S-T-R-E-S-S!

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Every week I get an e-mail from a website called healthwatch.se where I can self-report my stress level, sleep, satisfaction with work and social life, and other indicators of importance for my health. The program automatically colour codes my responses into green, yellow, and red, corresponding to healthy or unhealthy levels of the reported items. Time trends are available as well as advice on how to improve on the red zones.

There is just one problem with the tool. It lacks a function reacting to deleting the reminder e-mail to respond to the weekly questionnaire within two seconds of receipt. If the developers had thought of that I wouldn’t have to rely on my dyspepsia to remind me that my stress levels are way out in the red zone. Purple would be more appropriate, actually.

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I once had a woman in at the ED in psychiatry who seemed completely out of it. She was brought in by colleagues from work because she seemed so confused and was reported to have forgotten her three-year-old son at preschool – she simply missed picking him up. She walked around at the ED with her notebook in one hand and never stopped talking about meetings and things to do and the thing with the son was just a mistake, could happen to anyone, what’s the fuss, she has got things to do, although she forgot where the car was, did she park it somewhere here? I sent her for a brain CT because I thought her acute confusion might be due to a tumour.

It was Hans Selye, the world-famous Hungarian researcher who first described stress in physiological terms. He talked about stress being a way of preparing the individual for fight – pumping adrenalin into the body getting muscles ready to act, the brain ready to focus.

Except when stress happens too often and too much and without a good reason for all the physiological reactions it can become destructive. Today we even talk about toxic stress, e.g. when children grow up in chronic disadvantage involving poverty and family violence. We are only beginning to understand the consequences of such chronic stress, but we already know it includes modification of our DNA through epigenetic processes. Adult victims of childhood abuse show high levels of such DNA modifications.

It was stress that got my patient to the ED, luckily she had no brain tumour. The fall that followed this hyperexcited phase was almost visible and she hit rock bottom: she suffered burnout. I have seen far too many women since who have suffered stress-related depression. Smart, ambitious, lovely people who could not maintain the balance that kept them sain.

I am convinced it is not workload per se, but the frustration of not being able to strike a good balance in life and suffice in all their different roles that makes women like me sick from stress if we’re not careful. In my last year as a PhD student I described that it was not medical aspects of their type 2 diabetes, but role conflict that caused women stress. “Traditional gender roles in the home, obligation profiles at the workplace, cultural expectations on women’s bodies, and prejudice about the psychological etiology of women’s diseases in health care, could all contribute to women’s experiencing role conflict in their daily diabetes management.”

Until those on healthwatch develop their new functionality I will trust my body when it shakes and churns, screaming its warnings to me. I will now take a walk and breathe. All good things start with focused, calm breathing.

Why do I not celebrate my own successes?

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“Do you know there are rumours about you at work?” Chills down my spine: what is this about? Then I spot the look in his eyes and understand he is kidding me. Well, he is and he isn’t.

“Rumour says you won a research award of the year in the county? What the f… were you thinking not telling us all about it? How bad can you get at promoting yourself?” He laughs and shakes his head in disbelief. “Seriously, this is big, isn’t it? Like, you make a huge fuss about someone in the group winning an award for best poster at a national conference, but you don’t think this is even worth mentioning?”

Well, to be truthful, I did mention it to the two PhD students who were still at work when I got the message about the award. A couple of others had seen the press release the day after and there was some talk about it during coffee, especially since my husband sent me flowers to work! He clearly knows more about celebrating success…

But then I never really thought to bring it up at the team meeting, maybe because the official prize ceremony will not take place until another month. And there were lots to do and all that. But maybe considering my PhD student’s question is worth the while. Just because he is American doesn’t mean he cannot have a point…

I often tell my PhD students how important it is to always celebrate small successes and it’s true, I am quick to celebrate theirs. So why don’t I follow my own advice?

