Spoon-Fed – by Dr. Tim Spector
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Dr. Spector looks at widespread beliefs about food, and where those often scientifically disproven beliefs come from. Hint, there’s usually some manner of “follow the money”.
From calorie-counting to cholesterol content, from fish to bottled water, to why of all the people who self-report having an allergy, only around half turn out to actually have one when tested, Dr. Spector sets the record straight.
The style is as very down-to-earth and not at all self-aggrandizing; the author acknowledges his own mistakes and limitations along the way. In terms of pushing any particular agenda, his only agenda is clear: inform the public about bad science, so that we demand better science going forwards. Along the way, he gives us lots of information that can inform our personal health choices based on better science than indiscriminate headlines wildly (and sometimes intentionally) misinterpreting results.
Read this book, and you may find yourself clicking through to read the studies for yourself, next time you see a bold headline.
Bottom line: this book looks at a lot of what’s wrong with what a lot of people believe about healthy eating. Regular 10almonds readers might not find a lot that’s new here, but it could be a great gift for a would-be health-conscious friend or relative
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Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
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Reporting Highlights
- Progress Denials: Insurers use a patient’s improvement to justify denying mental health coverage.
- Providers Disagree: Therapists argue with insurers and the doctors they employ to continue covering treatment for their patients.
- Patient Harm: Some patients backslid when insurers cut off coverage for treatment at key moments.
These highlights were written by the reporters and editors who worked on this story.
Geneva Moore’s therapist pulled out her spiral notebook. At the top of the page, she jotted down the date, Jan. 30, 2024, Moore’s initials and the name of the doctor from the insurance company to whom she’d be making her case.
She had only one chance to persuade him, and by extension Blue Cross and Blue Shield of Texas, to continue covering intensive outpatient care for Moore, a patient she had come to know well over the past few months.
The therapist, who spoke on the condition of anonymity out of fear of retaliation from insurers, spent the next three hours cramming, as if she were studying for a big exam. She combed through Moore’s weekly suicide and depression assessments, group therapy notes and write-ups from their past few sessions together.
She filled two pages with her notes: Moore had suicidal thoughts almost every day and a plan for how she would take her own life. Even though she expressed a desire to stop cutting her wrists, she still did as often as three times a week to feel the release of pain. She only had a small group of family and friends to offer support. And she was just beginning to deal with her grief and trauma over sexual and emotional abuse, but she had no healthy coping skills.
Less than two weeks earlier, the therapist’s supervisor had struck out with another BCBS doctor. During that call, the insurance company psychiatrist concluded Moore had shown enough improvement that she no longer needed intensive treatment. “You have made progress,” the denial letter from BCBS Texas read.
When the therapist finally got on the phone with a second insurance company doctor, she spoke as fast as she could to get across as many of her points as possible.
“The biggest concern was the abnormal thoughts — the suicidal ideation, self-harm urges — and extensive trauma history,” the therapist recalled in an interview with ProPublica. “I was really trying to emphasize that those urges were present, and they were consistent.”
She told the company doctor that if Moore could continue on her treatment plan, she would likely be able to leave the program in 10 weeks. If not, her recovery could be derailed.
The doctor wasn’t convinced. He told the therapist that he would be upholding the initial denial. Internal notes from the BCBS Texas doctors say that Moore exhibited “an absence of suicidal thoughts,” her symptoms had “stabilized” and she could “participate in a lower level of care.”
The call lasted just seven minutes.
Moore was sitting in her car during her lunch break when her therapist called to give her the news. She was shocked and had to pull herself together to resume her shift as a technician at a veterinary clinic.
“The fact that it was effective immediately,” Moore said later, “I think that was the hardest blow of it all.”
Many Americans must rely on insurers when they or family members are in need of higher-touch mental health treatment, such as intensive outpatient programs or round-the-clock care in a residential facility. The costs are high, and the stakes for patients often are, too. In 2019 alone, the U.S. spent more than $106.5 billion treating adults with mental illness, of which private insurance paid about a third. One 2024 study found that the average quoted cost for a month at a residential addiction treatment facility for adolescents was more than $26,000.
