All posts by gabbert2013

About gabbert2013

I have been a psychotherapist for 20+ years. I specialize in Marriage & Family Therapy and addictions. My practice name is Interactions Therapy Center. I've learned a few things over the years and hope you'll find these blogs interesting.

Why Do We Not Follow Advice?

Have you ever been given sound advice and disregarded it, only to regret it later? Have you been diagnosed with a disease, been prescribed medication, and fail to take it as prescribed? Have you been given step by step instructions for constructing a piece of furniture or a recipe, only to throw out the directions and wing it? As it turns out, this is a common human phenomenon. What’s up with this noncompliance or refusal to adhere to instructions?

There are few consequences for refusing to follow directions on assembling a piece of furniture or follow a recipe. However, there can be severe consequences for medical noncompliance. A third of people will not fill their prescription, and half of the remaining group will fill it but will not take their medication correctly. They’ll miss doses, stop it prematurely, or not take it at all. Medication noncompliance is responsible for 10% of all hospitalizations in the US and costs the health care system up to $289 billion per year.

Interestingly, a study found that US women are more likely than men to be noncompliant with medications for even serious diseases like heart failure and HIV. This has consequences for women’s health. We tend to be compliant when it comes to others, but not ourselves. If a child or a pet is in your care, you follow directions as prescribed. Twenty percent of women said they were more likely to follow the prescription plan for their pet than for themselves. But when it comes to self care, humans are more likely to fail.

Some medication noncompliance is the fault of the prescriber but the vast majority will fail of their own accord due to their environment or lack of resources. You cannot expect someone to fully comply if they have to choose between food, housing and medication. Or perhaps they distrust doctors. Or simply fail to understand the necessity of the medication.

There are many factors that affect adherence. These include having the intellectual ability to understand what is being advised and it fits your belief system. If you have a belief about the subject that runs counter to the advice given, you will act according to your own beliefs. You need sufficient memory to follow through on the advice. Confusion may follow too much detailed information. If you don’t respect or trust the opinion of the advice giver, you won’t follow their advice. There are certain personality traits that lend themselves to non adherence. Contrary, stubborn, passive-aggressive, and conduct disordered people will not easily accept the advice of others.

Admittedly, not everyone gives good advice. Michael Hyatt says “Never take advice from people who aren’t getting the results you want to experience.”

Jordan Peterson, in his book 12 Rules for Life, says “Treat yourself like someone you are responsible for helping.” He also says “Just take the damn medicine.”

Advertisements

Can You Take Criticism?

No one likes being criticized. We cringe when we hear the words “We have to talk.” Sometimes we don’t even get a fair warning of what’s coming. It’s natural to get defensive. It’s even healthy to defend ourselves against an unfair character assassination that could devastate our self esteem. But if we value this friendship and want to maintain a relationship with the critic, we need to engage in non-defensive communication. This requires maturity on our part while we are on our best behavior.

Harriet Lerner, PhD, lists 12 keys to non-defensive listening in her book Why Won’t You Apologize?: Healing Big Betrayals and Everyday Hurts.

  1. Recognize your defensiveness. This will allow you time to get some perspective rather than lashing out reactively.
  2. Breathe. Calm yourself.
  3. Listen only to understand. Do not interrupt, argue, correct facts or state your own criticisms.
  4. Ask questions about whatever you don’t understand.
  5. Find something you can agree with.
  6. Apologize for your part in the spirit of collaboration.
  7. Let the offended party know they have been heard and that you will continue to think about the conversation.
  8. Thank them for sharing their feelings.
  9. Take the initiative to bring the conversation up again.
  10. Draw the line at insults.
  11. Don’t listen when you can’t listen well.
  12. Define how you see some things differently. A premature apology from an overly accommodating, peace-at-any-price type of person is unsatisfying.

If we are the one doing the criticizing, we need to watch our words and understand the difference between a complaint, criticism and contempt. According to researcher John Gottman, PhD, 96% of the time, the outcome of an argument can be predicted based on the first three minutes of a conversation. Starting a conversation in a soft manner is far more effective than a harsh start-up. A complaint is specific, limited to one situation, and states how you feel. Example: “I’m upset that you didn’t pay the gas bill.” A criticism is global, includes blame, and often has words like always and never. Example: “How can I ever trust you?” Contempt is a verbal attack on your character. Example: “You stupid jerk.”

