How to cope with a teenager? What do teenagers lie or are quiet about? Should we take offense when they do?

How to cope with a teenager? What do teenagers lie or are quiet about? Should we take offense when they do?

The integral interview with dr Aleksandra Bubera by the journalist Lidija Janković, part of which was published on the portal B92.net on 03.10.2018.

When and what do teenagers not tell their parents about? How dangerous is it when they try to solve the problems they are not up to by themselves? These are some of a number of questions posed when they are at this tender age and quite often parents are not sure how to react. Experts say they need to understand them and talk with them a lot, and if they catch them lying, they should work together to decide what should be the consequences of what has been done.

While growing up our children encounter the first challenges in life, first disappointments, successes and failures, and first infatuations. To what extent should parents be “involved”, or rather, should they insist on the children keeping them updated and how should they react when they realize that their children are keeping quiet about certain things?

Whether our child will confide in us or not is usually determined much before the child becomes a teenager and it depends on the situation in the family, on the family’s function mode and on its cause and effect principles. Children will keep quiet when they believe that they have done something wrong enough to be severely punished or told off, when they are afraid the parents will insult and humiliate them, or give them a beating, when they are afraid the parents will only make solving the problem more difficult, when they are so ashamed of what they have done that they believe the parents will reject them, but also if they have already learned that they can easily manipulate their parents and that it is the best way to go unpunished for what they have done, and which they are aware is inadequate. That is why it is very important to create an atmosphere much earlier where a child can tell his or her parents everything and where nothing is so bad as a child feeling alone when faced with a problem that he or she cannot solve by him or herself. If this has not been accomplished earlier, it is important that the parents start mending the relationship with the children by listening to them and understanding them, by having control over their own reactions, and also by being reasonable and offering constructive criticism when it is needed, in a way that will help the child learn from the mistakes made, instead of feeling ashamed, humiliated, etc.

We are very often surprised to see how quickly our children have grown, or when we hear from them about the things we do not expect to have happened (e.g. their first kiss), so how are we supposed to react? Should we hide our surprise, or show concern about the things happening so fast to them?

If we follow our children closely, similar events will not be surprising to us, as we will be aware what is going on in their lives, who they socialize with, how they spend time, what the current issues in the society are, what other children do, etc., so we will have some idea about what can take place and when. However, if something catches us by surprise, it is no use hiding it, because the children will notice, even if we are good at it, they will know we are surprised. It is also important not to do the opposite and make such a song and dance of it. We should acknowledge our surprise and explain why we feel so, then take some time to digest, take a deep breath, count to… to as much as we need to, and then talk to them calmly and rationally about the event and try to understand what happened and what has brought about the feeling that it is “too soon” for us and “right on time” for the child. Then we should talk and see how to deal with it. Some children need instruction and information, as parents consciously or unconsciously avoid certain topics. Other children need understanding and support in order to understand themselves and their own actions; some are aware of the boundaries. It varies from case to case.

For example, if a teenager is a smoker and the parent finds out, the child promises to quit, but carries on anyway… What should the parent do? How to deal with this kind of situation? What is a bigger cause for concern – smoking or lying?

I cannot say whether parents should be more worried about one or the other, but, the thing is that more urgent is the fact the child is lying to you. Smoking is certainly harmful, but right now lying will cause more significant consequences. That is why you should deal with it first. Does the child tell lies out of fear of the consequences, or because he or she has learned it is the easiest way of avoiding them? In the first case, it is crucial for the parent to amend his or her relationship with the child and for the child to realize that he or she is the most important to the parent and that the parent will do everything possible to understand what is going on and why, and to set the things straight, which includes the child’s understanding that his or her life and health are more important than fitting in the peer group. In the other case, it is important that the child understands that the consequences of lying are usually harder than the ones of telling the truth and that with all the “wheeling and dealing” they are actually doing disservice to themselves and that in the end what they are “getting away with” now will “cost” them a lot more in the long run – whether it is smoking, or anything else.

How far can we go being friends with teenagers, and how much of an authority should we be to them?

Friendship between parents and children is not functional while children are teenagers. This form of relationship is functional when children grow up, become independent and gain integrity, while parents are still in good shape and do not depend on their children. As long as children depend on their parents, parents should pose as authority to them. Which is different from being authoritarian, despotic, etc. Parents’ authority should be fair, emphatic and have clearly limitations.

Our child comes home from a party and we notice that he or she has consumed alcohol. Would banning them from going to parties be a solution?

The thing to do is to inquire about the whole incident and then discuss the situation with the child: what are the rules in the family, what has been agreed on, what are the direct consequences, and what are the further consequences of such conduct. The consequences of such behavior are to be agreed upon together, too. Sometimes it will be a temporary ban on going out, and sometimes something else, which depends on the nature of the transgression and the damage to the child and to the relationship of trust with the parents. The consequence should fit these things. And again, parents are supposed to be fair and emphatic and responsible for having clearly set limitations for this kind of situation too.

What would be the most important advice on dealing with teenagers, what should, and what should we not do with them?

Teenagers are individuals who are no longer children, but are not adults either. They know some things much better then we do – for instance, when it comes to the new technologies they were born into and grew up with. But at the same time, they do not know many things which are to be learned through life experience. We need to be aware of these facts and not to assume the stance of knowing everything better. There are things we do know better, but many parents are confused and terrified by how their children feel in the modern world and how things and relationships function. And it does not help to further frighten children. It is crucial that we avoid the situation where the child is being stubborn, because they will do the opposite of what we tell them to do, even if it is not what they want and they know it is not good for them, only in order to stand up to us, because they believe that we are not fair. That is why it is important that parents hold some authority, but at the same time be protective, informative, leading, understanding, compassionate and set the limits and cooperate with the child from that position.

We could in some respects compare it to running a company – if the management wish the company to be fully functional, they have to cooperate with the employees, have to listen to them and negotiate to a certain extent, and know when to listen to themselves and when to listen to the advice come from the “grass roots”. They cannot function one without the other.

“Psihopolis” published a very good book by Nigel Latta on this topic – Tinejdžeri (kako im postaviti granice i pri tom sačuvati živce) which has originally been published by HarperCollins as The Politically Incorrect Guide to Teenagers: before your teenagers drive you crazy (2010). Part of the interview is available on the site B92.net.


Aleksandra Bubera on the Déjà Vu Phenomenon

Aleksandra Bubera on the Déjà Vu Phenomenon

The complete interview with the journalist Marina Jungić, part of which was published in the “Život plus” („Life plus“) section of „Večernje novosti“ („Evening news“ newspaper) (22 April 2018)

Many people claim they have at least once in their lifetime had this feeling that they have already seen or gone through something. What is behind this phenomenon of déjà vu and what causes it to appear? There are numerous theories about what causes it, ranging from the emotions surpressed in the distant past and genetic memory to reincarnation and all sorts of disfunctions. What is true here and what is not?

One of the researchers who have looked into this and wrote a book entitled The Déjà Vu Experience, Alan S. Brown, offers thirty different explanaitions of the phenomenon (and none of them mention reincarnation or genetic memory).

The déjà vu phenomenon is experienced by people without any neuropsychiatric disfunctions or psychological problems, that is, by perfectly healthy individuals and it is a rather common in human experience. In neurology it is known that some forms of epilepsy (the so-called temporal lobe epilepsy with partial seizures) are characterized by these experiences.

In medicine there have been cases of déjà vu being linked to the presence of anxiety-related disorders such as certain phobias or obsessive-compulsive disorder, depersonilazition disorder or some other similar disorders related to anxiety, such as dissociative or even psychotic disorder. (Dissociative symptoms include the feeling of the detachment of oneself and experiencing oneself, the dissociation of body movements and consciousness, or any other kind of detachment of things normally occuring together.)

The theories explaining the causes of this phenomenon are based on various studies. Some of them use observation and description of the feelings in people who frequently experience the phenomenon, while some of them examine it in a laboratory, where the phenomenon, or a state very similar to it, is artificially induced.

Thorough research has produced a theory of “divided attention” – like the situation when we are doing two things at the same time, so we can’t pay attention to both; for example, when the phone rings while we’re going to another room to get something. By the time we reach the other room, we can’t remember what it is we are looking for because our attention has been drawn in the other direction, so the phone call appears to be the first, not the second in the order of events – as if we have confused the order of the events. This theory explains that the same happens in the déjà vu phenomenon – the brain “confuses” what it saw first and it is the thing that actually occured later.

Another theory has a similar stance, stating that déjà vu is a break in the recognition of memories, where the sense of stimulating a memory is separated from the stimulus itself, and this is called the hypothesis of “impaired familiarity of a memory”.

The part of the brain that is the most active in memorizing new data is called hippocampus. Hippocampus is of crucial importance for the declarative (explicit) memory and the process of recollection. It is also responsible for temporal sequencing of the remembered, as well as for the assessment of similarity. The researchers presumed, and it was confirmed in some laboratory experiments, that the déjà vu phenomenon can be most easily provoked by the sense of similarity – that is, by showing the testees certain scenes which have the same elements that are repeated, but in such a way that they are not completely recognizable.

Furthermore, in the vicinity of hippocampus there are structures which are also connected with it and responsible for the feeling and the reaction of anxiety (septo-hippocampal system), and this might explain why people with some sort of anxiety disorder experience this phenomenon more frequently and intensely.

