A Philosophy That Respects Individual Differences
Dr. Turecki’s clinical approach is based on certain fundamental principles:
A Broad View of Normality
A person can be different without being abnormal. It is possible to suffer from significant personal problems without being diagnosed with a serious psychiatric disorder. Problems exist on a spectrum, ranging from mild to problematic to abnormal. Dr. Turecki’s cut-off point lies quite far out along that spectrum. He believes that an individual can be eccentric and have poor social skills without having Asperger’s Syndrome, that not all highly active impulsive children have ADHD, and that not all people who experience highs and lows suffer from Bipolar Disorder.
Psychiatric Diagnosis and the Use of Medication
Dr. Turecki believes that too many people, especially children, are being diagnosed with psychiatric disorders, and that medication is dispensed too readily. He sees children and adolescents in consultation, many of whom are either receiving extremely high doses of psychiatric drugs or are on multiple medication cocktails. Such practices can be dangerous, particularly if there is no careful monitoring. Dr. Turecki is conservative about diagnosis and medication use. In order for him to make a psychiatric diagnosis, the symptoms have to be extensive and there must be significant impairment of functioning and relationships. Today’s drugs are powerful as well as effective, but have to be closely monitored. He certainly uses medication in his practice, but often at lower doses than some of his colleagues, and he always reassesses the patient’s condition periodically to see if dosage can be lowered or if the drug can be discontinued.
The Role of Therapy
There is a growing tendency to see psychological problems as biologically based, and to treat them with medication. However, not all difficulties are due to a “chemical imbalance,” and medication does not address deeper personal conflicts or lack of coping skills. Many well-functioning people get involved in self-defeating relationships or engage in self-destructive behaviors. Psychotherapy can be most helpful to such patients, even if it is combined with small doses of medication to provide symptom relief. Another form of therapy, CBT (Cognitive Behavioral Therapy) and its offshoots, aims to change behavior and illogical thinking and to teach coping skills.
Underperformance Is Not Disorder
In today’s highly competitive school environment, starting as early as nursery school, children and adolescents are pressured to perform at levels that may be too high for them. Stimulants, such as Ritalin or Adderall, are often used to improve school performance, and to help a child do well on standardized tests by enhancing his or her ability to focus (in some ways this is not that different from athletes using performance-enhancing drugs, including stimulants). Whatever your own opinion is on improving functioning chemically, neither you nor your doctor should confuse performance enhancement with the use of medication to treat a psychiatric disorder. There is also a burgeoning black market in prescription drugs among teenagers and college students. They use stimulants to do better in school or to get “up” (a similar mechanism to Cocaine), as well as other prescription drugs to self-medicate for anxiety or depression, or just to get high or mellow. Such drug abuse can result in addiction, unintended overdoses or psychosis. Medications shoud never be prescribed without careful monitoring.
Temperament refers to the nature of an individual, that aspect of the personality that is innate. While most evident in childhood, temperamental characteristics persist into adult life. A strong-willed adult was usually a stubborn child; a shy child may learn to compensate later in life, but still feels shy on the inside. Traits that can cause problems in childhood may later work to one’s advantage. For example, a highly active, impulsive child might gravitate to the stock market as an adult, a profession requiring high energy, quick decision-making and multi-tasking. A child very sensitive to the taste, texture and smell of food could become a master chef.
In his therapy with adolescents and adults, Dr. Turecki, always pays attention to their temperament and helps them to understand themselves at this level. Knowing the temperamental characteristics of your child allows you to truly accept her for the person she is, and to gear your expectations to her genuine capacities. Certain children are born temperamentally difficult, and are consequently much harder to raise than average children. Their parents are often confused, guilty and angry. There are effective techniques to help these parents. (See Books and Private Practice.)
Goodness of Fit
This term refers to the level of compatibility between individuals, or between a person and his environment. A good fit can improve any relationship, whether in a marriage or a friendship or between a boss and her assistant. However, it is in the parent-child relationship that “goodness of fit” is most important. A parent may love both her children but have a better relationship with one of them because their temperaments interact more easily. Goodness of fit also plays a role in many of the child’s other significant relationships, such as with his teachers. The way a child is viewed can vary greatly with the circumstances. For example, a highly active impulsive eight-year old girl, with two older brothers, and attending a non-demanding public school would probably be viewed as a tomboy. But if that same child were the only daughter of two older rather finicky parents living in a small Manhattan apartment and enrolled in an all-girls private school that requires uniforms, she would very likely be diagnosed with ADHD and put on medication.
This seemingly daunting term should not be confused with perfect parenting. Expert parenting does not require a detailed knowledge of child development or an extensive library of sometimes-contradictory books on childhood problems. To be an expert parent you primarily need to understand and accept your child for the person he truly is (not the child you wished you had) and to do your best to adapt your parenting style to the temperament and capabilities of your child.
A parent can get into repeated power struggles with a child, resulting in ineffective discipline and excessive punishment. Dr. Turecki calls this the “vicious cycle.” In such cases a shift in attitude is needed. Instead of viewing the child as a powerful adversary out to thwart her, the parent tries to see him as a little person who is also affected by the conflict. It is important for the parent to stay calm and disengage early when a back-and-forth argument is developing. This is very hard to do at first, but the eventual rewards are great. In addition, any serious talks with the child should never take place when emotions are heated, but always at a calm time. Such “planned discussions” are an opportune time for defining rules and expectations. They should not start by telling the child what he has done wrong. Rather, the aim is to arrive at a collaboration. Measured praise for improved behavior is much more effective than criticism and repeated lectures. (See The Difficult Child.)
Children Are Resilient
The kind of mistakes made by loving, well-intentioned parents do not damage their children. Even if temporary problems may result, a bruise is not the same as a scar.
The Importance of Self-Image
Self-image is the single most important factor in deciding whether to recommend therapy. A chronically low opinion of oneself makes everything worse. Dr. Turecki focuses on the strengths of his patients because a feeling of success obviously enhances one’s self-esteem. Conversely, while believing that obvious problems should be addressed, Dr. Turecki discourages excessive focus on areas of lesser competence. Some parents expect too much of their children and this can affect the child's self-image. Although some children actually thrive on busy schedules, others might struggle with them. Once again, temperament and goodness of fit play a key role in determining the self-image of a child.