Before you confront someone on a point of contention, remind yourself of the value of this relationship. If you value them, it is worth taking the time to frame your complaint in a manner that they can hear.

Substance Abuse Prevention

You can’t teach “just say no” and expect good results. Prevention has to be experienced throughout one’s life.

Perhaps you participated in a DARE (Drug Abuse Resistance Education) program through school. Typically, police officers talk to a class of students for an hour once per week for 10 weeks. DARE has a zero-tolerance agenda and teach that all kinds of drugs, including alcohol and marijuana, are equally bad. They make use of scare techniques such as photos and videos of the negative consequences of addiction.

One would think this education would be a deterrent to addiction. However, it turns out that beginning in the late 1990s studies showed that DARE had no effect on whether or not students would go on to use or misuse drugs and alcohol in the future. After 20 years of implementing this program in schools, long term studies proved its ineffectiveness. Some evidence even suggests lower levels of self-esteem and a higher risk of substance misuse of students who went through DARE.

There are other curriculums with more promising results. The following are evidenced-based programs.

NOPE (Narcotics Overdose Prevention and Education) is designed to combat opioid addiction.

PROSPER (Promoting School-community-university Partnerships to Enhance Resilience) is designed for middle school students that is based on resiliency concepts via strong families.

Shatterproof is designed to stop drugs from shattering the lives of families. They focus on inspiration and anti-stigma efforts. They address addiction as a disease.

High school drinking and drug use is the lowest it’s been in 15 years. However, addiction often begins in adult years. Rather than rely on a 10-week school-based program, some programs are designed for families. Parents can be helped to communicate in positive ways, improve relationships with their children, and support academic and extracurricular activities. While Big Brother/Big Sisters doesn’t focus on substance prevention per se, they serve as a protective factor in youths lives.

A comprehensive prevention program will address risk and protective factors for substance use problems. Risk factors include early aggressive behaviors, lack of parental supervision, alcohol and drug use and easy availability, and poverty. Protective factors include good impulse control, parental monitoring, academic competence, anti-drug use policies, and strong neighborhood attachment.

People who become addicted to a substance often have underlying issues such as poor emotion regulation, insecure attachment, and may have a history of trauma. They may have repeated failures, helplessness, hopelessness and feel demoralized. These issues are not going to be addressed in a 10-week class.

According to SAMHSA, some prevention interventions are designed to help individuals develop the skills to act in a healthy manner. Others focus on creating environments that support healthy behavior. Research indicates that the most effective prevention interventions incorporate both approaches.

So, what can you do? Do your part to create a healthy environment for people from birth through adulthood.

What’s the Deal with Internet Trolls?

An internet troll is a person who deliberately tries to disrupt, attack, offend or cause trouble in an online social community. They may post offensive or hateful comments, display upsetting photos or videos, or subtly attempt to sway opinion with falsehoods. They may start quarrels or upset people, by posting inflammatory, extraneous, or off-topic messages. The intent is to provoke readers into an emotional response of disrupting normal, on-topic discussion, often for the troll’s amusement. These are not people who have bad manners. They are purposefully disruptive.

The effects of trolls can be simply annoying or can be fatal. Some victims have killed themselves. It can be damaging to an entire nation as may be the case of Russian interference in swaying US public opinion toward a particular outcome.

Trolls flourish within anonymity. They are not likely to behave this way in face to face encounters due to social barriers. Eye contact is shown to inhibit negative behavior by increasing empathy. Trolls can express themselves online without regard for a moral code where there are no repercussions for bad behavior. They may hide their identity through fake profiles.

Internet trolls are horrible people as found by a Canadian study. They compared people who said that trolling was their favorite internet activity with people who don’t troll. The trolls score high on personality traits of narcissism, Machiavellianism (sneaky, cunning, and lacking a moral code), psychopathy and sadism. The authors of the study are quoted as saying “Both trolls and sadists feel sadistic glee at the distress of others. Sadists just want to have fun . . . and the internet is their playground.” It is your suffering that brings them pleasure. They may also be motivated to troll by boredom, craving attention or revenge.

