave: She had three children, and “he had convinced me that I would be unhappy anywhere,” said Ms. G., who does fund-raising for a nonprofit. “I wasn’t only a bad wife — in every respect — but I was a negligent mother, or an overbearing mother, I was unsupportive of him, I was a bad cook, I prioritized work over family, my family liked him better than me, our friends liked him better than me. The worse I felt about myself and doubted myself and internalized his view of me and the way the world should work, the more submissive and accommodating I became.”

In the end, it was he, not she, who filed for divorce, after catching her in an extramarital affair. She is not proud of her actions, but she is grateful it got her out of the relationship. “I would never have left if he hadn’t filed,” she said. “I was afraid.” Since then, she has been trying to re-establish connections with family members and friends.

Dr. Fontes ultimately left her partner after four years. The decision came after she spent two weeks away from him, and realized how diminished she had become. “There were repeated telephone calls and emails every day, but it was such a relief to wake up and go to sleep without having to check in with this other person,” she said. “I recovered a sense of who I was as a separated person, my own opinions, my own perspective.”

When It’s Not Just a Boo-Boo: The Push to Treat Children’s Pain

Sally Deng

It began with a roller-skating accident three years ago. Taylor Aschenbrenner, then 8 years old, lost her balance amid a jumble of classmates, tumbled to the floor and felt someone else’s skate roll over her left foot. The searing pain hit her immediately.

The diagnosis, however, would take much longer. An X-ray, M.R.I.s, a CT scan and blood tests over several months revealed no evidence of a break, sprain or other significant problem. Taylor’s primary symptom was pain — so severe that she could not put weight on the foot.

“Our family doctor first told us to give it some time,” said Taylor’s mother, Jodi Aschenbrenner, of Hudson, Wis.

But time didn’t heal the pain. After about a month, an orthopedist recommended physical therapy. That didn’t end the problem, either. “I couldn’t walk or play outside or do anything,” Taylor said.

After she had spent a year and a half on crutches, her orthopedist suggested she see Stefan Friedrichsdorf, the medical director of pain medicine, palliative care and integrative medicine at Children’s Hospitals and Clinics of Minnesota. He and his team promptly recognized Taylor’s condition as complex regional pain syndrome, a misfiring within the peripheral and central nervous systems that causes pain signals to go into overdrive and stay turned on even after an initial injury or trauma has healed.

He came up with a treatment plan for Taylor that included cognitive behavioral therapy, physical therapy, mind-body techniques, stress-reduction strategies, topical pain-relief patches and a focus on returning to her normal life and sleep routine.

“That turned things around so fast, if I didn’t see it myself, I wouldn’t have believed it,” Mrs. Aschenbrenner said. “I thought, ‘finally, someone understands what this is, has experience with it, and knows how to fix it!’”

But why did it take so long for a child in unbearable pain to find relief? Experts say children’s pain is, for the most part, grossly underrecognized and undertreated.

“Unfortunately, in 2016 pain management in the United States and all Western countries is still abysmal,” said Dr. Friedrichsdorf, who noted that pediatric pain receives the least attention. “Data shows that adults with the same underlying condition will get two to three times as many pain medication doses as children.”

There are effective treatments. But pediatricians, specialists and even parents have been slow to turn to them because pain in children has long been misunderstood and medical training in pain management is scant. Veterinary schools require “at least five times more education on how to handle pain” than medical schools, Nora D. Volkow, the director of the National Institute on Drug Abuse, said..

As recently as the 1980s, babies would routinely undergo invasive medical procedures, including open-heart surgery, without anesthesia or analgesics because physicians believed that infants’ brains were not developed enough to feel the pain. And it was thought that even if babies did feel pain, it wouldn’t ultimately matter because they wouldn’t remember it later on.

The emphasis in Western medicine has traditionally been on “saving lives and executing medical procedures effectively, while pain has been pushed way down on the priority list,” said Christine Chambers, a professor of pediatrics, psychology, neuroscience and pain management at Dalhousie University in Halifax, Nova Scotia.

Many doctors and parents also fear that pain medications will have dangerous side effects, like developmental problems and addiction. But current scientific evidence supports a different conclusion.

“Research shows that poorly managed pain exposures early in life can actually change the wiring in the brain and prime children to be more sensitive to it later on, putting them at risk for developing chronic pain in childhood and adulthood,” said Anna C. Wilson, a child psychologist and assistant professor of anesthesiology at the Pediatric Pain Management Center at Oregon Health & Science University. And while babies or young children may not consciously remember it, their nervous systems will.

