Approach and Philosophy
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. Gingras’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. Gingras 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, especially if there is no careful monitoring. Dr. Gingras is conservative about diagnosis and medication use. In order for him to make a psychiatric diagnosis, the symptoms have to be extensive and severe, and there must be significant impairment of functioning and relationships. Today’s drugs are powerful as well as effective. 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 Psychotherapy
There is a growing tendency to see psychological problems as biologically based, and to treat them with medication and/or behavior therapy. However, not all difficulties are due to a “chemical imbalance,” and medication does not address deeper personal conflicts. Many well-functioning people describe a sense of emptiness, of quiet despair. They repeatedly get involved in self-defeating relationships or self-destructive behaviors. These patients want more than symptom relief. Their goal is to conquer their inner demons. They aim to lead a more fulfilled life, one that comes more closely to achieving their true potential. Much unhappiness in later life can be traced to childhood experiences that result in unresolved inner conflict. Psychotherapy can be most helpful to such patients, even if it is combined with small doses of medication to provide symptom relief
Underperformance Is Not a 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 without fidgeting or being distracted (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. 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.
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. Gingras, in addition to offering important psychological insights, 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 understand her for the person she is, and to gear your expectations to her genuine capacities. Certain children are born temperamentally difficult, and are consequently harder to raise than average children. Their parents are often confused, guilty and angry. There are effective techniques to help these parents.
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 four older brothers, raised on a farm 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, 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. Dr. Gingras 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. She then makes a conscious effort to position herself as the child’s ally. 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” should not start by telling the child what he has done wrong. Rather, the aim is to arrive at a collaboration, and this may involve admitting your own role in perpetuating a conflict.
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. Gingras focuses on the strengths of his patients because a feeling of success obviously enhances one’s self-esteem. Conversely, while believing that obvious vulnerabilities should be addressed, Dr. Gingras 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.