The standard joke in my family of origin is that when someone gets an award – and my parents often do – the question asked is: Is it just the humiliation or is there some cash involved? This irony does not mean we are not proud, but it is kind of part of the expectation to excel. There is no fanfare and certainly no bragging about that prize or award. And to distance oneself and show humility is more important than anything else. But I am afraid we might be missing an important point here.

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Only judging people on what they achieve is of course very dangerous and no child in the world should have to feel that not succeeding with something takes away their worth as a person. Nevertheless, an important driver for people is mastery and achieving something in the face of effort is truly rewarding per se.

Think of the child who finally succeeds going up the steps, finishing a puzzle, solving a maths problem or getting a 100 likes on Instagram for a photo they have worked on! Achieving results through effort is good for children’s self-esteem and builds resilience. So we should probably not shy away from expecting both effort and certain results from our children.

But even if there is an intrinsic reward of flow there, is it wrong to celebrate when an effort is successful? I think I could do more of that. Even if the phrase “promoting yourself” still makes me genuinely uncomfortable.

But there is change about to happen! Today I got an e-mail summarising the evaluation of a seminar I have participated in at the national meeting of our governing political party. We got 3.91 on a 4-point scale as presenters (with a high response rate) and the seminar as a whole got 3.85. Someone even wrote that my presentation was best. So I bought an ice cream and gave myself two extra minutes in the sunshine. And I will probably tell my colleagues about it at the next team meeting.

In fact, I will post those results right here, right now, as a later e-mail I just received put us as the top-ranked seminar of the 28 that whole day, in front of seminars with ministers and other high-profile politicians. The average score for the day was 3.34 so the general quality was pretty good, as well! I am not sure if this is bragging, self-promotion, or celebration, but here I go:

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Made it!

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Flexibility in planning is probably a major protective factor against nervous breakdowns. To accept the fact that you never really know what you will find when the alarm clock rings is a good start.

So I was going to attend a conference where THE HERO of public health, Sir Michael Marmot, was going to give a talk. I was adamant to see him and get my well-deserved dose of inspiration. The conference was set to start at 10 and at 10.40 he would begin to speak in Southern Stockholm. To get there I needed 1 hour and 12 minutes, according to the GPS function on my phone.

6.45. The alarm clock rings – one of three children down. Aspirin, tea, a quick clinical assessment (sorry, but in that order) and she is found to be excused from school and to be observed closely to see whether she will qualify for staying home alone or in need of surveillance.

7.30. A knock on the door. The electrician! Shit. Pretty in my bathrobe, unwashed, and uncombed I answer the door and start by saying that we said 8 o’clock, not 7.30. They look puzzled and I remind myself that fix-people are good at fixing things, not at keeping time.

8.01 I cycle Joel to school.

8.05 We realise that we forgot his PE stuff. Shit! I’ll get it to him later.

8.10 The electricians have identified the problem – no, they are not switching off the electricity while I am trying to apply some make-up, but they need to go and get some parts at the shop. Why do they always do that? And why do I always have to pay for their having to do so?!

8.15 Reassessment of the ill daughter yields the result that she can stay at home alone with the back-up of our savour – Antónia. I am convinced she is quite fine when she quickly hides the I-Pad as I enter the room.

8.30 One of my PhD student’s thesis is going to the publisher at 10 o’clock so I decide to have a last look through it. I eat my breakfast standing by the computer and go through the pages.

9.00 I don’t know if I should be happy or panic when I find a couple of spelling and other errors. I decide to be happy, an error less is always a bonus.

9.07 …Which I tell her when she calls and asks if she can send in the thesis. I tell her to check the abstract and acknowledgements an extra time – that’s what 98% of people will read anyway.

9.08. The electricians are back, they have questions. I realise that I will miss the start of the conference.

9.15 New assessment of the ill daughter: is it really ok to leave an ill child alone to get to a conference where I am not a speaker?

9.30 Almost on my way, almost. Will miss the first talk of the conference. Just need to fix…

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9.45 I drop the PE stuff at the school and leave Uppsala at 9.46. Due to a little planning and probably some miracle, I don’t get lost.