Health insurers frequently review patients’ progress to see if they can be moved down to a lower — and almost always cheaper — level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients’ conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided.
Their doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it, but not so much that the companies prematurely cut them off from care. And when insurers demand that providers spend their time justifying care, it takes them away from their patients.
“The issues that we grapple with are in the real world,” said Dr. Robert Trestman, the chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing. “People are sicker with more complex conditions.”
Mental health care can be particularly prone to these progress-based denials. While certain tests reveal when cancer cells are no longer present and X-rays show when bones have healed, psychiatrists say they have to determine whether someone has returned to a certain level of functioning before they can end or change their treatment. That can be particularly tricky when dealing with mental illness, which can be fluid, with a patient improving slightly one day only to worsen the next.
Though there is no way to know how often coverage gets cut off mid-treatment, ProPublica has found scores of lawsuits over the past decade in which judges have sharply criticized insurance companies for citing a patient’s improvement to deny mental health coverage. In a number of those cases, federal courts ruled that the insurance companies had broken a federal law designed to provide protections for people who get health insurance through their jobs.
Reporters reviewed thousands of pages of court documents and interviewed more than 50 insiders, lawyers, patients and providers. Over and over, people said these denials can lead to real — sometimes devastating — harm. An official at an Illinois facility with intensive mental health programs said that this past year, two patients who left before their clinicians felt they were ready due to insurance denials had attempted suicide.
Dr. Eric Plakun, a Massachusetts psychiatrist with more than 40 years of experience in residential and intensive outpatient programs, and a former board member of the American Psychiatric Association, said the “proprietary standards” insurers use as a basis for denying coverage often simply stabilize patients in crisis and “shortcut real treatment.”
Plakun offered an analogy: If someone’s house is on fire, he said, putting out the fire doesn’t restore the house. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?”
Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.
During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.
A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.
How Insurers Justify Denials
Buried in the denial letters that insurance companies send patients are a variety of expressions that convey the same idea: Improvement is a reason to deny coverage.
“You are better.” “Your child has made progress.” “You have improved.”
In one instance, a doctor working for Regence Blue Cross and Blue Shield of Oregon wrote that a patient who had been diagnosed with major depression was “sufficiently stable,” even as her own doctors wrote that she “continued to display a pattern of severe impairment” and needed round-the-clock care. A judge ruled that “a preponderance of the evidence” demonstrated that the teen’s continued residential treatment was medically necessary. The insurer said it can’t comment on the case because it ended with a confidential settlement.
In another, a doctor working for UnitedHealth Group wrote in 2019 that a teenage girl with a history of major depression who had been hospitalized after trying to take her own life by overdosing “was doing better.” The insurer denied ongoing coverage at a residential treatment facility. A judge ruled that the insurer’s determination “lacked any reasoning or citations” from the girl’s medical records and found that the insurer violated federal law. United did not comment on this case but previously argued that the girl no longer had “concerning medical issues” and didn’t need treatment in a 24-hour monitored setting.
To justify denials, the insurers cite guidelines that they use to determine how well a patient is doing and, ultimately, whether to continue paying for care. Companies, including United, have said these guidelines are independent, widely accepted and evidence-based.
Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.
MCG Health did not respond to multiple requests for comment. A spokesperson for the Optum division that works on the InterQual guidelines said that the criteria “is a collection of established scientific evidence and medical practice intended for use as a first level screening tool” and “helps to move patients safely and efficiently through the continuum of care.”
A separate spokesperson for Optum also said the company’s “priority is ensuring the people we serve receive safe and effective care for their individual needs.” A Regence spokesperson said that the company does “not make coverage decisions based on cost or length of stay,” and that its “number one priority is to ensure our members have access to the care they need when they need it.”
In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
“It’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at the Anthem subsidiary Beacon and at Humana for a total of six years before leaving the industry in 2022. In her role, Lindsey said, she would suggest approving or denying coverage, which — for the latter — required a staff doctor’s sign-off. She is now a mental health consultant for behavioral health businesses and clinicians.