However, in some studies in which researchers monitored brain activity it turned out that the part of brain that was the most active in the déjà vu phenomenon was the frontal cortex (the front part of the brain). This part of the cortex is the most active when decisions are made, which indicates that during the occurence of this phenomenon some sort of decision is being made, or more precisely, a choice is made between the existing options. This helped the researchers realize that during the occurence of the déjà vu phenomenon the brain is dealing with some sort of a conflict. It is assumed that the conflict in question here is a conflict between the accuracy and the mistakes related to the memorized data. This means that the phenomenon is actually the brain’s attempt to compare the data and correct any mistakes in the memory.

And finally, as a conclusion – just as pathophysiological disfunctions of the brain, or rather, neurobiological causes, such as epilepsy, can trigger this phenomenon, psychological disorders, stress, fatigue and exhaustion can set it off too.

How do you explain different forms of the phenomenon: “what we have already heard”, “already visited”, “already felt”, and “already seen”?

Different forms of it that we encounter are explained by the fact that we perceive sensory stimuli with our senses, while our memories are almost invariably a combination of sensory perceptions mixed with the cognitive and emotional rendering of these, the meanings assigned to them and the importance of the experience, which depends on the person’s overall set of beliefs and his or her previous experiences. It follows that memories are rather complex.

Besides, when we’re talking about only one particular memory, research has shown that each time we turn to it, the very process of remembering something changes it a little bit. So, when, for example, we talk about a story we read the day before, and when we talk abot it in a couple of days’ time, or in a few months’ time, or finally in a couple of decades, the memory will differ significantly from the first one.

If we take only these two facts into account, then we see clearly that this phenomenon, too, can have so many variations due to the sensory, cognitive-emotional and empirical processing of the memory. Because of these changes in the memory we can have a virtually endless number of combinations when it comes to this kind of phenomenon.

Is this phenomenon more frequent with younger, or older people, who have more memories and experiences, and more travelling behind them?

According to the studies, déjà vu is more frequent among young people, than among older people, although it has been seen among the very old as well. This is linked to the theory which sees déjà vu as a memory “tester” – it is quite possible that as we age our testing system works less, or that we are less able to notice mistakes in our memory, although it has been proved that there are much more of them as we grow old. The phenomenon is seen in equal measure among men and women.

It is more common among people who have travelled a lot, who are better off, and whose political and social views are more liberal. This is explained with the fact that people who travel more extensively have more chance of encountering sights which may remind them of something they have already seen. People with more liberal views will be more open to uncommon experiences and to exploring them further.

What happens in our consciousness when we feel we are familiar with places and situations which we have never visited or seen before, or when we have a feeling we have met somebody who is actually a complete stranger to us?

In psychological terms, it is much easier to explain the phenomenon of “recognizing” a person than a place or a situation, although there could be some common features in them. The phenomena of “liking” and “disliking” function in much the same way. The only thing is that, when you like somebody at first sight, or when we’re talking about the phenomenon of “love at first sight”, it is really a matter of instant and unconscious recognition.

What you recognize is a similarity which you “read” based on the non-verbal signals. This means that, based on one’s posture, movements, tone of voice and facial expressions, you recognize a similar set and range of feelings, which go with a similar set and range of thoughts and behaviours, as in the patterns known to you from your family. Or it is based on the image of your ideal person, who would be your ideal partner or a friend, or a colleague, etc. And that explains the “chemistry” triggered at first sight. But when this happens, you’re totally unaware that you recognize this similarity.

In the déjà vu phenomenon you are aware of the similarity, but you don’t know where or when you’ve seen it before. Speaking of similar situations, when you take another look at a seemingly familiar situation, and keep in mind that you’ve never been in such a situation before and giving it a context, that is, when you realize what meaning you’ve attached to the given situation, you will became aware that you’ve already attached the same or similar meaning to a situation, although the situation itself may have been different from the present one.

The phenomena of “projection” and rubber – banding, which is actually  “catapulting one’s mind into the past” are known to psychology: these are the situations when you “glue” the people and situations you have experienced before over the people and situations in the present and perceive them in much the same way as those from the past. And again, in this case you don’t feel you’ve gone through this before or been in such a situation before you analyze it.

Some researchers claim that déjà vu is more frequently experienced by people who are better at remembering things and describing their dreams than other people. Sometimes, the clients we work with say they seem to have predictive dreams in which they “saw” the surroundings they were in later on, and which was significant to them. In these cases, those people don’t take into account the fact that they could’ve seen the surroundings in a movie, on TV, on a postcard, etc., so they attached more significance to it than it deserved.

Researchers also looked into the predictive aspects of the déjà vu phenomenon and came to the conclusion that this predictive power of the déjà vu phenomenon is non-existant.

Could déjà vu be connected to our wish for a favourable experience or event from the past to be repeated?

From the psychological point of view, and taking into account everything stated so far, this idea might stand to reason, but the occurences of déjà vu aren’t always pleasant or always unpleasant – they vary, and the fact that they do, consequently, leads us to reject the hypothesis.


Is there a possibility for the introduction of paid leave for women during “those days”?

Is there a possibility for the introduction of paid leave for women during “those days”?


Some believe that this might result in discrimination, that is, that men would be preferred over women as employees, as well as in the abuse of this “privilege”.

The Italian parliament is discussing the proposal of a bill which would compel companies to allow their female employees three days of paid leave during their menstrual period each month. There are conflicting opinions on the possible effects of this bill in Italy itself, while in Serbia experts generally do not believe that the law would be adopted, and even if it was, they suspect it would have negative repercussions for women.

If Italy passes the bill, it will be the first western country carrying out the policy of granting working women “menstrual leave”. The debate has already started in the Chamber of Deputies of the Italian Parliament, and if the bill is passed, employers will be obliged to allow three days of paid leave each month.

Some media have welcomed the law which would help the working women who suffer from menstrual cramps, but it was also criticized by people who believe that it might be counterproductive as it might lead to employers preferring men over women as employees.

Psychiatrist and psychotherapist Aleksandra Bubera, MD, believes that there is little chance of this bill being adopted in Serbia, and that, if adopted, it would lead to negative consequences.

“This issue may be viewed in terms of equality. However, I think that the equality in question is being misunderstood. Equality means having the same rights, which is supposed to mean that we have the same obligations. And if you take the perspective of the Serbian society, women have more obligations, because nowadays  they both work and do all the other things, mainly home-related. Also, if you look at the structure of firms and political parties, you might find structures with more women, but still, there will be more men in the leading and executive positions. It does not seem realistic to me that this could be adopted in Serbia, and even if it happens, I believe that employers will employ more men than women in that case, especially if they are not obliged to introduce the policy of gender equality in employment,” states Bubera for Belgrade media.

On the other hand, economist Miroslav Zdravković, the editor of the portal Makroekonomija, says that it would be ideal if all women in Serbia were in employment, if they were paid regularly and were not subjected to any kind of pressure at work.

“Maybe in our case it would be enough to ensure that nobody is given a notice if the problems are serious and obvious. Or alternatively, we could pass the law giving women 40 days’ leave a year, where the state would cover half of the period with the amount of a monthly salary, while women would use the other 20 days when they need to (for obligations related to their homes, children, their school, etc.). Taking into account the fact that women have conquered all the previously exclusively male jobs, I doubt that they would be employed less if they received any additional benefits in the form of employers’ understanding of their situation. There are many fields where men are no competition to women,” argues Zdravković.

Source: Pink.rs




Violence on the Internet: How to protect your child from the “predators” who stalk children in cyber space?

Violence on the Internet: How to protect your child from the “predators” who stalk children in cyber space?

UNICEF’s research has discovered that around 85% of children aged between 8 and 17 actively use the Internet.

The Internet is a “window on a world” to so many children today, but a “window” which exposes them to numerous dangers of the virtual reality. Peer violence, especially the one found on social networks, has been on the rise in the past years, even among the primary school children.

UNICEF has also conducted a research on digital violence among children and it has produced disastrous results – over 85% of children aged between 8 and 17 who have access to the Internet spend two or more hours on the computer daily. The amount of time increases with children’s age. The research has also shown that the communication on the social media increases with children growing older, especially when they reach the age of 12.

“The Internet is now available to virtually everybody, and most people don’t use it for educational purposes. Very often this is how people get into contact with various forms of violence. Personally, I have been insulted for listening to a different sort of music,” a pupil, S.J., says to the portal Pink.rs.

Psychiatrist and psychotherapist Aleksandra Bubera, MD, says that nowadays children under the age of twelve should not be allowed to use any of these electronic contrivances which would enable them to use the Internet uncontrolled.

“Steve Jobs did not allow his children to use computers before they turned 12, and I believe that we should all follow his example. However, this is practically impossible in the modern world. Today in schools all children have smartphones, and if you don’t let your child have one, everybody in school will be mocking him,” she explains.

According to her, parents are the ones who should take care of and control their children, as they are an
“easy target” for the “predators”.

“The solution might be to buy a “brick phone model”, as it does not enable you to surf the net. It would be good to limit their use of the smartphone to an hour or two, which is, apart from the increased security, also beneficial in the fight against the addiction to the new gadgetry,” she explains.

“A loophole” in the cyberspace

It is a fact that the social networking site Facebook cannot be used by persons younger than 18, but there is a loophole, and that is – posing as somebody else.

“Parents should control their children’s activity in social media. You never know who has sent them a message or a friendship request,” explains Bubera, and stresses that the most important thing here is the trust between parents and their children, because you never know who is stalking you in the cyberspace.