10.54 There he is, Sir Michael Marmot! We is witty, wise, and convincing. He talks about the importance of a universal approach and I love hearing that the base for all future equity in health and a dignified life is investing in the early years, through e.g. high quality preschools. He says a lot of what I know, but it is news to me that inequity if unequally disadvantageous for lower social groups between countries. Usually what we think is that inequities are equally disadvantageous for all groups in comparison, but he shows graphs that the worse off are so much worse off if there is inequity within a country compared to other countries with less inequities.

When the talk on work-life balance is on, my mobile rings. My other daughter reports that she is not well and is heading home from school. What I don’t see on the list of political solutions to enhancing work-life balance is this: every family should be entitled to an Antónia, a wonderful and trusted person who is where you can’t be, when needed. I might just work on installing that: Lex Antónia.

The power of peer support

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They sat there in the ring, curious, but a bit wary of what was going to come. I felt the adrenalin in me rise, that feeling of being ready for “combat”: focused, breathing the air of anticipation. Conducting interviews, especially focus group interviews, is one of the most fun things I do as a researcher. And I do it far too seldom.

Focus groups are a way to gather information on a topic using the group’s discussion and interaction as a main driver for the exchange. It is called a focus group because the interview facilitator helps the group keep its focus on a certain subject matter. The observer, in turn, helps the facilitator by focusing on the group’s interactions and non-verbal exchanges. As well as the recording devices – the ones that invariably go dead when they shouldn’t.

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Although focus groups do not have a therapeutic purpose, they do have the potential to be a source of support to their participants. Conducted well, focus groups can leave group members with a feeling that they have both given and received support through openly sharing their experiences.

The parents in this particular group all had children with severe disabilities. The burdens they carried were unimaginable to those of us who are blessed with averagely developing children. But they didn’t talk about the burdens: they talked about making everyday life work, the comic situations they sometimes ended up in, the disempowering professionals they had to deal with, and about the unique relationships their disabled children formed with their able siblings.

They laughed, exchanged anecdotes and practical solutions, got upset on each other’s behalves, and talked and talked until we were out of time. I felt elated after the session and privileged to have gained their trust. But what’s more important: they left giggling, talking to each other.

The day after I received an e-mail from the centre coordinator. She said the parents all seemed so happy and at ease, they even seemed to walk taller! Now all the other parents wanted to participate in a focus group as well…

Although conducting focus groups takes skill and an accepting attitude of unconditional positive regard is helpful in facilitating an open discussion, it is not me that worked the magic: it is the power of peer support.

To feel you are not alone in your struggles, to share experiences with people in similar situations, has enormous healing potential. It is empowering to give and take advice and support as equals – each person contributing with unique experiences. Feeling empowered, in turn, increases self-efficacy, the extent to which a person feels they can do something about their own situation.

I certainly hope it won’t take so long until the next time I can charge my combat gear of three microphones and feel the anticipation of a group around me. And if you ever get a chance to participate in a peer support group – go for it!

Nine fifteen

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The cornerstone of all parenting programs is to teach parents about spending quality time with their children. I once promised myself that one way to achieve this is to simply say yes to any suggestion of the child at any time for a common activity. Even if it isn’t just then, you can always say “I’d love to“, and tell the child she exactly you can do it. Whatever, but say yes. And do it, it often turns out to be more fun than you thought.

This works out very well with a seven-year-old who wants to play chess or an 11-year-old that wants to read her newest story to me. But what about the fourteen-year-old oyster who grunts at best as a response and spends most of her time watching series in a dark room? She is clearly not interested in my sort of “quality time”. Whenever I enter the room I am advised about the whereabouts of the door. Useful information when the next sentence is: “Out!”

But the other day I came up with the genius idea that every day at 9.15 p.m. I am going to enter her room, sit on her bed and spend 5 minutes in the room. For those minutes she is asked to turn off her computer screen and put away her phone. “Can we agree on that?”, I asked on the day of my idea. “Maybe, maybe not…” Her new favourite expression. In teenageian it means “Fine, it sounds like I’ll need to give you this one, although I am declaring I disagree”.