A spokesperson for Elevance Health, formerly known as Anthem, said Lindsey’s “recollection is inaccurate, both in terms of the processes that were in place when she was a Beacon employee, and how we operate today.” The spokesperson said “clinical judgment by a physician — which Ms. Lindsey was not — always takes precedence over guidelines.”
In an emailed statement, a Humana spokesperson said the company’s clinician reviewers “are essential to evaluating the facts and circumstances of each case.” But, the spokesperson said, “having objective criteria is also important to provide checks and balances and consistently comply with” federal requirements.
The guidelines are a pillar of the health insurance system known as utilization management, which paves the way for coverage denials. The process involves reviewing patients’ cases against relevant criteria every handful of days or so to assess if the company will continue paying for treatment, requiring providers and patients to repeatedly defend the need for ongoing care.
Federal judges have criticized insurance company doctors for using such guidelines in cases where they were not actually relevant to the treatment being requested or for “solely” basing their decisions on them.
Wit v. United Behavioral Health, a class-action lawsuit involving a subsidiary of UnitedHealth, has become one of the most consequential mental health cases of this century. In that case, a federal judge in California concluded that a number of United’s in-house guidelines did not adhere to generally accepted standards of care. The judge found that the guidelines allowed the company to wrongly deny coverage for certain mental health and substance use services the moment patients’ immediate problems improved. He ruled that the insurer would need to change its practices. United appealed the ruling on grounds other than the court’s findings about the defects in its guidelines, and a panel of judges partially upheld the decision. The case has been sent back to the district court for further proceedings.
Largely in response to the Wit case, nine states have passed laws requiring health insurers to use guidelines that align with the leading standards of mental health care, like those developed by nonprofit professional organizations.
Cigna has said that it “has chosen not to adopt private, proprietary medical necessity criteria” like MCG. But, according to a review of lawsuits, denial letters have continued to reference MCG. One federal judge in Utah called out the company, writing that Cigna doctors “reviewed the claims under medical necessity guidelines it had disavowed.” Cigna did not respond to specific questions about this.
Timothy Stock, one of the BCBS doctors who denied Moore’s request to cover ongoing care, had cited MCG guidelines when determining she had improved enough — something judges noted he had done before. In 2016, Stock upheld a decision on appeal to deny continued coverage for a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder and anxiety. Pointing to the guidelines, Stock concluded she had shown enough improvement.
The patient’s family sued the insurer, alleging it had wrongly denied coverage. Blue Cross and Blue Shield of Illinois argued that there was evidence that showed the patient had been improving. But, a federal judge found the insurer misstated its significance. The judge partially ruled in the family’s favor, zeroing in on Stock and another BCBS doctor’s use of improvement to recommend denying additional care.
“The mere incidence of some improvement does not mean treatment was no longer medically necessary,” the Illinois judge wrote.
In another case, BCBS Illinois denied coverage for a girl with a long history of mental illness just a few weeks into her stay at a residential treatment facility, noting that she was “making progressive improvements.” Stock upheld the denial after an appeal.
Less than two weeks after Stock’s decision, court records show, she cut herself on the arm and leg with a broken light bulb. The insurer defended the company’s reasoning by noting that the girl “consistently denied suicidal ideation,” but a judge wrote that medical records show the girl was “not forthcoming” with her doctors about her behaviors. The judge ruled against the insurer, writing that Stock and another BCBS doctor “unreasonably ignored the weight of the medical evidence” showing that the girl required residential treatment.
Stock declined to comment. A spokesperson for BCBS said the company’s doctors who review requests for mental health coverage are board certified psychiatrists with multiple years of practice experience. The spokesperson added that the psychiatrists review all information received “from the provider, program and members to ensure members are receiving benefits for the right care, at the right place and at the right time.”
The BCBS spokesperson did not address specific questions related to Moore or Stock. The spokesperson said that the examples ProPublica asked about “are not indicative of the experience of the vast majority of our members,” and that it is committed to providing “access to quality, cost-effective physical and behavioral health care.”
A Lifelong Struggle
A former contemporary dancer with a bright smile and infectious laugh, Moore’s love of animals is eclipsed only by her affinity for plants. She moved from Indiana to Austin, Texas, about six years ago and started as a receptionist at a clinic before working her way up to technician.