There is, however, reason for optimism. Contrary to previous conventional thinking, the effective use of pain medication for children does not hinder brain development, according to several studies.

Research has also shown that the appropriate medical use of prescription pain medications, such as opioids, when properly monitored, does not lead to addiction in young children and adolescents, Dr. Friedrichsdorf said.

A host of other behavioral interventions have been shown to prevent and treat pain as well. Pain experts say these can and should be used even during seemingly minor medical procedures, such as vaccinations. Parents can hold their children during the procedure, breast-feed or give them a sweet solution to suck on, distract them with a song or breathing exercises, and use a topical numbing cream.

One recent study also found that a parent’s behavior and approach to their children’s vaccinations can affect a child’s response to needles.

“That vaccination at age 5 might not seem like a big deal to you, but if it goes wrong and causes a lot of pain, then the child becomes fearful,” Dr. Chambers said, which can perpetuate a cycle of fear and pain over medical care.

“One of the best ways to address the epidemic of chronic pain in this country is to stop it before it starts,” Dr. Wilson at Oregon Health & Science University said.

“If we could reduce painful experiences and problems in childhood, we might be able to reduce chronic pain in the next generation.”

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The Teenager With One Foot Out the Door

Getty Images

High school graduation can give way to an uneasy season in the raising of a teenager. In place of a summer of family togetherness, parents often feel out of step with adolescents who are preparing to leave home. Though there are certainly joys that come with having a young adult around the house, they can’t cancel out the parting tensions that many families face.

Parents sometimes warn one another about teenagers who feel compelled to soil the nest before flying off to college or other adventures. Home life can become so unpleasant that those who once dreaded their graduate’s departure can’t wait to pack his or her bags. There’s a hidden function to this friction: It’s easier to part from people whose company we can hardly stand.

But subtler dynamics can also be at work. Firm plans for moving out may heighten a teenager’s tendency, which the psychoanalyst Anna Freud observed in 1958, to live “in the home in the attitude of a boarder.” With one foot out the door, a teenager may treat his parents like meddlesome landlords if they should ask what time he will be coming home, or suggest that he drive younger siblings to soccer. And just when new grads are resisting rules and expectations that held sway only a few weeks ago, their folks are often itching to offer some last-minute guidance.

Parents who want to discuss sexual ethics, finances, the hazards of heavy drinking or even the importance of getting enough sleep rarely find an eager audience in teenagers who have already decamped psychologically. These moments may be easier to navigate if we consider why adolescents act like tenants in the first place. It’s a huge developmental step to leave home, a step that teenagers don’t take all at once. Tweens usually begin the slow process of departing by closing their bedroom doors to do the exact same things they used to do with their doors wide open. In their last weeks around the house, adolescents travel the final stretch of this path. They practice living on their own while still enjoying, if they’re lucky, the safety and support of a loving home.

We shouldn’t give up on talking with teenagers about how they will care for themselves and treat others once they move out. But we should set aside the expectation of lengthy heart-to-heart talks. When teenagers are broadcasting their detachment, the most successful conversations may be the ones that begin, “It might seem like we’ve already covered this, but there are just a few things I want to touch base about before you go. I promise to keep it short.”

When soon-to-depart teenagers aren’t rubbing family members the wrong way or holed up in their rooms, they’re often nowhere to be found. Feeling confident in their ties to their parents, adolescents cling to their friends. Or they immerse themselves in efforts to resolve a meaningful high school romance. My years of working with teenagers have taught me that a surprising number of recent grads find themselves in pop-up entanglements that bloom, out of nowhere, in late summer.

Parents who are trying to cherish a teenager’s last days under their roof may be reluctant to split time with high school friends or a serious romantic partner, much less with a passing fling. But adults don’t need to take a teenager’s consuming social life as a personal rejection. The intense focus on peer relationships is often connected to the psychological strain of parting with family. A teenager who preoccupies himself with saying goodbye to his friends often manages to distract himself from difficult feelings about leaving his family. Agonizing about the future of an obviously doomed 11th-hour relationship beats tuning in to the full sadness of moving away from a beloved sibling.

It’s no picnic to send a teenager into the world. Most parents feel both wistful about the past and anxious (and perhaps even a bit envious) about their adolescent’s future. Must we add feeling at odds with or ignored by our teenagers to this emotional stew? Perhaps we could simply discuss these common post-grad dynamics with our adolescents, then go on to enjoy our last summer together.

We could. But we probably shouldn’t.