Yesterday I knocked at exactly 9.15. “It’s nine fifteen, I said, Mommy-time!” She couldn’t really hide the little smile in the corner of her mouth. I don’t know that we made a lot of conversation, but she put her phone down and didn’t leave.

I sat there on the bed and told myself that is she can give me five minutes of her time, I can give her five minutes of NOT telling her off because of the state of her room or not having practiced her maths. Given that I spend 90% of the time I talk to her making those kinds of comments, five minutes is a welcome brake – for both of us.

I am looking forward to 9.15 p.m. today. Maybe, some time soon, she will too. If nothing else, she accepts that tiny slot of time to be spent with me. Maybe she will even mind if she doesn’t hear that knock on her door when I am away.

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We are just gorillas

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“Mom, is it okay to skip school sometimes? Maybe today?” My first-grader looks at me, not touching the jacket he is supposed to put on. Oh, Friday, I think to myself. “No, sweetie, today is school and work, but remember what day it is?” The prospect of TV and tacos and all the rest of Friday evening ‘family chill’ usually helps a bit. “But I don’t want to go to school, I don’t like this school!” Tears flooding his eyes as he angrily wipes them away. Ok, not routine Friday talk. Time to let go of the computer and listen.

“What is it you don’t like at school?” He grimaces, waits a second to check I’m still there, listening. “They call me smug”. “Who does?!”, I roar, before I remember what I read on a parenting site about keeping calm when your child tries to tell you something potentially tricky or upsetting. “Is it anyone special who says so?”, I try again, in a calmer voice now. No answer. I also allow for the possibility that he is a bit cocky and ask him. “I don’t think so, they just say I am smug all the time!”

Why children are loyal to their bullies beats me. Or maybe it doesn’t: bullying causes shame and guilt, making the victim think it’s their fault. But I think I know exactly who it is so I ask my son and he says it’s him, but I am not to say anything to the teacher. Another typical thing of bullying, don’t look, don’t tell! Well, watch me, I know this shit!

I was regularly beaten up by a boy on my way home from school for no reason when I was about 11. I didn’t even know him, he lived a street away, but he waited for me at the bus stop and beat me every day. It never occurred to me to tell someone. One day, when the boy who was in love with me (I found that out later, it was inconceivable for me at that time that someone would be in love with me) asked to accompany me home. I know, it’s old-fashioned, but I am 40 after all!

Anyway, the bully stood there waiting, we got off the bus and bang, he started his routine beating of me. He was mighty surprised to find a furious 11-year-old boy beating his guts out! It never happened again.

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The participants of bullying have been studied and yield insight to why bullying can keep on going for such devastatingly long periods of time. There is of course the Victim and the Bully. Then there are the Reinforcers of the bully, the Assistant of the bully, the Defender of the victim, and finally the Outsiders. The latter are more often girls, whereas the former are more often boys. Both bullies and victims more often have ADHD-type problems.

Modern anti-bullying interventions appreciate the pivotal role of the Outsiders because they are the largest group in terms of numbers. They are the ones who can take action against bullying informally, in their spontaneous everyday interactions. If they are helped to realise their role and get coaching, that is.

Of course I realise I might be overreacting when I think this is bullying. I hope that it is the course of all children entering a new class, and not immediately making their way down the hierarchy. If they instead challenge the current leader by being smart, social, and outspoken, rivalry will occur.

So I tell my son the story of the young gorilla who was the leader of the pack and everyone’s favourite. Until another young gorilla came along! And now the girls didn’t think the first gorilla was the most beautiful and charming anymore, and the guys wanted to play with the new gorilla as well. The new gorilla even beat the first gorilla in the mango-pealing race. That’s when the first gorilla got really angry!