This is the reason a forum for parents and children was organized in “Vlada Aksentijević” primary school in Belgrade, in which they were able to receive information about various aspects of digital violence.

“What I learned here is the fact that there’s a large number of offenders who repeat their grave crimes, and we don’t need to read newspapers and watch TV in order to understand what can happen to people,” says a worried father, Z.C., whose child goes to this school. He adds that it would be best to set up a database of repeat sex offenders and thus enable the parents to be aware of the potential dangers.

The Foundation “Tijana Jurić” has been asking for harsher sentencing of pedophiles, as well as for a register of repeat offenders. Igor Jurić said to Pink.rs that this would be an important step in the fight against the problem.

“We see so many cases of the so-called repeat offenders, that is, people who repeat the offences after serving their sentences. The only action that would produce results is to take them off the streets. This is why the foundation’s been calling for the setting up of a public register of convicted pedophiles, which would provide parents with the information on who’s living in their children’s vicinity,” Igor Jurić said to Pink.rs.

“A child is an easy victim; children are trusting and largely uninformed. They are vulnerable because they can’t tell why somebody’s being good to them,” Bubera points out and adds that joint work, trust and control are the most important in the prevention of such cases.

The problems and dangers are numerous and frequently encountered. It is not easy to develop a healthy and strong relationship with a child built on trust and understanding. The fact is that your child will sooner or later turn to somebody for help if they fall victim to this kind of “predator”. Make sure that this person of trust is yourself.

J.Stanković

Source: Pink.rs



Assertive rights

Assertive rights

ASSERTIVE RIGHTS

  1. You have the right to independently assess your own behaviour, thoughts and emotions, and take responsibility for their occurrence and the consequences that they have upon you.
  2. You have the right not to give reasons or make excuses to justify your behaviour.
  3. You have the right to judge yourself whether you are responsible for solving other people’s problems.
  4. You have the right to change your mind.
  5. You have the right to make mistakes and be responsible for them.
  6. You have the right to say, “I do not know”.
  7. You have the right not to communicate with people, managed only by how they feel, or how they will feel; you have the right not to depend on the affection of other people.
  8. You have the right to be illogical in making decisions.
  9. You have the right to say, “I do not understand”.
  10. You have the right to say, “I do not care”.

RIGHTS “AS SEEN IN THE MIRROR”

  1. Allow other people to be self-responsible.
  2. Do not ask others to justify themselves to you for making their own choices.
  3. Allow others to set their limits when it comes to you.
  4. Let the other person change his/her mind.
  5. Allow others to be wrong and their responsibility for their being wrong.
  6. Allow others to be ignorant and clairvoyant.
  7. Do not manipulate rejection and affection to control someone else’s behaviour.
  8. Do not insist that others behave logically or according to your logic.
  9. Do not ask other people, no matter for how long you know each other, to read your thoughts.
  10. Allow others to make choices on their own, make judgements by themselves and grow to their own extent. Allow them not to take care about your definition of perfection.

Perfectionism

Perfectionism

Aleksandra Bubera

Interview with Suzana Bijelić, journalist, published in “Blic” Daily Papers in May 2011.

What is perfectionism?

  • Perfectionism is a feature that can be regarded both as a positive and a negative trait.

In clinical practice this trait is regarded as negative, as in clinical terms perfectionism means that a person[1] accepts oneself only if he has met cruel imperatives. This means that he believes that he is OK (and/or valuable enough) if and only if he is perfect. The following logical presumption ensues from this: if I’m not perfect, I am not worthy enough, or in worse scenarios I am not worthy at all, and in the worst case, if I’m not perfect, I should not even live.

The root is in the Life Script – a life plan developed at unconscious level from the second to the seventh year of age that consists of various Script messages, conclusions and decisions that do not match reality, but a child adopts them as realistic due to underdeveloped process of thinking and objective dependence on parents. Script imperatives (cruel drivers, imperatives, or in professional terms: drivers) are in fact parental messages by which the child’s right to life or the right to love is extremely conditioned.

Therefore, when he fails to meet the requirement of being perfect, the feeling of inferiority is triggered (he feels less worthy than others) or self-contempt (he feels unworthy at all) or self-hatred (he deems to have deserved to die).

It is clear that no one can be able to fulfil the requirement of being perfect at all times. Especially as the condition “Be Perfect” may apply to overall functioning, which is a worse case, or to some areas in his life only (work, physical appearance, intellect, performance, etc.).

What needs to be distinguished from perfectionism as conditioning self-worth and the right to exist is an autonomous aspiration for excellence in achievements, which is inherent in humans. The difference is that a perfectionist will deem that he is not OK if he does not do something perfectly, while he who strives for extraordinary results autonomously, detaches oneself from his behaviour, which means that regardless of whether he has succeeded or failed in his aspirations for extraordinary achievement, he knows that he is OK, a worthy person, with a full right to life and a sense of personal values, with or without top-level achievements. Also, this person knows that perfection does not exist, thus he will not criticize himself if he does not achieve perfection, and will also evaluate himself as a person who deserves to live and be important and loved.

What is a perfectionist characterized by? Can a perfectionist be recognized at first glance?

  • Perfectionists like to finish their work perfectly, that is why they need much time to achieve that as they work slowly, work in detail and with care. They like to be precise. Before they show their work, they check it several times and we can rely on their work. Sometimes they are late, they exceed deadlines because they need more time for polishing and final check.

Within a group, they tend to keep the work for themselves as they think that no one will do it as perfectly as they can. These are typically persons who are proactive in resolving issues and who are proactive in interactions with other people, they resolve “one-to-one” situations better than issues involving bigger groups of people.

These persons tend to be proportionate and “in tune”, both in physical terms and in choosing outfit. The problem is usually in the fact that it is difficult for them to enjoy what they have achieved, because they can hardly allow themselves to have fun and relax, because they are overly responsible and conscientious. For example, while other people would simply enjoy dancing, a perfectionist would strive to dance the steps out perfectly, counting in himself “one, two, three, two, two, three…”

They are often tense, they are their own worst critics. They expect the same perfection from other people, and they can also criticize others as they criticize themselves, although, in practice, most of them are much more critical of themselves than of others.

They are not familiar with the concept of “being good enough” – their formula is as follows: imperfect = bad.

As regards thinking, feeling and behaviour, a perfectionist will usually choose thinking, while having a problem with feelings.

These are people who are reliable, good workers and often pillars of society.

How does a person become a perfectionist in a negative sense? What kind of role do parents have in this, who tend to achieve their unaccomplished goals through their children’s actions?

  • The reason for sending such messages can be dysfunctionality of the parents, but in most cases it is a good intent, with the lack of information on proper upbringing.

Most parents have a strong desire that their child makes extraordinary achievements.

In this case, in order to ensure that a child accepts his values, a parent links them either with an indirect, and sometimes a direct threat to life itself, or with rejection, because he does not know otherwise. A child faces the same issue here because it is dependent on his parents and his survival is indeed objectively conditioned by their presence and love, the child believes that the ordered value is the real necessity (such as food and water), because, if it is not fulfilled, the child will be rejected and/or die.

Since many parents do not know how to separate “being” from behaviour, and since a small child cannot separate itself from its behaviour, it practically means that the child believes that the following applies:

I have done something bad = I am bad

Imperfect=bad

Out of which the formula is deducted:

Imperfectly done =>done badly =>I am bad

There are usually two methods by which a person adopts such beliefs:

  1. A parent reiterates the child in various situations that it has the right to exist only if it is perfect or that the child will be loved (accepted) only if it is perfect.
  2. A child misunderstands that parents condition its existence and value with the idea of perfection.

In any case, a child deducts that it is so much important to be perfect and it perceives the idea of perfection as a matter of life and death, and when it grows up, without having revised this wrong conclusion, as an adult person he/she constantly tries to be perfect in order to have the right to live and feel worthy.

Is perfectionism actually a psychological problem?

  • Yes. Although psychotherapy considers an imperative as a pathological driver, people influenced by it think the opposite. They are proud of their perfectionism.

It is important to understand that such people when they were children were loved only when they had fulfilled the imperative of being perfect, that on such basis they had developed the expectation that other people would accept or respect them only if they were perfect, and that they respect themselves only if they are perfect. That’s why these people put perfectionism at the forefront when they are presented because they regard perfectionism as their value. Such a person introduces himself/herself as: “You know, I’m a perfectionist…”

What kind of health problems can the aspiration to perfection result in? Certain forms of perfectionism are said to cause emotional and physical problems, resulting in depression, even in suicide.

  • Knowing all above presented, that is, that a person actually extremely conditions his/her right to personal value, and/or life with perfection, it is clear that if a person fails to fulfil this condition, a feeling of inferiority, self-contempt, unworthiness or potentially self-hatred will appear.

Depression actually involves a bad image of oneself, and therefore one of the above feelings. A person is depressed when he deems that he is worth of contempt only, or that he is unworthy, and if he deems that he deserves to die because of not having fulfilled the required condition, a suicide becomes a potential outcome.

That is why in psychotherapy it is always important to start from the image of oneself, what it is like, and whether a person conditions his worthiness and existence with anything particular. For this reason, in practical work it is important that a therapist should start from the problem that a person seeks help with. Only when a client has realized that there is a strong link between his/her problem and his/her perfectionism, does he/she become ready to deal with perfectionism as with a problem, not as something that is regarded as a value and something he/she should be proud of.