With their parting maneuvers, young people are subconsciously tempering the emotionally intense, landmark moment of leaving home. In moving out, teenagers give up almost everything they have ever known, with little grasp of what they are getting. It’s no surprise that they rely on adaptive, if sometimes off-putting, psychological defenses to buffer such a stressful transition.

As for the adults, there may be some comfort in knowing that high school graduation isn’t the end of parenting. It simply marks the next phase of it: the one where we bear with our teenagers as they find their way to the door.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.

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Worried? You’re Not Alone

Oliver Munday

I’m a worrier. Deadlines, my children, all the time they spend online — you name it, it’s on my list of worries. I even worry when I’m not worried. What am I forgetting to worry about?

Turns out I’m not alone. Two out of five Americans say they worry every day, according to a new white paper released by Liberty Mutual Insurance. Among the findings in the “Worry Less Report”: Millennials worry about money. Single people worry about housing (and money). Women generally worry more than men do and often about interpersonal relationships. The good news: Everyone worries less as they get older.

“People have a love-hate relationship with worry,” said Michelle Newman, a professor of psychology and psychiatry at Pennsylvania State University, who was not involved in the writing of the report. “They think at some level that it helps them.”

The belief that worrying somehow helps to prevent bad things from happening is more common than you might think. Researchers say the notion is reinforced by the fact that we tend to worry about rare events, like plane crashes, and are reassured when they don’t happen, but we worry less about common events, like car accidents.

But that doesn’t mean all worrying is futile. “Some worry is actually good for you,” said Simon A. Rego, the author of the new report and a cognitive behavioral psychologist who specializes in anxiety disorders and analyzed decades of research on worrying for the paper. “It’s what we call productive or instructive worry, that can help us take steps to solve a problem.”

One study published in 2002 recruited 57 young adults and asked them to list their worries in a diary for seven days and rate each worrying episode.

When the researchers analyzed the results, they determined that about 20 percent of the worries were about anticipating a negative outcome in the future. But nearly half of all the documented worries reflected a process of problem solving. While that can be constructive, people who worried a lot and couldn’t control their worrying were less likely to find a solution to their problem. The researchers, Marianna Szabo, now at the University of Sydney, and Peter F. Lovibond of University of New South Wales in Australia, concluded that failing to come up with solutions may actually lead to more pathological worrying.

In 2007, the same researchers tried to correlate aspects of worrying with specific components of problem-solving, like defining the problem, gathering information, generating solutions, evaluating and choosing a solution. Once again, they concluded about half the cognitive content of the worry episodes included attempts to solve a problem. Once people devise a solution, they quit worrying one-third of the time. But people found it hard to stop worrying if they weren’t satisfied with the solution they came up with.

People “get caught up in the worry itself,” Dr. Newman said. “It becomes so habitual, I call it ‘a process looking for content.’”

That kind of worrying can get out of hand. “Excessive worriers have multiple domains that they worry about, and if something triggers a worry in one domain, it can seep into other areas,” Dr. Rego said, “and things can move back and forth like wildfires — once one gets going, it can start other fires as well.”

Worrying, a cognitive process, should not be confused with anxiety, which generally refers to an emotional state of unease that also includes worry. While 38 percent of people worry every day, most of them do not have anxiety. Generalized anxiety disorder, the primary feature of which is excessive and uncontrollable worrying, affects only 2 to 5 percent of the population.

Liberty Mutual Insurance officials commissioned the report to better understand how Americans can “break the worry cycle,” since the insurance business is designed “around helping people live with less worry,” said Margaret Dillon, the company’s executive vice president and chief customer officer for the United States, adding that it could also help them develop the most appropriate products. The report noted, for example, that top worries for people ages 25 to 44 are about finances and housing, she said.

If you’re worried about your worrying, the report suggests some coping strategies, including:

Divide and conquer Try to come up with a solution to a worrisome problem by breaking it down into four parts: defining the problem, clarifying your goals, generating solutions and experimenting with solutions. Grab a pen and paper and brainstorm, the report suggests.Studies have shown this approach can help ease depression and anxiety.

Practice mindfulness Choose a routine activity or part of the day and try to experience it fully. Set aside concerns, and try to be “in the moment.”

Schedule a worry session Pick a designated time of day to mull your problems. If a worrying thought enters your mind outside of your scheduled worry session, jot it down so you can think about it during your scheduled worry time. Then get back to your day.

Practice accepting uncertainty Notice your thoughts and label them (as in “there is the thought that I can’t manage”). Let go of tension in your body; soften your forehead, drop your shoulders and relax your grip.