I demonstrate the story by making sounds and start theatre-punching him, putting on my angry gorilla-face, my son laughing through his tears. I can see he gets it, but not only that – he appreciates me trying so hard. Yet there is this look of ancient knowing in his face that brings me to a halt. It’s like saying “Thanks for the effort, mom, but this shit is not going away just like that”.

At school it breaks my heart to say I am not coming in with him to class. But I pull the teacher aside. I am not going to be a passive Outsider or desperate Defender of the Victim. I want the school to work this out, using the peer group. Now. Otherwise, there are no guarantees for what Mama Gorilla might do!

Can “we” be pregnant?

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The lady on the radio was upset. Upset by the fact that young couples nowadays say ‘We are pregnant’. What kind of a language use is that, she exclaimed. Clearly they cannot both be pregnant!

The other day I met some friends who have a six-month-old son, a happy little chap who prefers night-time company and feeds, to sleeping. Both his mother and father showed signs of sleep-deprivation as they made an effort to be social rather than fall asleep on the sofa. Frankly, they looked like shit, both of them. It was pretty clear it was their child, their nights, their decisions, their problem.

I think if I asked the lady on the radio if she thinks it’s fair that both parents take turns to get up and take care of their fussing six-month-old at night, she’d say yes, of course! Why should the mother carry the whole burden while the father gets to sleep – maybe with earplugs?

Well, here is the thing. We either want fathers to become and stay involved in pregnancy, childbirth, and caring for the child – or we don’t. We can’t pick and choose the bits and pieces where we want their involvement and exclude them from others.

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But are services before and after childbirth equipped to meet fathers’ needs? In a recent editorial I wrote for Acta Paediatrica I list a number of studies that have shown how fathers feel excluded from prenatal and child health care. They feel invisible, in the way, a disturbing presence that has no apparent role of its own to hold in a system by and for women.

What many maternal and child health nurses seem to be unaware of is their own ambivalent attitudes. On the one hand think it’s good to see more fathers attend their services, whereas on the other they do not take any active steps to accommodate fathers’ needs and do not specifically encourage their participation.

If there really is a new generation, who believes ‘they are pregnant’ services should be ready to meet them as such. Professionals working in the system need to be able to bracket their own attitudes about gender power relations in parenting and serve the family they meet based on the family’s preferences.

In a recent interview our team made with a child she referred to Mommy Sally and Mommy Vera without a wince. There was nothing strange about that for her. We have only just started to explore all the possible versions families can constitute in our postmodern society. Luckily, kids are mostly fine. The only thing that counts for them is having several involved adults around them who are sensitive to their needs. I think ‘we are pregnant’ is an excellent start for that!

Lessons in acceptance

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I had some very clear ideas of how I was going to spend my 40th birthday. I felt that the number 40 had some weight to it, I really wanted to make something of the day. So I planned skating on sparkling ice on the lake with my husband in the early morning sunshine, drinking hot chocolate from a thermos, then cake with my co-workers in the afternoon, and dinner out with Australian Shiraz as a compulsory component. A new metropolitan-style restaurant downtown was my choice and I looked forward to a nice family meal. And work, of course, during the day, as it is my passion, so wouldn’t leave that out.

As it turned out, there were some problems executing the plan. The weather was a terrible grey with fog and rain in the morning. The ice – if any – would be wet and unsafe. Joel had been sick for days and the dinner reservation had to be cancelled. The cake at work found a happy, but decimated group of very sweet co-workers – the rest of them sick at home or away for work. Luckily, there was an urgent deadline job to do and a grant application to put in so the work bit went fine. No Shiraz on reserve at home, though.

I guess the point is that I didn’t mind. Not the least bit, in fact. I accepted the day to be as it was and not the way I had wanted it to be. Bicycling in the rain to get some dry crackers and apple juice for my sick son was maybe not what I had planned, but was perfectly content doing. A pity that he threw it all up a couple of hours later.

Acceptance is not the same as losing personal agency. In fact, it is only through agency we can gain control of our situations and act in responsible ways. A sense of personal agency is empowering, even in the most miserable situations. We don’t always have a free choice. But we can choose how to act in a given situation.

