There is a strong belief among many people, that Australian Natives are beautiful but have no perfume. A stroll through the bush will dispel that rumour easily.

The fragrance of crushed leaves and scented blossoms can be almost overpowering at times. But many of the natives have a more subtle fragrance; you have to be close to them at the correct time to appreciate the flavours and scents.

The perfume of native plants is often produced at different times of the day or night. Perfumed native flowers include many of the Grevilleas (some like G. biternata and G. G. buxifolia have a strong honey-like perfume others like G. buxifolia have a light fragrant perfume), Boronias ( e.g. B. floribunda, B. serrulata and B. megastigma), Sowerbaeas (Vanilla Lilies), Xanthoreas (Grass Trees), Banksias, Eleaocarpus reticulatus (Blueberry Ash) which has a strong almost aniseed scent, Hakeas, Pittosporum undulatum (Native Daphne) — the perfume of this species may becoming overpowering in the evening –, Leptospermum species (e.g. L. flavescens), Homoranthus species (which has a Baked Biscuit scent) and Hymenosporum flavum (Native Frangipani). Many of the white flowering Eucalypts, Melaleuca and Callistemon species have a strong honey scent.

There are a number of fragrant orchids particularly the Dendrobium species: these tend to be strongest from early morning to the early afternoon. While some of the Cymbidium species such as C. suave have a good perfume during the middle of the day). The Sarcochilus species have what is best described as a spicy aroma.

The aroma released by some plants foliage is not revealed until it has been disturbed, crushed or brushed against. These include the Backhousia citriodora (Lemon Myrtle) which is probably the best of all native lemon scents and is also used commercially as a cooking ingredient, while the foliage of B. anisata is strongly scented like aniseed; Eremophilas, Eriostemon species, Prosantheras,

Leptospermum petersoni (Lemon-scented Tea-tree — also good as a hedging plant), Darwinia citriodora (a light lemon scent) and some Melaleucas (Paperbarks) also have scents.

Of course you can’t forget the Eucalypt family with its famous eucalypt scent, which is redolent of our bushland. But now many other countries are growing vast plantations of them for timber, firewood and revegetation programs on every continent bar Antartica. One species, the E. citriodora gives off a strong lemon-come-eucalypt scent while Agonis flexuosa has a combination of eucalyptus and peppermint scent.

Calomeria elegans has been used as a substitute for lavender. Some species of Boronias also have strongly scented foliage.

And let’s not forget the grassy type plants, the lomandra’s and the Grass trees, both of which give a lovely honeyed smell when in flower.

So why not think about using some fragrant native plants in your garden. Not only will you get the benefit of supporting your local environment. But you might also get other benefits, like attracting birds, other wildlife and butterflies to your garden.

Although there are many things that can go wrong during a home remodeling project, spending too much doesn’t need to be one of them. At www.remodelormove.com, we hear far too many stories from people who have ended up spending far more than they wanted to spend on a remodel. This doesn’t have to be the case. In fact, there are many things homeowners can do to control the cost of their remodeling projects.

Before anyone begins a home remodeling project, I encourage them to think very carefully about protecting themselves from the top five reasons costs get out of hand.

1. Contractor relationship and the remodeling contract.

Many homeowners find costs spiraling when they remodel because they either have not developed a good working relationship with their contractor or because they don’t communicate with the contractor effectively. Poor communication generally results in a weak contract.

Homeowners must be able to communicate with the contractor — before a contract is written — to clarify what they do or do not want done. There needs to be clear agreement, reflected in the contract, about the extent of the work, the quality of workmanship expected, the quality of the materials use, and other specific details of the remodeling design. All of these details should be spelled out in the contract.

When this doesn’t happen, most homeowners find themselves making decisions and choices that cost extra either in labor or materials. In some cases, poor communication and failure to understand expectations can result in disaster.

2. Poor Planning.

Without careful planning, many homeowners end up spending far more than necessary on many materials, fixtures, etc. They also fail to schedule their projects at times when they can save on some of the associated costs. For example,

* Many people just don’t understand that many contractors charge lower rates (by as much as 5 7%) for work during their slow time.

* Workers are more productive and efficient in cooler weather than they are in the heat of summer.

* Shop for materials and fixtures far enough ahead to be able to benefit from shopping sales.

* Avoiding late changes and upgrades is also part of planning. Changes in the design, the materials, or the installation of items after purchases have been made and work has begun are more costly than most people realize. There will be additional labor costs and materials costs to accommodate each change.

* Avoid upgrades. They seem small at the time the decision is made, but they add up to significant additional cost very quickly.

3. Budgeting and Estimates.

Unfortunately, too many homeowners start with a remodeling contract instead of a budget. The first thing homeowners should do is create a budget for the remodeling project. The budget should reflect what they already know about the cost of materials, tools, fixtures, etc. I usually recommend using a planner to help with itemizing costs and related expenses and to keep track of all the information and estimates homeowners gather during the planning stage of their project. I even wrote one to help people with these issues (www.remodelingorganizer.com).

People need to remember that different contractors quote in different ways. They need to gather as many quotes and estimates as possible before they decide which contractor to hire. At the very minimum, one should compare at least five estimates; three is not enough. And try to get at least two estimates from different “types” of contractors — large contractors with lots of employees, and small companies with few if any employees.

Creating the budget first, helps homeowners select designs and materials that will result in the quality they want at a price they can afford.

4. Comparison Shopping.

Most homeowners are accustomed to shopping for deals on most large purchases, such as cars, boats, etc. But when it comes to a remodeling project, many seem to think there are no deals to be found. Many homeowners enter into agreements with contractors to have the materials purchased by the contractor without regard to cost. Many other homeowners assume that the price of all materials will be the same everywhere. When people shop around and compare prices, they can save a bundle on materials, fixtures, tools, etc.