How do you stop them? They can be banned or blocked from individual user accounts or they can be reported to authorities. The most effective way to discourage a troll is to ignore it. Engaging in the dialog invites further disruptive posts. Their intention is to humiliate anyone who attempts to strike back. Unfortunately, personality traits of narcissism, Machiavellianism, psychopathy and sadism cannot be cured. They can alter their behavior if it serves them in some way, but they cannot be cured. There is insufficient research on the number of trolls, but statistics indicate that only one to 3 percent of the general population has these personality traits.

The lesson for the general population is to be aware of your online behavior and seek to be courteous toward others. I’ll end with a quote attributed to Ian MacLaren “Sir–A thought to help us through these difficult times: Be kind, for everyone you meet is fighting a hard battle.” Don’t be a troll.

Let’s Talk About Self-Injury

Imagine that you are a fourteen-year-old who has a history of parental abuse or neglect, is struggling at school, has few friends and is vulnerable to peer pressure. You are in frequent conflict with your parents. Some of your friends are known to intentionally harm themselves and say that they find relief in doing so. Do you have the skills to manage intense emotions? If you do the same by cutting your arms and legs, is it a cry for help, or a precursor to suicide?

What would lead someone to harm themselves? These are people who have problems regulating emotions. They don’t know how to cope with intense or overwhelming emotions and find relief through damaging their skin. It is most common among adolescents with an onset around age 13 or 14 and increases as they reach older adolescence up to age 17. It offers a temporary escape from intolerable feelings. The intent is survival rather than death.

How does creating pain by hurting your body help someone who is already in psychological pain? The self-injury may provide a distraction for someone who is better able to tolerate physical pain than emotional pain. It may give them a sense of control over their feelings. It is an attempt to express internal feelings in an external way. It may communicate intense emotions to the outside world. And it may serve as punishment for perceived faults.

Most people who harm themselves are not doing so for attention or making a cry for help. They typically wear long sleeves or long pants to hide the scars or cuts.

Self-injury is the deliberate destruction of body tissue without suicidal intent. It is listed in the DSM 5 as a diagnostic disorder. Its criteria are five or more days of self-inflicted harm over the course of one year without suicidal intent and, the individual was motivated by seeking relief from a negative state, resolving an interpersonal difficulty, or achieving a positive state.

However, a spectrum of behavior exists from self-injury on one end progressing to suicide attempts on the end. Self-injury is a strong predictor of future suicide attempts. It is important not to assume that someone who harms their body wants to kill themselves, but keep in mind that there is increased risk for suicide.

The goal of therapy is to help clients learn to tolerate uncomfortable feelings and find healthier means of managing overwhelming emotions. They can benefit from learning to control impulses. Increasing family and social support is a buffer against these intense states. Research shows that strong parental bonds can differentiate those who think about suicide from those who actually attempt suicide.

If you know someone who self-injures don’t panic or become angry. Although this behavior is alarming, understand that this is someone who is struggling emotionally. Ask them what you can do to help them from injuring themselves. Realize that this is a coping strategy, not a weapon against you. Model healthier coping skills. It is a treatable condition.

Can Mental Health Treatment Prevent Mass Shootings?

19-year-old Nikolas Cruz opened fire on a Florida high school on Valentine’s Day, 2018. He killed 17 people. In an attempt to understand why this occurred, and how to prevent it in the future, many focus the debate on lack of gun control and mental illness. Could mental health treatment have prevented this?

Nikolas Cruz participated in mental health treatment, but we don’t know what type of treatment he received. He stopped his treatment for unknown reasons. He is described as having had “emotional problems” since childhood, a quick temper and anger problems. These often led to property destruction, odd behavior toward other students in school, and expulsion from school. The expulsion was related to fighting and/or carrying a knife in school. It was said that he struggled with grief or depression related to the death of his mother who died in November from pneumonia. The couple who took him in after his mother died said they did not see any warning signs. They thought he was doing well at his new school and was working hard to get his high school diploma.