Acceptance and commitment therapy is a therapy form taking advantage of acceptance of all feelings and experiences as a basis for change. In stead of avoiding, repressing or rigidly reiterating hurtful or unwanted feelings and using them as an explanation for destructive behaviour, ACT advises Accepting your reactions and being present, Choosing a valued direction, and Taking action. It sounds pretty straightforward when you think about it.

To me this sounds much like the type of self-regulation we are trying to promote in children using the Triple P parenting program. Good parenting is all about teaching children to experience their feelings, impressions, and impulses, and yet not to be ruled by them, but be able to regulate the direction and actions they take. To wait for their turn, to continue trying to solve a maths problem even if it’s difficult, to control the impulse of hitting their mate in the face for calling them a loser at soccer.

Effective self-regulation is actually quite a big ask and there are a lot of adults out there who could do with more such skills. Sometimes, lack of self-regulation is overt, you can easily tell when someone seems out of control. However, sometimes it is subtle: have you ever had a co-worker whose problems somehow always turned out to be your problems? Well, that’s a sign of self-regulatory processes in need of a brush-up.

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The good news? We can promote self-regulation in each other. If I have a problem and someone helps me find the answer based on my own resources rather than giving it to me, I improve my problem-solving ability and self-efficacy. I learn that many of the answers I might be looking for are well within my reach and will use that experience next time I encounter a difficulty. Thus, interaction with others becomes a way of gaining insights rather than projecting fears and feelings of inadequacy on those we meet.

So I Accepted that my birthday turned out differently than I had planned, Chose to direct my bike towards downtown and Took action: a new dress on sale crowned the day’s ACT. Self-regulated and done! And Joel is all better now.

Measuring for improvement

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One of the things I have to do as a leader is to guide my group to reach its goals. This, of course, requires setting measurable goals. Then we have to monitor our progress based on data that somehow describe the goals we set up. If we do not measure our achievements, we will not know if we have succeeded. If the goals we are to reach are not described in ways that are in accordance with actions we can take to reach them, we might as well save ourselves the trouble of setting goals in the first place.

In the swimming hall in Uppsala where I like to go to do my laps, there are three lanes: Extra fast, Fast, and Exercise swimming. In Melbourne, there were also three lanes: Fast, Medium, and Slow. There was also a sign saying that if someone taps your toe while swimming you should move to a slower lane.

If my goal is to be faster at swimming what should I do? “Exercise” will get me there, right? But if no one taps my toe if I am too slow, how will I know I should be moving faster? If my goal is simply to exercise – is the Exercise lane the right one for me? Well, no, because the ones who swim there are extremely SLOW and I do crawling.

ImagePhoto: Fanni Sarkadi, Melbourne, Australia

The issue of measuring is of course not an easy one. In science we use things, such as impact factors and rankings. Such technical measures of success are criticized for creating a business management paradigm in research and are argued to not necessarily enhance quality. However, I guess the fact that there is a journal called Scientometrics (a Hungarian co-publication) shows that bibliometry is here to stay.

It is also hard to measure quality in health care. Physicians are particularly weary of letting the essence of their profession be forced into dry numbers. Nevertheless – if your loved ones had cancer, would you rather have them treated at a centre with 0,5% complications and 85% 5-year survival rates or somewhere with worse or not even measured outcomes?

Schools are a third sector where measurement is a subject of perpetual debate. Should we or should we not give grades, from which age, based on what criteria?

When Johanna saw her grades in year 5 in Australia she said she wanted better ones. At our meeting to develop Johanna’s study plan for this year in Sweden I asked the teacher if she could help Johanna by giving her an indication of what grade her performance on tests would give her. “We don’t do grades in year 5”, she said. I know that, I said indication, you know, make-belief type of thing. Nope. And my daughter, obviously in need of some kind of measure and/or external motivator simply said: “Ok, I will study in sixth grade, not now”. That really made my day.