Further, according to Freud, perfectionism would be classified in the so-called “anal” personality traits, which would therefore have to do with the functioning of the digestive tract in a wider sense. Thus in mild cases, it can lead to disrupted functions, like constipation or diarrhoea, nausea and vomiting in situations when a person is unable to fulfil the criterion of perfection. If these situations occur frequently and with perfectionists they do, they may result in predispositions for various diseases such as stomach ulcer, peptic ulcer and some diseases triggered by stress, although their precise cause is unknown, such as, for example, ulcerative colitis.

Since a perfectionist works under high pressure, it can also lead to the tendency to blood pressure disorders, hypertension and its effects on the heart and blood vessels. This does not mean that perfectionism is the cause of these diseases, but that with other numerous factors it can make the person more susceptible to these diseases.

Does a great desire to succeed and excel slow down a perfectionist in success achievement?

  • Yes. Because when these obligations are related to the right to life, then they function as real needs and as the conditions that a person has to fulfil in order not to die, which brings a person into a situation to constantly work under great pressure, and paradoxically to make more mistakes, which perfectionists are very bothered by.

Therefore a person must “be perfect” in order to avoid a disaster (unworthiness or death).

Every human being has the right to exist and the right to personal value as these are basic human rights, and that is why it is a disaster if we deprive ourselves of it or revoke it, or if someone else does this.

On the one hand, a person has learned to enhance his motivation in this way, and on the other hand, he fails to recognize that in reality it is not a real disaster or a real necessity.

In order to be efficient, we need to distinguish when we need to do things well enough, very well, in an excellent or in a perfect manner. For example, it’s good to have a surgeon who strives for excellence because he will better operate on a patient. However, in emergency case, for example during an accident, when things have to be done quickly in order to save lives, a surgeon-perfectionist could dwell on details for too long while the patient, for example, might bleed out.

So, if we were to do everything perfectly, we could do very few things because we would not have enough time.

For perfectionists it is important to get information about Pareto principle on efficiency or optimal results. Pareto was an economist after whom this rule was named, because he first used the 20-80 ratio. In the actual case, this would mean that a perfectionist invests 80 percent of the time to do 20 percent of things, leaving him only 20 percent of the time to do all the other 80 percent. Which means that a perfectionist is generally inefficient, although the things he has completed are perfectly completed.

Could you explain in more details the relation between this “weakness” and the incidence of social phobia since the smallest mistake looks as a disaster and irreparable damage to a perfectionist?

  • A social phobia is a fear to talk to others because a person deems that it would be a disaster if he made a mistake. That is, a person thinks that it is okay to say something only if it is perfectly true and beautifully worded.

Of course, a requirement for perfection is here as a condition that a person must fulfil in order to feel worthy. Since it is almost impossible to fulfil these requirements, a person usually chooses not to talk at all and when forced to do so in front of others, he has symptoms of fear of a possible disaster in terms of blushing, increased heart rate, headache, dizziness, sweating, sometimes even the urge to urinate or feeling of sick.

These persons need help them to distinguish between the feelings of worthiness and need for perfection, as well as to allow themselves to make mistakes, and before that they need to learn that a mistake is not a disaster, but an opportunity for learning and acquisition of knowledge.

Hardworking bosses are perfectionists, isn’t that right?

  • Perfectionists are their nice subordinates who are also perfectionists, and they do not like associates who are not perfectionists. Perfectionists are appreciated, respected and praised, and are very critical of people who are not perfectionists, because they consider them superficial and irresponsible, as well as insufficiently precise and reliable.

When is perfectionism healthy and when does it represent an unhealthy pursuit of great achievements?

  • Perfectionism is always unhealthy. An autonomous desire to excel, but not to be perfect is healthy, SOMETIMES in CERTAIN activities and fields of life, when it’s really important to do things in an excellent manner, which are the situations that occur rarely in a life of an average person.

It is important that we differentiate between the situations in which an exceptional “performance” other than “good enough” performance is required.

It is also important to emphasize the distinction between excellence and perfection. Excellent means that something is “extraordinary” and that it’s so good that it’s not usual, and which is so different than anything else that nothing can be done more, because it is of top quality and final. And if we think little better, the perfection in nature actually does not exist.

Perfectionism is a trait that is often attributed to talented people. It is that they themselves when they are at their best complain of not being at their best. They cannot rejoice in success … Why?

  • A perfectionist has the wrong logic: “either I did something perfect (and therefore I’m worthy) or I did something bad (so I’m unworthy)”. They do not accept that something can be temporary, good, good enough, very good, excellent, extraordinary, but only the categories of being either “perfect” or “bad”. But perfection does not exist, so they often evaluate their achievement as bad, when it’s not perfect.

[1] Refers to all genders (he, she, it)


Life script

Life script

Aleksandra Bubera

Interview with Sanja Kostić, published partially in the Večernje novosti daily on September 4th 2011.

What is a life script and how does it affect the way we form our identity?

– A person’s life script is an unconscious life plan that they “make” in childhood.

A life script is actually made up of a number of script decisions. A script decision is a faulty belief or faulty representations of beliefs regarding an important life question, and this decision is made based on script conclusions.

Children acquire script beliefs from a combination of parental influences, their own environment, insufficient information, and also because of a specific way of thinking. A child thinks differently than an adult, so there’s a pretty good chance they will get something wrong. Children are prone to magical thinking and they make concrete connections between events. For example, a child might say: “The man on the TV who is in charge of the Sun and rain said that the weather will be nice tomorrow”.

We say that scripting is unconscious, as it happens quite early on (between the ages of two and seven) which means that we forget a great deal. As a result, we forget how and when we reached some conclusions and decisions, so we don’t review them later on. Instead, we act on them automatically. To us they are axioms, i.e. truths that are not to be questioned.

We can compare this with the following experiment: imagine that we subject a person to hypnosis, and while they are in this trance state, we suggest them to walk over to the table and re-arrange the flowers in the vase once they’re out of the trance. We also instruct them to forget receiving these instructions. The person awakens from the hypnotic trance, approaches the table and re-arranges the flowers. When we ask them why they did it, they offer a rational explanation: e.g. they like the flowers better this way than the way they were before. However, the real reason is that they’ve received these instructions in an altered state of mind. This process in which a person tries to justify their behaviour in a way that makes sense is called rationalisation, and this is how the script works in life.   

So, when we are quite young, we decide that we will behave in a particular manner when it comes to certain things. We forget all about that afterwards, and we rationalise our behaviour. That is why our life script controls our life, unless we find a way to become aware of it and review our decisions and conclusions. This revision process is universal. We can all remember a time in our lives when we corrected some of our misconceptions. Nevertheless, we often believe that we are making autonomous decisions and choices (autos+nomos – living under one’s own law) about many important life questions, while in reality we’re acting based on a long-ago adopted, outdated and often incorrect life plan. 

For instance, a child wants to pursue a career in singing. Unfortunately, singing is seen as negative in their family so the child decides that it’s not good, and later in life chooses to pursue law – a respectable profession, with good earnings etc. (rationalisation in line with their family’s wishes). They still wants to sing, however, and are often frustrated by their chosen profession.

At what age do people start forming their behavioural patterns?

– We start forming these behavioural patterns practically from the moment of birth, since the relationship that the child has with their mother (or caretaker) is really important.

Children have a developmental need for love and bonding, for constant stimulation and care. If these are lacking, the child’s psycho-physical state will be significantly impaired, which research has proven time and again. Adults still want love, stimulation, connection – they contribute greatly to the adult’s quality of life. However, if these are in short supply, the adult’s mental and physical health won’t deteriorate the way a child’s would.  This is why a mother’s care and her bond with the infant determine from the very beginning how safe the child will feel later in life, whether they will feel like they can be protected, loved, whether they will feel it’s possible to satisfy their needs and wishes.

Real socialisation begins when children are about a year and a half old and have already developed some skills and abilities (walking, talking a little, etc.). This is the time when the child first comes to terms with other aspects of relationships that exist in addition to love and care – boundaries, requests, etc. So, the life script is formed between the ages of two and seven. Children at that age are quite young, their thinking is underdeveloped and they believe everything adults tell them because their life depends on adults. They overestimate the significance of many events and situations and that’s why they experience them far too emotionally. All this increases the chances of reaching faulty conclusions and basing decisions on them – misinformed conclusions and decisions based on that conclusions which will be used as guidelines later in life.

What affects personality the most? That is, what do we base our decisions, conclusions, beliefs, convictions, values, etc. on?

– Script decisions can be made under an external influence or a child can reach a wrong conclusion on their own due to insufficient information and concrete thinking. Still, the most significant source of messages based on which the child draws conclusions about herself, others and the world are the people who are the most important to the child, meaning parents, family, friends and other authorities. The more important the person is to the child, the greater the effect of their messages on the child. 

Children do not embrace everything that is communicated to them; however, chances are greater for a child to accept a message, when:

  • the message is communicated by a person very important to the child;
  • the message is repeated often;
  • the message is more intense (and followed by more intense emotions);
  • a similar message is repeated by several people;
  • the child received few or no opposite messages.

Messages can be communicated through actions, too. Often they aren’t remembered as verbal – rather, the child learns by modelling their parents’ behaviour. For instance, if the parent regularly makes negative remarks about, let’s say, people of another nationality or a group of football fans, even though  they aren’t speaking to the child directly, the child will overhear them and probably adopt this belief. Likewise, the child observes the relationship between their parents, and whether they’re abusive or gentle to one another, the child will adopt this type of behaviour as “normal”.