Would Cruz have committed mass murder if he had the right kind of treatment, or if he had continued treatment?

It is my opinion that mental health treatment will only minimally stop mass shootings. Research demonstrates that mental illness is not a predictor of violence. There is some association between mental illness and violence, but the association is weak. One study, from Annals of Epidemiology, states “evidence is clear that the large majority of people with mental disorders do not engage in violence against others, and that most violent behavior is due to factors other than mental illness.” Anger is a problem for people with and without mental illness. Anger can be, but isn’t always, a component of mental illness. Also, many people with anger issues do not have a mental illness. According to the American Psychiatric Association, “mass shootings by people with serious mental illness represent 1% of all gun homicides each year.” Counseling can be helpful toward anger management, but only for people who are motivated for change.

It has been said that President Trump revoked former President Obama’s executive order barring mentally ill persons from gun purchases. Congress did revoke regulations preventing some people from purchasing a gun, but it was already limited in scope. People prevented from purchasing a gun have been determined by a court to have marked mental illness who are a danger to themselves or others; or lack the mental capacity to manage their own affairs; who has been declared insane by a court in a criminal case; and those people who are found incompetent to stand trial or found not guilty by reason of lack of mental responsibility. This is a very narrow subset of mentally ill people and would not apply to the vast majority of people who commit homicide.

The mental health system in America is broken. Treatment is not readily available to those who need it, particularly in rural areas. More than 50% of Americans who suffer from a mental illness do not receive treatment. High cost, limited health insurance, resistance and stigma are all barriers to help.

President Trump has said when someone is obviously disturbed they should be reported to authorities. Fair enough, but police officers rely on mental health providers to assess dangerousness and place people in the most appropriate level of care. Multiple levels of care include outpatient, intensive outpatient treatment, partial hospitalization, inpatient hospitalization, and residential. Persons with mental health disorders should be provided with health care which is the least restrictive. The aim is to preserve the patient’s dignity, rights and freedoms as much as possible. One is not easily or quickly committed to seclusion or restraint for their own or other’s safety. Most states have a 72-hour period in which an assessment is completed for emergencies. Once the 72-hour hold is lifted, patients can request a discharge. Or, if the hospital team believes it is necessary, they will start the commitment process. This process begins after a threat to self or others has been substantiated. It is not a highly effective prevention measure.

It is critically important to institute an action plan against shootings. The number of mass shootings is increasing. A national organization that tracks school threats says there are 10 threats a day on average. After the Parkland, Florida incident there have been about 50 threats a day on average.

When assessing potential lethality, professionals ask if the patient has access to weapons. If they are deemed dangerous, they take action to limit access to weapons. That’s a first step in decreasing risk. In the case of mass shooters, gun control is the first line of defense.

So what else can we do to prevent violence? Adopt and teach emotion regulation skills. Emotion regulations are measures taken by an individual to monitor, evaluate and modify intense emotional reactions. Deficits of emotion regulation are linked to depression, anxiety, substance abuse and other conditions. Improving emotion regulation skills can serve as violence prevention. For example, one skill is to accept and tolerate negative emotions. I would like to see these skills modeled by adults and taught across all levels of education.

Perhaps if Nikolas Cruz practiced emotion regulation skills he would have found healthy ways of expressing his anger and grief.

What People in Opioid Addiction Recovery Want You to Know

Chances are you either know someone with a substance abuse problem, or have a problem yourself. According to the National Survey on Drug Use and Health (NSDUH), 21.5 million Americans (aged 12 and older) battled a substance use disorder in 2014. There are more than 23 million Americans in recovery from addiction to alcohol and other drugs.

Addiction, by definition, involves negative consequences to the person’s life. It is often devastating to families and friends. It’s often said that addiction is a family disease. That means that everyone in the family is affected by one member’s addiction. Addiction affects the stability of the home, the unity of the family, mental and physical health, and the overall family dynamic.

They desperately want the addiction to stop. Once a person who misuses alcohol or drugs starts a recovery process, the family is greatly relieved.