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When Parents Have a Favorite Child

Dr. Perri Klass

Dr. Perri Klass Vivienne Flesher

To my own mother, it was an article of faith to show no favoritism. If two of us asked her whose drawing she liked best, the answer was predetermined: I like them just the same. When I tried to trick my mother by saying I had done both drawings myself, she saw right through me; she understood that children are constantly trying to elicit evidence of who is ahead and who is behind. And to the end of her life, if someone tried to draw my mother out in public praise, by saying, with reference to some particular milestone or achievement, oh, you must be so proud of your child, she would respond, firmly, yes, I’m proud of all my children.

Her parents, back in the 1930s, had no concerns about treating children equally; the boy was the boy was the boy; the girls were the smart one and the pretty one.

Dr. Barbara Howard, a developmental behavioral pediatrician who is the president of Total Child Health and an assistant professor of pediatrics at Johns Hopkins University School of Medicine, often sees behavioral problems that stem from a child’s sense of not being the preferred one. “It’s impossible not to have favorites, and we do know that the perception of favoritism is one of the biggest factors in sibling rivalry,” she said.

“Often the child is trying to get the attention of the parent who is rejecting them — the more you push a kid away, the more he will come at you,” she said. “So if you see a kid coming at a parent, being aggressive or being clingy or needy or overly attention-seeking, often the parent doesn’t like the kid that much, or the kid perceives it.” She may ask the parent what that child’s behavior evokes; which other family member does it make you think of; what possible future does it make you imagine? Often, she says, the parent is aware of feeling strained toward that child, and feels terribly guilty about it; finding ways to enjoy spending time together can help them both.

Years ago I read a novel — someone please tell me what it was — in which a mother secretly and privately assured each of her children, don’t tell the others, but you have always been my favorite. I liked that system, and, as a mother, I think I could do it with perfect sincerity — one on one with each of my three children, I think I could say it and it would be true.

Ellen Weber Libby, a clinical psychologist and author of “The Favorite Child,” said some families have a shifting favoritism, where different children hold the advantage from day to day or week to week. That kind of rotation, she said, yields a healthy, normal competitiveness. Ask the children, she says, and they will tell you. “The people who don’t know are usually the parents, who live in denial because there’s a myth that to have a favorite child is bad.”

The danger comes when the favoritism is steady and persistent and becomes a lasting part of the family dynamic.

Evolutionary psychologists think of parental investment in their offspring as the division of a finite pool of resources, rather than, perhaps, an infinity of love. “I would argue that parents do sometimes have favorites and do invest unequally,” said Catherine Salmon, an associate professor of psychology at the University of Redlands in California, who studies relationships and is a co-author of “The Secret Power of Middle Children.” Birth order can matter here, she said, with middle children perhaps less likely to be favorites, compared with first children, who monopolize their parents, for that first period, and last children, who represent a final chance to invest.

Dr. Salmon pointed out that the effects of parental favoritism may be much sharper in families where there isn’t enough to go around in the first place, so the inequities may be particularly harsh. On the other hand, Dr. Libby said, in a prosperous family, the favorite child may grow up entitled, immune from the rules that apply to the other children.

“I think you can let people off the hook from feeling guilty about having a favorite — put it right out there and say of course you have a favorite, people have favorites, it’s what you do with it that matters,” said Dr. Howard. “You’ve got to find something you appreciate about each kid and build on that.” With children whose behavior is problematic, she may suggest developing new rituals, like an early-morning cuddle before the day gets going.

“Parents don’t appreciate the difference between love and favoritism,” said Dr. Libby. “I think it’s hard for parents to say, I love my children the same and from time to time there is a child I do favor. I favor a child because at that moment that child makes me feel more successful as a parent.”

So yes, there may be real inequities — but what may matter more is the perception of favoritism, and what everyone involved does with it, both in terms of behavior, and in terms of memory and emotion. We all carry with us into adulthood a sense of where we stood, how we were perceived and how we were treated.

On a good day, the idea of the favorite child can be a bit of a running joke, which serves as a reminder to parents to play fair, and as a reminder to children that while love is infinite, parental approval and esteem need to be earned, and are worth competing for, within reason.

When Dr. Libby had to put together her first PowerPoint presentation, she said, she found herself feeling overwhelmed. She texted her children: “Whoever gets back to me first is my favorite child for today.”

“Within a nanosecond my daughter, who never has time to call me, was on the phone, and my son said, damn, when your phone was busy I knew my sister was on it!”

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