Parents also shape children’s self-perception. They tell children what they’re like. So if they call the child stupid and inadequate, the child will believe them. The child will believe them just the same if they call her capable and smart. Children also learn very quickly which behaviours are rewarded by their parents and which are ignored. This too shapes the child’s behaviour later in life.

How aware are we of our life script? Can we change or upgrade it and how?

– Most people are not aware of their life script as, by definition, it is an unconscious life plan.

What people are aware of is that they have a problem in life – a difficulty or struggle. Only when they decide to address the root causes do they realize that they, in fact, have some faulty beliefs.   

Faulty beliefs in our lives act as “self-fulfilling prophecies”. This means that if a person believes that they’re stupid, they will act accordingly. They will behave in a stupid manner and prove to themselves that they truly are stupid and will have “real” arguments to support this claim. I’ve often in my psychotherapy practice come across people who believed they were stupid and incompetent, while I found it rather obvious that they weren’t.

It’s quite common for such a person to keep doubting their own intelligence even after they take an intelligence test and find out they have a very high IQ (intelligence quotient), as they are able to find a lot of evidence that supports their belief that they are stupid.

This illustrates that our beliefs often have a much stronger impact on our behaviour and life than reality does. That is why we say that people bend reality and adjust it to their belief system. Our belief systems are inert, they strive to remain unchanged, even when presented with strong evidence to the contrary.   

The good news is that we can become aware of the faulty conclusions we had once adopted. We can become aware of the fact that we once believed we were, for example, incompetent, ugly, unlovable, and this is the first step towards changing those beliefs. Beliefs can be changed – this is the natural course of life. We all remember believing in witches and Santa Clause, and then afterwards realising they didn’t exist.  

Luckily enough, reality also helps change our beliefs by constantly refuting them. However, most people still need help – from friends, authorities, psychotherapists, role models or important life events. Psychotherapy is a proven, efficient method to change our beliefs. That is, in fact, what psychotherapy primarily focuses on – correcting our faulty beliefs about ourselves, others and the world. Of course, there are other ways to achieve this, some of which I mentioned earlier.

How does our life script affect our behaviour? Can it hinder us or interfere when it comes to important life decisions?

– Our life script can greatly influence our behaviour. If a certain decision is related to an area of life in which we have a script belief, our decision will be in line with the script.

Does our script make life predictable, given that we know how we should behave to meet expectations and what to expect based on such behaviour in any given moment?

– Yes, it does. If my client and I come to understand their life script, the decisions and beliefs that it’s made of, we can predict with great certainty how their life will turn out. Often even how it will end – unless they do something to change their belief system. Unfortunately, some people have script beliefs that they are bound to be unsuccessful, suffer, go crazy or commit suicide. Luckily, these beliefs can be corrected as well.

If a person has a realistic understanding of the world, themselves and other people, they are autonomous. Autonomy means being able to live your life in line with yourself and your wishes (as much as circumstances allow for it, of course) and not limiting yourself to living within the boundaries imposed by your script.

It also means fighting for yourself and making your life as good and fulfilled as circumstances allow. It means not seeing imaginary obstacles where there are none, while at the same time assessing the actual ones. Overcoming these obstacles if possible, and learning to accept the insurmountable problems as such.

Bear in mind – a person with erroneous beliefs will believe many solvable problems to be insurmountable because they see themselves as insufficiently competent, for whichever reason, to tackle these issues.

How does our life script affect emotions and love, beliefs and opinions on relationships?

– Relationships, love and emotions are important life questions. If we have faulty beliefs regarding these matters, we will behave accordingly. For instance, if a person believes that they are unlovable or that they aren’t good enough or attractive enough, they will act as if it were true. Consequently, it is highly likely that they will be perceived as less valuable or attractive by other people, thus greatly reducing their chances of having a quality romantic relationship. 

Our beliefs are reflected not only in our actions, but also in what other people notice about us right away. For example, if a person believes they are competent and attractive, it will be reflected in their posture, walk, use of body language, gesturing, tone of voice, the way they speak to people. If, however, the person believes they are ugly and stupid, it will be visible in the aforementioned ways. This is something people are quite skilled at noticing, even when they are consciously unaware of it. It is often the grounds for intuition, liking or disliking. This is why it is often said that the change should come from inside.

To illustrate – at the beginning of the film “My Big Fat Greek Wedding” we can see what the protagonist thinks of herself, and how she gradually changes her opinion. As she does, her appearance, behaviour and relationships change accordingly. In the end she becomes to show as smart, attractive, determined, persistent, desirable – quite unlike the loser; people often thought her to be.

So – this is the exact same person – identical potentials and capacities. But once she changes her beliefs, she shines her brightest and starts living in an entirely different manner.

How does our life script determine the manner and patterns we use to choose and find partners?

– Similarly to what we just discussed. If a person believes they deserve subpar treatment, they won’t object to a partner treating them that way. In contrast, if they expect to be treated decently, with respect and kindness, they won’t settle for anything less than that.

There has been some interesting research about the similarities and differences between relationships that started with “love at first sight” and relationships in which people fell in love after knowing each other for some time. It turns out that both these types of relationships have the same ratio of successful to unsuccessful outcomes. What this tells us is that we’re quite quick to recognise the people that fit into our life script, or, hopefully, into our autonomous choices.

Psychologists also say that life patterns affect how we behave in relationships and how we perceive them, how we think about giving, taking, control…

– Like everything else in life, (actual circumstances notwithstanding), our relationships are mostly defined by how we believe relationships should (or have to) be.

The relationships that work best are the ones in which both partners have similar beliefs about what relationships should be like. These partners are on the same page. Since there’s a myriad of beliefs about romantic relationships, chances are we won’t often find a person with the same beliefs about relationships that we have. This is what leads to so many misunderstandings and disagreements in partner relationships. And it’s also the reason that it is quite difficult to find people who we would be compatible with.

But it is also important to mention that there isn’t only one “Mr/Mrs Right” with whom we can have a quality relationship. There are many people with whom we share beliefs and values and with whom this would be possible. And since beliefs aren’t set in stone, it is also possible that we become more compatible over time. Through growing and developing together, we might both reach a set of beliefs that will allow us to function harmoniously. 

Development is the natural course of life. That is why it’s important to be with a person who wants to grow in a similar direction and at a similar pace as we do. When we do, it’s one of the most beautiful things we can experience.

Does a quality love relationship require that we share a similar “life scenario” with our partner, have similar life priorities and values? And does that mean that opposites do not attract after all? Or do we still need a bit of variety?

– It is important that we and our partner share the same value system. Especially when it comes to core values. We’ve all heard about relationships falling apart because one or both partners weren’t willing to compromise about some important life questions, e.g. where to live, how to raise children, matters of money, religion, family relations etc.

The issue of  similarities and opposites has probably been around ever since people started consciously contemplating these topics. There are various theories, debates and research. Looking at this topic from a developmental point of view: sometimes it is better for a person to choose someone who is similar to them as this will lead to better understanding and stability in the relationship. On the other hand, this can deprive the relationship of positive friction and growth through constructive conflict.

Again, if you chose someone quite different from you, it would require both partners to put substantial effort into development, growth and adjustment. It would take considerable flexibility to accept the other person as is. Often in such relationships, what drew us to the person in the first place, later starts bothering us the most. If partners are significantly different, and are not ready to work, put a lot of effort into personal development as well as into their relationship, chances of it working out are slim. It’s not impossible, though.

We often choose partners who are somewhat similar to us in core life values, and differ from us precisely in the spheres where we ourselves feel that we need a different developmental path. If both partners are aware of this and are willing to change, it can lead to faster growth for both people involved and to the relationship developing as well.

However, we also know that the people we fall in love with are not only the ones with whom we have the best chances of growing. In fact, they’re often also the ones with whom we have the best chances of confirming our faulty beliefs and negative life outcomes. A relationship with a person like this can have drastically different outcomes. What it comes down to in the end is whteher we are ready to face reality and do what needs to be done to correct our faulty beliefs. If we do, we can continue at a higher level of development – together. Many relationships fall apart at this point. This happens because the partners involved are not able to overcome their disappointement with reality and accept it as a chance for improvement. Instead, they take a step back and often seek a new partner – usually one with whom they repeat the same pattern.

When we see the same outcomes repeating regularly in life (whether in relationships, friendships, at work, etc.), it’s time to take a step back and think about it. This doesn’t happen by chance very often. Most likely it’s a consequence that script decisions have on our life. If you do what you’ve always done you’ll get what you always got. And in order to start doing things differently, we need to change the beliefs that lead to these actions in the first place.


Words First, Medicine Later– On Empathy

Words First, Medicine Later– On Empathy

Aleksandra Bubera

Interview published in Večernje novosti on June 20th 2010.

Empathy is the ability to understand others and to sympathize with them.

Just how many times have you said or heard someone say: “I have plenty of my own problems, I can’t worry about other people’s too” … This has become something we say almost without thinking, and we don’t even realize how selfish or insensitive we sound. It is a fact that we live in a time where it isn’t easy to take a moment and think about other people’s feelings. Despite that, just try to remember how many times you yourself were in a situation that you wished for someone to share your problems, your worries and your feelings with. If we understood how much it means to listen and to say a kind word, maybe we’d better understand empathy, which is something this society desperately needs. And it has always been a part of society. Even Hippocrates described it, in a single sentence “Words first, medicine later”! Our guest for our Život Plus(Life Plus) column is Aleksandra Bubera, M.D., psychiatrist and psychotherapist. She is here to tell us more about empathy, the ability to understand each other.