A person who becomes dependent upon an Opioid, such as heroin or prescription pain killers, has special challenges in recovery. By mid to late stage Opioid addiction their fear of withdrawal has caused them to act in ways they would never have otherwise behaved. In recovery, they may suffer intense guilt over their behavior. They want the support and trust of their family but can’t be fully open about their recovery because the family may have certain assumptions about recovery.

I talked with a group of Opioid dependent people in recovery who discussed their families’ assumptions. Here’s what their family members and loved ones want to believe about the recovering person:

1. Recovery is a decision, not a process.

2. The addiction is in the past and they are “all better now.”

3. They will never slip.

4. All of their days are sunny. They should be grateful and have a positive attitude.

5. If they were really motivated, they wouldn’t need medication for Opioid addiction.

The recovering addict wants to reestablish relationships with their family and don’t want to disappoint them. They may hide their true feelings from family. But if they could be really honest about their recovery they would say the following:

1. I’m not always happy. My life is infinitely improved in recovery and I have every reason to be happy. But I struggle with depression, anxiety and feelings of worthlessness. The underlying issues that contributed to my addiction are not gone simply because I stopped using substances.

2. I miss the drug’s warm blanket that numbed my pain, gave me energy and euphoria, and provided a distraction from life’s stress.

3. I still have cravings from time to time. I am perpetually on guard against relapsing.

4. I feel judged by my past. I am often misunderstood. For example, when I excuse myself from your presence, am tired, or behave badly, it is not evidence that I am getting high.

5. I may never have used a needle or heroin. Your assumptions, based on media sensationalism, may be wrong.

6. MAT (Medication Assisted Treatment) such as Methadone or Suboxone is the gold standard of treatment for Opioid dependency.

7. I’m tired of having to explain that MAT is not substituting one drug for another.

8. I’m not interested in tapering off my medication. I may choose to stay on MAT indefinitely. I have a chronic lifelong disease and will never be cured.

9. It’s not over. Although I’m drug free, the damage done can take years to repair.

Recovery support groups are a safe place for members to share their innermost thoughts and feelings. They are understood by others who have walked a similar path. But sharing their recovery journey with family members can be healing to the entire unit.

Can you ever again return to normal? With treatment, both the addict and family members can go on to live full, happy, and productive lives.

He Very Strongly Said He Was Innocent

Rob Porter, a White House staff secretary, is in the news this week. All White House staff are subject to a background check before being granted security clearance. The FBI knew of Porter’s domestic assault after interviewing his ex-wives and having access to police reports and a 2010 Order of Protection. The FBI passed this information to John Kelly who allowed Porter access to classified information in spite of this knowledge. This poses a risk of blackmail to the office.

He resigned after domestic violence charges toward his two ex-wives came under scrutiny after months on the job. Porter called the allegations “outrageous” and “simply false.” President Trump wanted to believe him. Trump made a statement “remember Rob Porter says he’s innocent and I think you have to remember that. He said very strongly yesterday that he’s innocent so you have to talk to him about that.”

Chief of staff, John Kelly, initially made a statement describing Porter as “a man of true integrity.” But after viewing photographs of Porter’s assault Kelly said he was shocked by the allegations. Why wasn’t he shocked when he first learned of the assaults? Porter was described as having kicked, choked and punched his first wife. He would throw her down on a soft surface, shake her, and rub an elbow or knee into her. His second wife stated that Porter dragged her naked and wet from the shower to yell at her. He dismissed these women’s words but was “shocked” upon seeing a photograph of one of the women with a black eye. Seeing is believing, but a testimony and criminal records are not believed?

Trump has a history of defending men who are alleged to have abused women, including himself. For example, Corey Lewandowski, his election campaign manager, who faced a misdemeanor battery charge after an altercation with a female reporter. And he defended Roger Ailes, Fox news producer amid sexual harassment allegations. And Fox news host Bill O’Reilly was described as “a good person. I don’t think Bill did anything wrong.” And Roy Moore, a candidate for the US Senate who lost the election after numerous allegations of sexual misconduct with underaged girls was supported by Trump. “He said he didn’t do it.” What he has not done is defend the victims of sexual or physical assault.