Moore’s depression has been a constant in her life. It began as a child, when, she said, she was sexually and emotionally abused. She was able to manage as she grew up, getting through high school and attending Indiana University. But, she said, she fell back into a deep sadness after she learned in 2022 that the church she found comfort in as a college student turned out to be what she and others deemed a cult. In September of last year, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week.
Moore, 32, had spent much of the past eight months in treatment for severe depression, post-traumatic stress disorder and anxiety when BCBS said it would no longer pay for the program in January.
The denial had come to her without warning.
“I was starting to get to the point where I did have some hope, and I was like, maybe I can see an actual end to this,” Moore said. “And it was just cut off prematurely.”
At the Austin emergency room where she drove herself after her treatment stopped, her heart raced. She was given medication as a sedative for her anxiety. According to hospital records she provided to ProPublica, Moore’s symptoms were brought on after “insurance said they would no longer pay.”
A hospital social worker frantically tried to get her back into the intensive outpatient program.
“That’s the sad thing,” said Kandyce Walker, the program’s director of nursing and chief operating officer, who initially argued Moore’s case with BCBS Texas. “To have her go from doing a little bit better to ‘I’m going to kill myself.’ It is so frustrating, and it’s heartbreaking.”
After the denial and her brief admission to the hospital emergency department in January, Moore began slicing her wrists more frequently, sometimes twice a day. She began to down six to seven glasses of wine a night.
“I really had thought and hoped that with the amount of work I’d put in, that I at least would have had some fumes to run on,” she said.
She felt embarrassed when she realized she had nothing to show for months of treatment. The skills she’d just begun to practice seemed to disappear under the weight of her despair. She considered going into debt to cover the cost of ongoing treatment but began to think that she’d rather end her life.
“In my mind,” she said, “that was the most practical thing to do.”
Whenever the thought crossed her mind — and it usually did multiple times a day — she remembered that she had promised her therapist that she wouldn’t.
Moore’s therapist encouraged her to continue calling BCBS Texas to try to restore coverage for more intensive treatment. In late February, about five weeks after Stock’s denial, records show that the company approved a request that sent her back to the same facility and at the same level of care as before.
But by that time, her condition had deteriorated so severely that it wasn’t enough.
Eight days later, Moore was admitted to a psychiatric hospital about half an hour from Austin. Medical records paint a harrowing picture of her condition. She had a plan to overdose and the medicine to do it. The doctor wrote that she required monitoring and had “substantial ongoing suicidality.” The denial continued to torment her. She told her doctor that her condition worsened after “insurance stopped covering” her treatment.
Her few weeks stay at the psychiatric hospital cost $38,945.06. The remaining 10 weeks of treatment at the intensive outpatient program — the treatment BCBS denied — would have cost about $10,000.
Moore was discharged from the hospital in March and went back into the program Stock had initially said she no longer needed.
It marked the third time she was admitted to the intensive outpatient program.
A few months later, as Moore picked at her lunch, her oversized glasses sliding down the bridge of her nose every so often, she wrestled with another painful realization. Had the BCBS doctors not issued the denial, she probably would have completed her treatment by now.
“I was really looking forward to that,” Moore said softly. As she spoke, she played with the thick stack of bracelets hiding the scars on her wrists.
A few weeks later, that small facility closed in part because of delays and denials from insurance companies, according to staff and billing records. Moore found herself calling around to treatment facilities to see which ones would accept her insurance. She finally found one, but in October, her depression had become so severe that she needed to be stepped up to a higher level of care.
Moore was able to get a leave of absence from work to attend treatment, which she worried would affect the promotion she had been working toward. To tide her over until she could go back to work, she used up the money her mother sent for her 30th birthday.
She smiles less than she did even a few months ago. When her roommates ask her to hang out downstairs, she usually declines. She has taken some steps forward, though. She stopped drinking and cutting her wrists, allowing scar tissue to cover her wounds.
But she’s still grieving what the denial took from her.
“I believed I could get better,” she said recently, her voice shaking. “With just a little more time, I could discharge, and I could live life finally.”
Kirsten Berg contributed research.