– Empathy is the ability to feel how another person feels in a given situation. Sympathy or compassion,  is an emotion which signals that we find other people’s feelings important, and that they themselves are important to us, which affirms a friendly relationship between us. Feelings that result from empathy and compassion are vicarious feelings. “Vicarious” meaning a representative, deputy, apostle. So, in a way, we can be other people’s representatives and be there for them.

Are we born with empathy, or do we develop it throughout life?

– We need socialisation in order to feel empathy and compassion. This means that we’re not born with these abilities, but that they are learned, i.e. empathy is developed throughout life. Small children, for instance, aren’t socialised. They function by following their needs and whims, and when they are quite young they feel no compassion for other people, animals… Their parents need to teach them: “It’s not OK to hit the kitten, the kitten is hurting, just as you hurt when someone hits you”.

How feasible is it to develop the ability for compassion with others at a time when people have increasingly less time for one another?

 – The modern way of living is quite different from communities in the past, when the ability for compassion was greatly nurtured and valued. Nowadays, children are brought up differently than back then – they are taught to care about themselves, their own wishes and needs more than about other people’s. Back in the day, people followed the biblical principle “Thou shalt love thy neighbour as thyself”, and the common interpretation was that one should make sacrifices for others. In contrast, nowadays that same sentence is narcissistically interpreted as “I come first, then after about 350 empty slots, everyone else.” Both interpretations are exaggerated. A realistic standpoint would be to take care of yourself first, but not to the extent that other people suffer for it (if they already don’t benefit from it). The circumstances and human society are constantly changing, but that shouldn’t be an excuse for indulgence, selfishness, narcissism and excessive hedonism.     

What ways are there to develop empathy?

– Building empathy must always begin with us and our impressions. We need to imagine how we would feel if we were in a certain situation, and it is our parents who start training us to do this. This is so callen “naïve” empathy, because it teach us about us, not other people, but that’s how we start. One of the functions of fairy tales, games, stories and poems for children is giving a child the ability to imagine situations that happen to other people, what they do, what they might feel and how they might think. It would be good to teach our children emotional literacy, first within the family, and then in kindergartens and schools. To do this, we must be emotionally literate ourselves to begin with. We need to teach children to understand themselves. We also need to teach them to take a step back from their own perspective and understand and accept that other people are sometimes quite different from them – that they have different wishes, reasoning and feelings from their own. If we ourselves understand it, and if we teach our children clearly, this won’t be a mystery to them any longer. It will become an automated activity, like riding a bike. Luckily enough, adults can also learn to be emotionally intelligent, emotionally literate and empathetic. There are many books, trainings and educational workshops that deal with people, feelings and relationships between people in various ways. For anyone interested in these topics, I’d like to recommend some books: Emotional Literacy; Intelligence with a Heart by Claude Steiner, Emotional Intelligence by Daniel Goleman, Emocije(Serbian only)  by doctor Zoran Milivojević

Is it true that people with developed empathy have higher quality romantic relationships?

– It is. When you can accurately feel what is happening inside another person, you can understand them well and correctly. This lowers the chances of misunderstandings. In contrast, when you don’t have this ability, you tend to interpret other people, their feelings, reasoning and actions according to what you yourself would feel and do, and not as it really is. The ability to see the world through other people’s “lenses”, and not only through your own, provides a rich source of hues in the spectre of human relationships.       

Plenty of research has shown that empathy is an important trait of successful business people. If it is important, how come there’s an unwritten rule that emotions should stay out of business and the business environment? 

– To put it more precisely, the rule should read that objectivity is always better than subjectivity when it comes to business. Not bringing emotions into work is impossible, unless you’re a person completely cut-off from your emotions. That’s a rather unhealthy person, a robot. Our experience confirms the results of research that empathetic, emotionally and socially intelligent people are more successful at work than people who are not. As every job, to a lesser or greater extent, consists of communication and cooperation with others, the ability to assess how others feel in their own skin, what bothers them, what they wish for allows for easier and better communication with them. This also entails motivating them to cooperate in a way that is beneficial for everyone.

Why is empathy particularly important in a tense work environment?

– It helps us stay out of unnecessary conflicts and also helps us react adequately. Business people are expected to be at the top of their game, to understand the core of things and relationships between people. However, everyone expects the other person to be ready and able to understand and adapt. This is why there’s a recent trend of investing in HR and training in the field interpersonal skills, not just professional competencies. Some of the areas covered are communication skills, both verbal and non-verbal, becoming more sensible for different ways in which people communicate their feelings, etc.

It is important to differentiate empathy from pity. What’s the key difference?

– Pity is feeling sorry when something bad happens to a person. It is a form of love, and not, as we often tend to perceive it, an expression of contempt or animosity. When a person doesn’t want pity, it’s often because they think it is a form of animosity or gloating over their adversity. Or they believe that this kind of compassion is reserved for people not worthy enough or capable enough to fight with the battles that life brings them. Pity is, in fact, compassion for someone we’re close to who is suffering. That person is someone we see as worthy, and that’s why it’s important to us how they feel. So, when we feel pity for someone, it’s quite the opposite of feeling contempt. The person we sympathize with is one we perceive as worthy. Empathy is broader term and includes emotional understanding of all emotional states of others, not just pity.

How can one show empathy?

– Empathy can be shown verbally and non-verbally. The better people know each other, the fewer words are needed.  A hug, a look or holding someone’s hand can be enough. But in case we don’t know a person well, or don’t know them at all, it’s best to check with them whether we’ve understood the meaning of what they said and how they feel.

How important is empathy in everyday communication?

– It’s important in all relationships, and since most of us communicate with a great number of people during the day – at work, at home, in public transport, during vacation and leisure – we practically need it in every waking moment.

If empathy is the ability to put ourselves into another person’s position, to understand their feelings – is it possible to be too empathetic? – By definition, empathy is realistic, so we can’t overdo it. We can only overdo it by taking too much on as a result of knowing how someone feels and then coming to a conclusion that we must do something about it. If no one asked us to do anything, if we do more than is up to us, and meddle in things that we should stay out of, we’ve got ourselves tangled in a so-called “psychological game”. If don’t become aware of it, at best we’re going to end up feeling pretty uncomfortable. However, if we can really understand why someone feels the way they do, we’re probably going to have the ability to estimate which actions to take, and which not to take. So, I’d say “yes” to empathy as I don’t think we can overdo it since it’s precise and realistic.  


Hypochondria

Hypochondria

Interview with MD Aleksandra Bubera, psychiatrist and psychotherapist, with journalist Branislava Laćarak, published in Večernje novosti daily papers 29.03.2014.

Hypochondria is often thought of as a condition of enormous fear of an illness, which is not important enough to be dealt with more seriously. To what extent is hypochondria a really serious condition and how much can it affect one’s life? Is this condition only “in one’s head” or can it cause some specific problems to a person?

  • Hypochondria implies excessive preoccupation with physical symptoms, health and illness due to pathological fear that a person suffers from a serious illness. Hypochondria was known even in ancient Greece, while the term has been used in medical practice since 16th or 17th century.

It belongs to fear-related disorders and belongs to the class of neuroses, i.e., light mental disorders. When I say light, I do not mean the suffering that a patient experiences because of the disorder, but I mean the cause, course and the prognosis of the disorder that are easier to approach to and treat, often by psychotherapeutic methods in contrast to severe mental disorders. And because of this hypochondria should be distinguished from delusional hypochondriac ideas that occur in severe, psychotic disorders – delusional ideas are unrealistic and sometimes very bizarre such as, for example, when a patient is fully convinced that he[1] has stomach-ache because he has frogs in his stomach, or that he has cancer because of the influence of evil forces from an unknown planet. In such cases the patient usually suffers from a very serious disorder that requires long-term and inevitable medical treatment, while psychotherapy can sometimes be applied.

Like all other disorders associated with fear, hypochondria is a disorder that greatly affects the quality of life, and/or a person is in constant fear, preoccupied, convinced that he is very ill, which affects his daily routines and enjoyment. When diagnosed with hypochondria, this means that a patient has been fully examined and found to be free from any physical illness. However, although someone does not have a bodily illness, this does not mean that he cannot have sensory experiences. Every emotion, pleasant and unpleasant, due to a physiological body reaction to emotion, which actually prepares the body for action, is felt in the body as a set of sensations and can be misunderstood as a symptom of an illness.

What is it caused by, how does it occur and what can affect its development in a favourable manner?

  • The so-called “emotional illiteracy” (alexitimia), which implies that a person does not recognize emotions, that he does not know what they serve for and thus he does not relate (normal) body reactions to (most often unpleasant) emotions, is the primary cause of the development of disorders. A person feels an emotion that he does not recognize (it is usually a very intense and unpleasant emotion), the body physiologically reacts with the preparation for action, which is reflected literally on the whole body – heart, breathing, blood pressure, sugar level, oxygen and carbon dioxide, muscle tone, functioning of internal organs, glands with external and internal secretion, brain, etc., and then a person, being not aware of the emotions he has felt, does not recognize the emotion, but only recognises the body reaction. Since the body reaction to intense emotions is also intense and the person is only aware of that emotion, other than of the psychological mechanism that resulted in the body reaction – he concludes that something unusual is happening in the body, something that is a sign of an illness. For example, heart palpitation, tightness and abdominal pain, headache, sweating, numbing of arms and legs, heavy breathing, etc. This condition includes the development of the so-called “hypochondriac mentalisation” in a person, and/or a system of beliefs that the body, organ or organ system will surely “let” him down.