Trump and Kelly believe every individual deserves the right to defend their reputation. True enough. But they don’t have a right to ignore or deny facts of history. When Trump asked “Is there no such thing any longer as Due Process?” he is referring to the presumption of innocence. In the case of Porter, he had due process in 2010 and was deemed dangerous when a judge granted an Order of Protection to his first wife.

There are not two sides to the issue of domestic assault. Domestic assault, whether it is physical, sexual, emotional, or economic, is a crime and should be treated as such. The White House sent the message that domestic violence should be covered up, perpetrators should be shielded and protected from accountability, and victims are not to be believed.

But he’s a good employee. Trump defended Porter saying “He did a very good job. We wish him well, he worked very hard. It’s a tough time for him. We hope he has a wonderful career and he will have a great career ahead of him.” As a perpetrator of domestic assault, he should not have a job that is risk sensitive. I also wish Porter well. It is my hope that he participates in a batterers education program and changes his thinking and behavior. I hope he addresses his need for power and control over women. As in his case, the cycle of abuse continues from one victim to another without intervention and treatment.

The stakes are high. Domestic assault is an epidemic. Three women are murdered every day by a current or formal partner in the US. Seventy percent of women worldwide will experience physical and/or sexual abuse by an intimate partner during their lifetimes. One in seven men have been victims of severe physical violence by an intimate partner in their lifetime. It is not to be denied or minimized just because you want to believe in the accused’s innocence.

Strongly stating that you are innocent, does not necessarily make it so.

Love (Usually) Wins over Heartache (Eventually)

Women who have experienced the pain of childbirth may say they’ll never do it again. Some people (more women than men) who divorce resolve never to marry again. Pet owners who experience the anguish of their pet’s death may grieve as intensely as losing a close family member. They may be hesitant to make another lifelong commitment to a furry being. But more often than not, love wins over heartache. In spite of the pain and heartache we allow ourselves to love again.

Do we forget the pain of our previous losses? Some people believe that time heals all wounds and that our memories of pain soften with time. Not necessarily so. Time alone doesn’t always heal your psychological wounds. Time is not medicine.

It is a myth that women are biologically programmed to forget the pain of childbirth. It hasn’t been forgotten, but the happiness and burst of oxytocin of cradling a baby colors the memory of the preceding pain. This is known as the halo effect. Over time, many women report labor and birth pain as less severe than they originally thought. But women who reported they had “the worst pain imaginable” continue to report that five years later. It could be that no matter how painful childbirth is, some women feel that the unconditional love and wonderful experiences with their child make childbirth worth the hours of pain.

If you have experienced the pain of divorce, you know how devastating it is to lose your best friend and see your future hopes and dreams disappear. Yet, many people try it again. Sixty-four percent of men had remarried in 2013, compared with 52 percent of women. Optimism alone doesn’t make for a happy remarriage. Sixty percent of second marriages end in divorce. Seventy-three percent of third marriages end in divorce. Professional counseling in the first marriage may save later heartache.

My husband and I lost Bingo, our eight-year-old Cavalier King Charles Spaniel, this week. Bingo had struggled with congestive heart failure and a respiratory illness until we made the difficult decision to facilitate his passing. As you can imagine, we are devastated to lose the company of this sweet, although neurotically anxious, boy. Would we do it again? It is too soon to tell, but if our past is an indicator of the future, we will open our hearts and adopt again.

Rather than throw in the towel and declare that we’ll never face heartache again, we need to heal, then assess whether the risk outweighs the costs.

How do we heal? Social support is critical to healing. Rely on your friends for comfort. Friends offered hugs and invitations to talk. I posted news of Bingo’s death on Facebook and received countless acknowledgments of my grief. Each hug and gesture of support made me feel warm and fuzzy. In fact, hugs ward off stress and protect the immune system. This makes me less susceptible to depression and anxiety. One study of hugs found that both perceived social support and more frequent hugs reduced the risk of infection and less severe illness symptoms. Hugs also lower blood pressure, alleviate fears around death and dying, improve heart health and decrease feelings of loneliness. One friend emailed me a group of photos of human/animal hugs that also gave me warm and fuzzy feelings, prompting a healing effect.