Don’t misunderstand me: I truly believe that intrinsic motivation (fun animation of Pink’s book in the link) is the best motivator and that as a research group leader my task is to find, not kill people’s drive to do good work. But even people who are truly intrinsically motivated need a certain measure of goal fulfilment. They want to know they are doing their job well. They want to be reaching goals. They want to know they have contributed!

I have heard so many frustrated colleagues who work hard and never know whether or not they are doing a good job. They become bitter and negative and lose their motivation, not because someone is trying to control them, but because nobody cares to value their work!

So I think the discussion every sector and workplace should be having is not whether we should be measuring our goals, but rather how this should be done best to tell us (and our clients and financers) if we are doing a good job.

The case of wrongdoings

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The couple therapist had a brilliant suggestion: Go home and try to do something wrong on purpose! We giggled and thought that this guy, with typical therapist-looks, was nice, although mildly insane. But we went home and tried. And tried. And did not succeed. Couldn’t, wouldn’t, do anything wrong on purpose.

Finally, I left some clothes on the hall floor after coming home with kids. Purposely not picking up the mittens, hats, and shoes scattered around. It was so hard to do that I finally understood the goal of the exercise: even if things go wrong in a family, it’s barely the person’s intention.

A new insight came the other day when both the girls’ teachers pointed out the importance of daring to be wrong when asked questions in class or not being certain about the validity a viewpoint. She said wrong or ambivalent answers could lead to more interesting discussions. My kids looked puzzled: they didn’t quite see the point of purposefully getting things wrong.

So apparently, what our family needs more of is being able to safely mess up. Get things wrong. Make mistakes. And not be persecuted on the altar of perfectionism – the grand enemy of creativity and happiness.

Being able to handle wrongdoings is an important part of any close relationship. Our internal working models of human relationships determine the way we deal with conflicts. Consider these four ways of viewing close relationships, based on attachment theory, and think about how it will affect the way the person reacts to a conflict.

  • It is relatively easy for me to become emotionally close to others. I am comfortable depending on others and having others depend on me. I don’t worry about being alone or having others not accept me. (Secure)
  • I am comfortable without close emotional relationships. It is very important to me to feel independent and self-sufficient, and I prefer not to depend on others or have others depend on me. (Dismissive)
  • I want to be completely emotionally intimate with others, but I often find that others are reluctant to get as close as I would like. I am uncomfortable being without close relationships, but I sometimes worry that others don’t value me as much as I value them. (Preoccupied)
  • I am somewhat uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I sometimes worry that I will be hurt if I allow myself to become too close to others. (Fearful)

Clearly, those with a secure attachment pattern will have a better inner ability to tolerate the ups and downs of relationships. The preoccupied or fearful attachment styles render the person vulnerable to feeling worthless, not accepted, and that conflicts might mean the end of a relationship. Someone with a dismissive style might be less tolerant to people’s shortcomings and be apt to back off rather than attempt to solve a conflict.

Adding perfectionism to the equation is like asking people to balance on a rope high up in the air while they are trying to deal with an actual or perceived wrongdoing of the other. It will become immensely difficult and shift the focus to not falling down instead of finding a mutually satisfying solution.

I think what the couple therapist was trying to get us to realise is that it is more than enough to have different personalities, cultural or social backgrounds, attachment styles, and temperamental traits involved in any conflict situation. We don’t need the illusion of perfection as a possibility messing up our chances in dealing with it.

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Fanni, our eldest, dropped a bag of Danish pastry on the floor yesterday with greasy crumbs scattering all over the floor. My gut reaction was of course to moan and accuse, but I quickly reminded myself to ease off and said it was no problem. The poor kid said about four times that it hadn’t been her intention to drop the bag until she heard what I was saying.

“Those things happen so easily, no problem. Look at the dog praising his luck. Just shove the rest up and it’s gone.” She just looked at me and said nothing, but I know we both felt much better already. If you think this is really basic stuff – good on you! You can advance to the next level of imperfection training.