The development of hypochondria is favourably influenced by the environment and education that do not deal with emotions, which is often for many reasons: generations deal with survival rather than with quality of life, while dealing with emotional life belongs to the domain of a comfortable life zone, not survival, which of course also entails not paying attention to emotions, either to all of them or just to some of them, and if we are not emotionally literate ourselves, we can hardly teach our children, pupils, students to be emotionally literate.

To what extent does the environment contribute to a person becoming preoccupied overnight with illnesses (media, newspapers, TV, movies, series…)?

  • These disorders rarely develop “overnight”, although there are cases when we can precisely identify the situation when it all started.

For example, the case of a patient whose hypochondria has been treated for several years and he has been examined almost every week for a body illness in a precisely defined, always identical part of the body, while psychotherapy identified the event when he had an intense unpleasant feeling for the first time and related his intense body reaction with this feeling, other than with an illness.

After this, when he thought back, he realized that the pains in that particular part of the body appeared ALWAYS when he felt the same emotion, which had been completely suppressed due to a certain context and circumstances. More repetitions of the model “emotion – not recognizing – a body reaction – interpretation as a symptom” is usually needed so that a person could conclude that he is certainly ill.

It often happens that when someone around the person gets sick or dies of some severe illness, and especially if the deceased person was close and dear to him, the person begins to have certain symptoms that may point to the same or similar severe illness. Especially if the deceased person was a cousin, the person is afraid of the “genetic resemblance” and of becoming ill.

Due to the overflow of unpleasant emotions (sorrow, fear, anger), which a person does not recognize as such and feels them in his body, which leads to the conclusion that something with the body is wrong, the person concludes that something terrible happens with him and that and he got sick.

Various traumatic events, such as the survival of one’s own severe illness or accident and various other traumatic events may also trigger this pathological cycle of the development of hypochondria.

The phenomenon of medical students who, while learning about a certain disease during their studies, start to “recognize” symptoms of the disease one by one, until finally they realize that they are not ill, but that they were only “immersed” in their studies about the disease, is also known.

Certain influence can be made by media effects to young people who do not yet have enough life experience, especially if they deal with a disease with sensationalism and in a very scary way.

What are the most frequent illnesses that persons suffering from hypochondria are afraid of?

  • Nowadays people are most often afraid of cancer, although they are also afraid of some other usually severe and hard-to-cure or incurable illnesses. Today they are often afraid of AIDS, which is most often associated with the feeling of guilt due to some sexual behaviour that a person considers inadequate.

People are also afraid of “bird” and “swine flu”, SARS, Ebola and similar severe infectious diseases.

Fears of diseases that were incurable at the time, such as tuberculosis, plague, cholera, etc., were more often present in the past.

Are the symptoms they feel and describe invented or realistic (heart pounding, dizziness, hand tremor…)?

  • Patients feel very realistic symptoms in the form of pains in various parts of the body – stomach ache, headache, chest pain, heavy breathing, heart palpitations, dizziness, sweating, trembling, they have an impression that they have temperature, weakness, fatigue, they have an impression that they have felt some lumps on various parts of the body, etc.

Therefore, they often undergo various laboratory tests, X-ray examinations, ultrasound examinations, CT scanning, magnetic resonance imaging, ergometry, spirometry, various “scopies” (bronchoscopy, colonoscopy, etc.) …

If doctors do not want to see and examine them, convincing them that a week ago they underwent an examination and that everything was fine and that they should not repeat it, they often get angry with doctors, because they feel doctors have no understanding and that they really feel physical symptoms and it must be a sign of a disease.

And, if they financially can afford it, they will change a doctor and the medical facility and undergo examinations from the beginning – and so on indefinitely.

At what age does hypochondria usually occur?

  • Most commonly it occurs during the period from late twenties to the fifties, although there are cases when it occurs in teens, as well as in mature age and in the old age.

What kind of people does it usually occur in (education, interests, physical and mental condition…)?

Hypochondria “does not choose” its victims. This means that persons susceptible to the development of this disorder cannot be profiled by education, interests and physical condition.

Generally speaking, persons who are emotionally illiterate or insufficiently literate are susceptible to hypochondria, and they interpret the emotional body reaction as a symptom of an illness, rather than as a normal physiological reaction of the body to emotion.

Therefore, the more we are in touch with our emotions and the more we know why we feel the way we feel, and which thoughts, situations or interpretation of the situations this emotion is connected with, the more we know what emotion we exactly feel, what it serves for, how to adequately demonstrate it and use it for such an action that will best contribute to adapting to the current life conditions, the less we will be susceptible to this and all other disorders related to somatization.

Somatization is a tendency not to recognize mental conflicts as such, but to manifest them in the form of physical disorders.

What are the signs indicating hypochondria and what should be done when it is recognized in someone? (Should an expert be consulted to obtain advice what to do next, where to go, who should a person talk to and what is your advice in this regard)?

When there is a persistent belief that a person suffers from a physical illness, regardless of having undergone numerous examinations that have not confirmed the existence of such illness, and of course, when a person does not believe physicians who claim non-existence of the illness, the person suffers from being preoccupied with the illness to the extent that various aspects of his daily routines are affected.

If these symptoms last six months or longer, a person can be diagnosed with hypochondria.

In this case, it is best to talk to a person and point out to him that all those difficulties may not come from a physical illness, but that there is a psychological conflict that he does not recognize and that it would be good to consult a psychotherapist, psychologist or psychiatrist.

In most cases, a person, if not sufficiently informed, will experience this as “calling out” that he is “psychotic” and resist such an approach.

But you may help him by informing him that there is a mechanism for emotion suppressing and somatization, that alexitimia exists and that as part of the treatment most of the psychotherapeutic schools work on correcting distorted beliefs and on developing emotional literacy at the same time, and in this way symptoms control, i.e. body reaction to emotions is achieved. During such treatments, triggers may often be identified, i.e., why the disorder occurred and what mental conflict is in the background.

Once this is clarified, a person can approach conflict resolution and learn how to resolve conflicts in the future rather than somatise it, after which the person has been cured.

How is hypochondria treated, how long does the treatment last, and can it be successfully or only partially cured?

  • There is no “spontaneous” healing – and/or, it is possible that a person himself stops to have fears, if he is aware of his distorted beliefs, the psychological conflict and the circumstances under which the disorder has occurred.

But in quite a number of cases, psychotherapy is needed, which will help the person to clarify this problem faster.

Sometimes medication is required – anxiolytics (benzodiazepines) and drugs that act in an anxiolytic manner and which are better in the long run – antidepressants, which have a good anxiolytic effect almost without exception.

What happens when hypochondria is not treated and what further problems can it result in?

  • If a person does not get into the nature of his or her own problems, it can greatly damage the quality of life, and in some cases, the person blames himself for, which can result in the secondary depression.

Are there persons who pretend to be hypochondriac, who are hiding behind this diagnosis and how should they be distinguished from those truly affected by hypochondria?

  • Persons who pretend to be hypochondriac are rare as hypochondria is not such a disorder that can be used to get a specific benefit out of it – as for example, if you successfully act out some serious disorders to get some material gain.

Someone would hardly accept to undergo all examinations that hypochondriacs undergo and who will repeatedly undergo unpleasant and unnecessary examinations week in, week out, to be calm for a certain period of time.

Can hypochondria be acted and why would someone do it?

  • Any disorder can be acted, but there is a clinical experience, as well as tests that can distinguish between true and “acted” disorders in most cases.

A person who acts the role of a hypochondriac would soon realize that the benefit is very short-lived – i.e. the concern of the persons he is close to will soon turn into preaching and/or ignoring, as this unfortunately also happens to people who really suffer from hypochondria because they are not only a burden for themselves but also for their environment, and people close to them often find it very difficult as they do not know how to behave with the patient – they have usually tried with having care, understanding, preaching, anger, ignoring, pleading, threatening etc., and the patient still has the same problems he has had before.

Do real hypochondriacs constantly visit doctors and seek help or not, and what does it depend on?

  • Real hypochondriacs constantly seek the help of a doctor, they constantly ask for referrals for new examinations, they are afraid that doctors have missed something, that they have not paid enough attention to some symptom or finding, they ask doctors to calm them down, but they also do not believe them.

They usually respond to a warm approach and understanding, but empathy is not enough to solve the problem.

Systematic problem solving is required, starting with work with symptoms, relating them with the body, emotions, thoughts and conflicts or trauma to solve the problem.

What percentage of the population can be classified as hypochondriacs and are there some subcategories of this condition, and how many of such people are there in our country (if any such information is available)?

  • There is no accurate data on how much this disorder is common in our country, it is estimated that this disorder is present in 1% to as much as 7% of the population. These higher percentages refer to the number of patients who seek advice in primary healthcare facilities, i.e., from general practitioners.

Less than half of these people gets to a psychiatrist, psychologist and psychotherapist, as some cases are treated in general practice, which is good if such treatment is successful.

The interview is available at the website of Večernje novosti.


[1] He/she may be used alternatively


Fears

Fears

Interview of MD Aleksandra Bubera, psychiatrist and psychotherapist, with journalist Ranko Pivljanin, in Blic Magazine weekly journal, issue 04.08.2013.