Once sufficiently, but not perfectly, healed, assess whether you are ready to take the risk of love again. Love is all about taking risks. Peter McWilliams said: “It is a risk to love. What if it doesn’t work out? Ah, but what if it does?” It’s your choice.

 

How Much is a Little Girl Worth?

In September 2016, Rachel Denhollander was the first woman to make a public allegation of sexual assault against former USA Gymnastics (USA Gymnastics) and Michigan State University (MSU) team doctor Larry Nassar. Nassar was accused of sexually abusing more than 140 children and young women. He was sentenced to 40-175 years in prison on seven counts of criminal sexual conduct in the first degree. He is already serving 60 years in prison on child pornography charges and awaits sentencing on three more counts of criminal sexual conduct in the first degree. 169 survivors and family members were allowed to give victim impact statements in court.

Denhollander made a powerful statement about the long and frustrating process of seeking an end to the abuse and justice to be served. In making a case for a long prison sentence, she asked the judge to consider “How much is a little girl worth? How much is a young woman worth?”. She pled for the maximum sentence and the fullest weight of the law to be used to protect another innocent child from sexual assault. Children are worth every protection the law can offer.

She described Nassar as a hardened and determined sexual predator. She was sexually assaulted by him over a 16-year period under the guise of medical treatment. Nassar groomed her for the purpose of his sexual gain. He found satisfaction in the suffering of his victims, some girls as young as six years old. He gained the trust of their parent, sometimes performing sexual violation with a parent in the room.

What was particularly upsetting in her testimony was the ability of others to minimize, deny and fail to act on behalf of victims. Four other victims prior to her allegation had described his behavior and penetration and their belief that they had been assaulted, in detail, to three different athletic departments at MSU. It was reported to MSU’s head gymnastics coach, to a track coach and to multiple athletic trainers and supervisors years prior to Denhollander’s contact with Nassar. Some of the trainers and people in positions of authority had been told of the abuse and were silenced. USAG was burying reports of sexual assault instead of reporting them. This led to a culture of abuse against children without fear of being caught. The USAG allowed Nassar to “treat” these girls in their own beds without having a medical license in the state of Texas.

Denhollander is angry. MSU responded to allegations with press releases saying that there was no cover-up because no one who heard the reports of assaults believed that Nassar was committing abuse. They didn’t know, because no one believed. And because no one believed, victims were silenced, intimidated, repeatedly told it was medical treatment and forced to return to Nassar for continued assault. Authorities said the allegations of assault didn’t count because it wasn’t told to the right person. They imply that the right person is the one who has authority to fire the alleged perpetrator.

As a result of this case, The US Olympic Committee has ordered the entire USA Gymnastics board to resign by January 31. Two MSU officials have quit. MSU athletic director stepped down following reports that the school knew of the abuse claims but failed to take action. These bodies are required to examine their plans for combating abuse.

So, who has the duty to protect children? Who is the right person to file a report? What is the right way to handle sexual assault allegations?

I am a mental health professional who is mandated to report allegations of abuse to our state department of child welfare. But everyone has a duty to protect children. Everyone is morally and ethically mandated to protect vulnerable people by nature of being a responsible world citizen. It is never an easy task to place a call for fear of negative consequences. However, it is not your role to be judge and jury as to the validity of an allegation. You are only called upon to place the call. Once you place a call, a case worker will assess whether the allegation is reportable according to their guidelines. If so, a police report is made and an investigation is held. They will deem the allegation founded, or unfounded, and take appropriate steps to ensure the safety of the child.

Here’s the wrong way to handle an allegation. Don’t ignore it and hope it will go away. Don’t deny the allegation and assume that the victim is confused, making it up, or the allegation lacks proof. Don’t honor your own belief that bringing forth the allegation will cause further harm to the victim, and therefore hide the report. Don’t assign malicious intent to the victim, believing them to be wanting attention, or seeking financial gain. Don’t hide behind the idea that there is fault on both sides, and the victim must have wanted it or contributed to it on some level. And don’t assume that children are resilient and no long harm has been done. Victims will have lifetime scars.

“How much is a little girl worth? How much is a young woman worth?” These are questions that you alone answer when you suspect or learn of abuse. Do your part in protecting children.