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Avocado vs Blueberries – Which is Healthier?
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Our Verdict
When comparing avocado to blueberries, we picked the avocado.
Why?
These two fruits aren’t as similar as some of the comparisons we’ve made—we often go for “can be used in the same way culinarily” comparisons. But! They are both popularly in the “superfood” category, so it’s interesting to consider:
In terms of macros, avocado has more protein, (healthy!) fat, and fiber, while blueberries have more carbs. An easy win for avocado here, unless you’re on a calorie-controlled diet perhaps, since avocado is also higher in those. About that fat; it’s mostly monounsaturated, with some polyunsaturated and saturated, and is famously a good source of omega-3 in the form of ALA.
In the category of vitamins, avocado has more of vitamins A, B1, B2, B3, B5, B6, B7, B9, C, E, K, and choline, while blueberries are not higher in any vitamins. So, not a tricky decision here.
When it comes to minerals, avocado has more calcium, copper, iron, magnesium, phosphorus, potassium, selenium, and zinc, while blueberries are higher in manganese. Another win for avocados.
There is one other category that’s important to consider in this case, and that’s polyphenols. We’d be here all day if we listed them all, but in total, blueberries have about 1193x the polyphenol content that avocados do. Blueberries got the reputation for antioxidant properties for a reason; it is well-deserved!
So, out of the two, we declare avocado the overall more nutritious of the two, but blueberries absolutely deserve the acclaim they get also.
Want to learn more?
You might like to read:
Give Us This Day Our Daily Dozen
Take care!
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Healthy Butternut Macaroni Cheese
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A comfort food classic, healthy and plant-based, without skimping on the comfort.
You will need
- ½ butternut squash, peeled and cut into small pieces (if buying ready-chopped, this should be about 1 lb)
- 1 onion, chopped
- ¼ bulb garlic
- 2 tbsp extra virgin olive oil
- 12 oz (or thereabouts) wholegrain macaroni, or similar pasta shape (even penne works fine—which is good, as it’s often easier to buy wholegrain penne than wholegrain macaroni) (substitute with a gluten-free pasta such as buckwheat pasta, if avoiding gluten)
- 6 oz (or thereabouts) cashews, soaked in hot water for at least 15 minutes (but longer is better)
- ½ cup milk (your preference what kind; we recommend hazelnut for its mellow nutty flavor)
- 3 tbsp nutritional yeast
- Juice of ½ lemon
- 2 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
- Optional: smoked paprika, to serve
Note: if you are allergic to nuts, please accept our apologies that there’s no substitution available in this one. Simply put, removing the cashews would mean changing most of the rest of the recipe to compensate, so there’s no easy “or substitute with…” that we can mention. We’ll have to find/develop a good healthy plant-based no-nuts recipe for you at a later date.
Method
(we suggest you read everything at least once before doing anything)
1) Preheat the oven to 400℉ / 200℃.
2) Combine the butternut squash, onion, and garlic with the olive oil, in a large roasting tin, tossing thoroughly to ensure an even coat of oil. Roast them for about 25 minutes until soft.
3) Cook the macaroni while you wait (this should take about 10 minutes or so in salted water), drain, and rinse thoroughly in cold water, before setting aside. This cooling increases the pasta’s resistant starch content (that’s good, for your gut and for your blood sugars, and thus also for your heart and brain), and it will maintain this benefit even when we reheat it later.
4) Drain the cashews, and tip them into a high-speed blender with the milk, and process until smooth. Add the roasted vegetables and the remaining ingredients apart from the pasta, and continue to process until again smooth. You can add a little more milk if you need to, but go easy with it.
5) Heat the sauce (that you just made in the food processor) gently in a saucepan, and refresh the pasta by pouring a kettle of boiling water through it in a colander.
6) Optional: combine the pasta and sauce in an ovenproof dish or cast iron pan, and give it a few minutes under the hottest grill (or browning iron, if you have such) your oven can muster. Alternatively, use a culinary blowtorch, if you have one.
7) Serve; and if you didn’t do the optional step above, this means combining the pasta and sauce. You can also dust the top with some extra seasonings if you like. Smoked paprika works well for this.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Butternut Squash vs Pumpkin – Which is Healthier?