What fears are citizens of Serbia faced with?

  • Citizens of Serbia do not differ in what they fear from people living in similar conditions and similar societies. All the feelings, even fears, depend on what the person finds important. And most of us find the existence, health, family, relationships with other people important. Naturally, every person has some additional, specific things that he finds very important. When we estimate that one of these values ​​is endangered, we will have an unpleasant feeling.

Whether we feel fear, anger or sadness will depend on our estimation whether we feel “stronger” than the situation (anger) or weaker than it, whether we can escape (fear) or whether we feel that the situation cannot be changed and we cannot escape it (passivity, sadness).

Therefore, when we estimate that we are “weaker” than the situation, but that we can escape, we feel fear. The only problem is that when we are afraid of the things we are only thinking about, but they do not happen in reality and we are not even aware of them, it’s like fighting an “invisible” enemy and we cannot even escape them. That’s why it’s very embarrassing and people feel to be at an impasse.

What are the examples from your practice? What do people say, what kind of problems do they have when it comes to fears?

  • People who have panic attacks most often ask for help, and these attacks are often accompanied by agoraphobia.

Panic is a fear that we will die very soon, often in a few seconds or minutes, because we are directly endangered by something and we try to find salvation and help as quickly as possible. Most often people believe they will get a heart attack or a stroke or that they will go mad. That’s why they contact emergency medical services most often because they believe they will die if they do not get help on time.

After several attacks and usually after a thorough examination by a cardiologist and a neurologist, numerous reassurances that the person is physically all right and recommendations to visit a psychiatrist, psychologist or psychotherapist, he[1] realizes that he is physically healthy, but since the symptoms continue and are very unpleasant, the person then believes that he has started to lose common sense.

The symptoms include heart palpitations, occasional arrhythmia, feeling that he cannot breathe and that he will suffocate, paleness or reddening, sweating, tingling, trembling and feeling of weakness in his hands and feet, feeling that he will fall and lose consciousness, sometimes that he will urinate or need to defecate, lose control and do something strange…

Agoraphobia is a fear of open space, but also of a place crowded with people or of a place which a person estimates that he cannot quickly and easily exit from. This happens because a person associates panic attacks with the places where they occur and these places are often the above mentioned places. A person then begins to avoid them, believing that these places and situations are the cause of panic attacks, not knowing that the cause is something completely different.

In fact, a person is anxious because of a situation, a problem, etc., which he does not recognize. Any feeling, whether pleasant or unpleasant is accompanied by a physical reaction that prepares us to better adapt ourselves to the situation. However, since we are usually anxious and worried about things that do not happen now and in front of us, but because of some things we think about or remember or we think that they might happen, we are often unaware of this process and therefore we do not know why our body reacts violently.

For example, if you feel heart palpitations or that you cannot breathe and that your legs are trembling because you just avoided being hit by a car at a zebra crossing, your body reaction would not be surprising, because it’s clear that it is normal in the given situation. However, if you are on vacation and sitting on your balcony drinking a morning coffee completely relaxed and your heart “suddenly” starts to pound, you cannot breathe and you feel dizzy – you will think that something’s wrong with you physically. In fact, you are not aware that while you were drinking your coffee, you were thinking about how you must return to work and that was not certain that you would keep your job because your employer had announced the layoff for the purpose of rationalization and cost reduction. It is logical that you are frightened and worried when you think about it and our body reacts in the same way when we are thinking about the circumstances we are afraid of, like when such circumstances actually happen and in that moment.

A comparatively large number of people are not sufficiently “emotionally literate”, i.e., they do not recognize well enough their feelings that are connected with reality, with what we are thinking about, and thus also they do not relate physical reactions to their feelings. Therefore in fact, they only register the reaction of the body other than the process of thinking and feeling that preceded it, which happens very quickly, often in milliseconds. And then they interpret this body reaction as a sign of disorder or illness – because of which they are even more scared, which further enhances the body reaction and creates a “vicious circle” or “spiral of fear”, when a person is more and more afraid, until it finally results in a panic attack, which is one of the most unpleasant conditions that we can experience.

Fortunately, although it is very unpleasant, the panic attack is completely harmless.

The problems that they actually start with can be very different, but it is always related to whether a person will be able to deal with them, whether he will be able to put up with them, and/or control them.

The most common problems are related to a bad image of oneself, relationships with other persons or failure to establish them – regardless of whether these persons are parents, children, partners, friends; the problems related to important life events – schools, studies, marriage, pregnancy, divorce, relocation, etc.; the problems related to work – whether it’s unemployment or fear that a person will not have satisfactory performance at his work, occasional fear of illness, etc.

There is a saying – “so many people, so many fears”. After learning how to control panic attacks, it is important that a person should find out exactly why he has certain fear at that particular moment of his life and when it is identified, then we should work with the person on the very cause of fear, other than on the symptoms that cause physical reaction to fear. Then it is causal rather than symptomatic therapy.

Which fear is bigger – fear of illness or fear of losing a job?

  • It would be logical to have a bigger fear of illness, especially of those that are life threatening, because the more important the value is threatened, the fear is more intense, but not for all people.

Unfortunately, there are people whose job is more important than health, because they feel that they are only worth if their performance is good. But also because the business is related to survival – i.e., “if I lose my job, I will not be able to support myself and my family” – this fear is usually quite strong, especially in a situation when jobs are few and hard to find, as in the situation of the “double crisis” in Serbia – chronic lack of money, unemployment, insecurity, collapsing and fast changes in the value system during the last few decades, plus the global economic crisis.

Do we have irrational fears and what are they?

  • Yes, we have. Irrational is any fear that is not based in reality and therefore is not adequate, which means that we are more or less afraid than we should be when it comes to the given situation.

Fear is reasonable when there is really something that threatens us and when our reaction is to escape to save our life or health.

There are several types of rational fears:

  • When we say fear, we mean the fear of something concrete in the outside world that threatens us – for example, the fear of a big aggressive dog running towards us and barking at us.
  • Apprehension or worry, and/or fear of something threatening that could really happen in the near or distant future.
  • Anxiety, which I will explain below, because it is most common.
  • Panic, when a person estimates that the situation is life-threatening, that he does not have enough time and tries to find a quick solution by applying the method “trial-error-trial”, which often seems completely disorganized and that is why a person is said “to have panicked” and moving “like a headless chicken”.
  • Stage-fright, fear of whether we will be seen by others as we would like to be seen, and/or whether our performance will meet the criteria of the one who evaluates it (for example, at auditions, exams, etc.). Stage-fright can be motivating, when it helps people to do their best and blocking, when a person actually blocks and fails to accomplish what is needed at that point, and such stage-fright is inadequate.

All the fears listed so far are the so-called “sympathetic fears”. The term “sympathetic” refers to the regulation by the so-called sympathetic autonomous nervous system in the body and practically means that adrenaline participates in all these fears, which brings a person’s body to a higher level of functioning and prepares it for active defense and protection. The autonomous nervous system is called “autonomous” because it is not actually under the control of our consciousness, but it autonomously regulates body functions that are important for maintaining life, such as breathing and cardiac action, for example. However, with conscious actions we can influence autonomous regulation to a certain extent – for example, breathing techniques, progressive relaxation, etc., which in turn create the conditions for the regulation systems in our body to obtain information that nothing threatening happens and that they can resume the ordinary regulation system, which is in effect when everything is all right.

There is another type of fear, called “horror”, when a person estimates that his end has come, that he is dying and that there is no salvation – this is a parasympathetic fear when the body applies protective mechanisms like “freezing”, such as when a person urinates, defecates or faints – which is the inherited defense mechanism.

For example, when a predator animal reaches an animal that is its prey, the animal prey can sometimes avoid death by stiffening and dropping like being dead, as some predators do not notice animals that do not move, while some predators do not eat dead, but only hunted animals. Similarly, people sometimes think that their end has come, they react in a similar manner, and/or lose consciousness, because it is an old inherited response (and in some situations such reaction can save one’s life, of which there are records of survivors from shooting, for example – a person fainted although he was not shot and came to consciousness after everybody moved away and he survived).

In clinical practice, anxiety is the most common type of fear. Anxiety is a fear that we will not be able or that we will not be capable enough of dealing with a certain situation or more such situations.

If in reality a person is not capable enough of dealing with a situation or problem and this is required from him or for some reason he must (and the word “must” is used only when something is really compulsory, and/or when it refers to basic living needs related to survival), then the person will be reasonably anxious. In most cases, however, a person either underestimates his ability, or overestimates the weight and importance of the situation and then he is unreasonably anxious.

Unreasonable/irrational fears are the ones that people most often ask help for.

There are several most common groups of irrational fears, and they are classified based on a person’s (irrational) estimate of what threatens him:

  • their own incapacity or a situation for which they estimate that it exceeds their capability (anxiety);
  • fear that they will be threatened by something external, by some object, animal etc. (phobias);
  • the fear that their own body will “betray” them and the belief that they are suffering from some usually severe and non-curable illness (hypochondria);
  • fear that they are “attacked” by some impulses and thoughts of being urged to do something rude or aggressive and that they will lose control over them and do it (obsessive fears);
  • Fear that they will be endangered or that they are endangered by other people (paranoia and paranoid fears).

Agoraphobia, anxiety, phobias, hypochondria, irrational fears, obsessive fears, panic attack, panic, paranoia and paranoid fears, fears, stage-fright, horror, apprehension, worry


[1] He/she may be used alternatively