- Cashew Nuts vs Coconut – Which is Healthier?
- The Many Health Benefits Of Garlic
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Sea Salt vs MSG – Which is Healthier?
Take care!
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Pine Nuts vs Macadamia Nuts – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing pine nuts to macadamias, we picked the pine nuts.
Why?
In terms of macros, it’s subjective depending on what you want to prioritize; the two nuts are equal in carbs, but pine nuts have more protein and macadamias have more fiber. We’d generally prioritize the fiber, which so far would give macadamias a win in this category, but if you prefer the protein, then consider it pine nuts. Next, we must consider fats; macadamias have slightly more fat, and of which, proportionally more saturated fat, resulting in 3x the total saturated fat compared to pine nuts, gram for gram. With this in mind, we consider this category a tie or a marginal nominal win for pine nuts.
In the category of vitamins, pine nuts have more of vitamins A, B2, B3, B9, E, K, and choline, while macadamias have more of vitamins B1, B5, B6, and C. A clear win for pine nuts this time, especially with pine nuts having more than 17x the vitamin E of macadamias.
When it comes to minerals, pine nuts have more copper, iron, magnesium, manganese, phosphorus, potassium, and zinc, while macadamias have more calcium and selenium. Another easy win for pine nuts.
In short, enjoy either or both (diversity is good), but pine nuts are the healthier by most metrics.
Want to learn more?
You might like to read:
Why You Should Diversify Your Nuts
Enjoy!
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Adult Children of Emotionally Immature Parents – by Dr. Lindsay Gibson
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Not everyone had the best of parents, and the harm done can last well beyond childhood. This book looks at healing that.
Dr. Gibson talks about four main kinds of “difficult” parents, though of course they can overlap:
- The emotional parent, with their unpredictable outbursts
- The driven parent, with their projected perfectionism
- The passive parent, with their disinterest and unreliability
- The rejecting parent, with their unavailability and insults
For all of them, it’s common that nothing we could do was ever good enough, and that leaves a deep scar. To add to it, the unfavorable dynamic often persists in adult life, assuming everyone involved is still alive and in contact.
So, what to do about it? Dr. Gibson advocates for first getting a good understanding of what wasn’t right/normal/healthy, because it’s easy for a lot of us to normalize the only thing we’ve ever known. Then, beyond merely noting that no child deserved that lack of compassion, moving on to pick up the broken pieces one by one, and address each in turn.
The style of the book is anecdote-heavy (case studies, either anonymized or synthesized per common patterns) in a way that will probably be all-too-relatable to a lot of readers (assuming that if you buy this book, it’s for a reason), science-moderate (references peppered into the text; three pages of bibliography), and practicality-dense—that is to say, there are lots of clear usable examples, there are self-assessment questionnaires, there are worksheets for now making progress forward, and so forth.
Bottom line: if one or more of the parent types above strikes a chord with you, there’s a good chance you could benefit from this book.
Click here to check out Adult Children of Emotionally Immature Parents, and rebuild yourself!
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Parenting a perfectionist? Here’s how you can respond
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Some children show signs of perfectionism from early on. Young children might become frustrated and rip up their drawing if it’s not quite right. Older children might avoid or refuse to do homework because they’re afraid to make a mistake.
Perfectionism can lead to children feeling overwhelmed, angry and frustrated, or sad and withdrawn.
And yet perfectionism isn’t considered all bad in our society. Being called a “perfectionist” can be a compliment – code for being a great worker or student, someone who strives to do their best and makes sure all jobs are done well.
These seemingly polarised views reflect the complex nature of perfectionism.
Annie Spratt/Unsplash What is perfectionism?
Researchers often separate perfectionism into two parts:
- perfectionistic strivings: being determined to meet goals and achieve highly
- perfectionistic concerns: worry about being able to meet high standards, and self-criticism about performance.
While perfectionistic strivings can be positive and lead to high achievement, perfectionistic concerns can lead to a higher chance of children developing eating disorders or anxiety and depression, and having lower academic achievement.
Perfectionistic concerns can result in lower academic achievement. Jessica Lewis/Unsplash Children and adolescents may experience perfectionism in relation to school work, sport, performance in art or music, or in relation to their own body.
Signs of perfectionistic concerns in children and adolescents may include:
- children being highly critical of themselves
- their reactions to mistakes seeming to be an overreaction
- intense preoccupation and worry over their standards and goals and/or procrastination
- significant change in performance, for example, lower academic results
- irritability and negative emotions, stress and feelings of worthlessness
- social problems with peers and friends, such as bullying and alienating themselves from peers.
A range of genetic, biological and environmental factors influence perfectionism in children. And as a parent, our role is important. While research evidence suggests we can’t successfully increase positive perfectionistic strivings in our children, harsh or controlling parenting can increase negative perfectionistic concerns in children.
Parents who are perfectionistic themselves can also model this to their children.
So, how can we walk the line between supporting our child’s interests and helping them to achieve their potential, without pressuring them and increasing the risk of negative outcomes?
Give them space to grow
A great metaphor is the gardener versus the carpenter described by psychology professor Alison Gopnik.
Instead of trying to build and shape our children by controlling them and their environment (like a carpenter), parents can embrace the spirit of the gardener – providing lots of space for children to grow in their own direction, and nourishing them with love, respect and trust.
Parents don’t need to control their child and their environment. Noah Silliman/Unsplash We can’t control who they become, so it’s better to sit back, enjoy the ride, and look forward to watching the person they grow into.
However, there is still plenty we can do as parents if our child is showing signs of perfectionism. We can role model to our children how to set realistic goals and be flexible when things change or go wrong, help our children manage stress and negative emotions, and create healthy balance in our family daily routine.
Set realistic goals
People with perfectionistic tendencies will often set unattainable goals. We can support the development of flexibility and realistic goal setting by asking curious questions, for example, “what would you need to do to get one small step closer to this goal?” Identifying upper and lower limits for goals is also helpful.
If your child is fixed on a high score at school, for example, set that as the “upper limit” and then support them to identify a “lower limit” they would find acceptable, even if they are less happy with the outcome.
This strategy may take time and practice to widen the gap between the two, but is useful to create flexibility over time.
If a goal is performance-based and the outcome cannot be guaranteed (for example, a sporting competition), encourage your child to set a personal goal they have more control over.
Parents can help children set goals they can achieve. liz99/Unsplash We can also have conversations about perfectionism from early on, and explain that everyone makes mistakes. In fact, it’s great to model this to our children – talking about our own mistakes and feelings, to show them that we ourselves are not perfect.
Talk aloud practices can help children to see that we “walk the walk”. For example, if you burn dinner you could reflect:
I’m disappointed because I put time and effort into that and it didn’t turn out as I expected. But we all make mistakes. I don’t get things right every time.
Manage stress and negative emotions
Some children and adolescents have a natural tendency towards perfectionism. Rather than trying to control their behaviour, we can provide gentle, loving support.
When our child or adolescent becomes frustrated, angry, sad or overwhelmed, we support them best by helping them to name, express and validate all of their emotions.
Parents may fear that acknowledging their child’s negative emotions will make the emotions worse, but the opposite is true.
Creating healthy balance
The building blocks of healthy child development are strong loving family relationships, good nutrition, creative play and plenty of physical activity, sleep and rest.
Perfectionism is associated with rigidity, and thinking that there is only one correct way to succeed. We can instead encourage flexibility and creativity in children.
Children’s brains grow through play. There is strong research evidence showing that creative, child-led play is associated with higher emotion regulation skills, and a range of cognitive skills, including problem-solving, memory, planning, flexibility and decision-making.
Play helps children’s brains grow. Mi Pham/Unsplash Play isn’t just for young children either – there’s evidence that explorative, creative play of any kind also benefits adolescents and adults.
There is also evidence that getting active outdoors in nature can promote children’s coping skills, emotion regulation and cognitive development.
Elizabeth Westrupp, Associate Professor in Psychology, Deakin University; Gabriella King, Associate Research Fellow, Deakin University, and Jade Sheen, Associate Professor, School of Psychology, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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