5. Pitch in to Save.

Lack of experience or skill leads many homeowners to conclude that they need to turn a project over to their contractor and just get out of the way. While this is true for some homeowners, for others doing part of the work can be fun and can help keep a project under budget. Painting, demolition, tiling, electrical, clean up are just a few of the projects homeowners can undertake to better manage the cost of their remodel.

I am convinced that if every homeowner considering a remodeling project would plan, budget, shop, pitch in, and be sure they are communicating clearly and effectively with their contractor, most remodeling projects could be completed within their budgets.

Peritoneal mesothelioma is less common than pleural mesothelioma, but both of these typically malignant mesotheliomas can be just as tragic. Peritoneal mesothelioma begins in the abdominal cavity, as opposed to the lungs and pleural areas of pleural mesothelioma. “Peritoneal” means it has to do with the peritoneum, which is a membrane that surrounds the abdominal area. “Pleural” refers to the pleura which is a membrane that surrounds the lungs. There is also a “pericardial” mesothelioma which targets the heart membrane first.

The lungs, abdominal area and heart all have a membrane made up of mesothelial cells, named the mesothelium. A cancerous attack of these membrane areas are mesotheliomas. Asbestos is the cause of peritoneal mesothelioma, pleural mesothelioma and pericardial mesothelioma in well over 90% of the cases. There are a few rare recorded cases of malignant mesothelioma when asbestos exposure was not identified. If you have been exposed to asbestos, there is a high chance you will suffer from an asbestos-caused disease such as asbestosis or pleural plaques. However, not all asbestos-caused diseases are fatal.

Peritoneal mesothelioma, pleural mesothelioma and pericardial mesothelioma can be fatal malignant mesotheliomas which spread uncontrollably, or they can be benign, when the tumor stays where it is and can likely be removed. Unexplainable weight loss is a mesothelioma symptom which may occur in as many as 90% of benign and malignant mesothelioma. Generally, benign mesothelioma tends to show less symptoms than malignant mesothelioma. Mesothelioma symptoms for peritoneal mesothelioma almost always includes abdominal pain. This is because there is excess fluid between the peritoneal membrane and the abdomen walls. Pleural mesothelioma has excess fluid in the pleural area and this causes shortness of breath and chest pain.

The mesothelioma symptoms of pleural mesothelioma and pericardial mesothelioma are not as outwardly visible as the symptoms of peritoneal mesothelioma. In peritoneal mesothelioma, the abdomen can appear larger. Tumor masses may be visible, but external tumor visibility only occurs in a minority of peritoneal mesothelioma cases. Nausea is a common mesothelioma symptom with peritoneal mesothelioma, and the abdominal area will also be very tender.

In a healthy peritoneal area between the membrane and the wall, the peritoneal fluid helps the intestines move food. In peritoneal mesothelioma however, excess fluid causes bowel obstruction. The mesothelioma symptoms of extra fluid and bowel obstruction both contribute to abdominal pain. The bowel obstruction can also produce mesothelioma symptoms of constipation and diarrhea. Many peritoneal malignant mesothelioma patients have reported mesothelioma symptoms of a burning sensation in the abdomen. Mesothelioma symptoms for peritoneal malignant mesothelioma may not surface for 20-30 years after asbestos exposure, but it generally surfaces sooner than pleural mesothelioma.

Peritoneal mesothelioma is fortunately rare, however its rarity sometimes makes it harder to diagnose. The symptoms are similar to hernias and gall bladder problems, and identifying peritoneal mesothelioma in a CT scan is difficult. The medical industry is aware that asbestos-related diseases will be escalating over the upcoming years, and treatment for peritoneal malignant mesothelioma is undergoing many clinical trials. If you have been exposed to asbestos and have unexplainable abdominal pain and are experiencing unexplained weight loss, begin preliminary testing for peritoneal mesothelioma. The sooner the testing begins, the higher the chances for symptomatic relief, and hopefully today’s mesothelioma clinical trials will lead to a mesothelioma cure in the future.

There are two main types of programs for addiction treatment in Alabama. The inpatient treatment program and the outpatient treatment program are the two options, which an addict can select to get treatment for his or her addiction. The addicts and their families get really very confused when it comes to selecting the correct options out of these two. There are few differences in the way both the forms of addiction treatment in Alabama are carried out.

Before seeing the differences between the inpatient and outpatient treatment program in Alabama, it will better to see what similarities between these two are. Both these treatment program give proper counseling to the addicts and their family to guide them about the various aspects of the addiction. Both these programs also educate the addict and their families through individual and group therapies.

The major difference between inpatient and outpatient treatment program in Alabama is about the location where the treatment program gets carried out. The addicts who choose an inpatient treatment program have to stay in the treatment center in Alabama and he or she will have to stay there till they come out of their addiction. In outpatient treatment program the addict will have to attend the treatment center whenever they will be called. Once the inpatient treatment program gets over (it may last three to six weeks) the patient will be also asked to take an outpatient treatment program.

The patients will be allowed to stay at their home if they choose to take an outpatient treatment program. It is helpful for those patients who cannot take leave from work and has to attend work while taking the treatment. This is the reason more than 80% of the people go for outpatient treatment program in Alabama. There are other several advantages of taking outpatient treatment program.

1. The patient can do their work without taking a break from work.

2. The patient can take treatment by paying less money, as the inpatient treatment programs are quite expensive.

3. The patients can see their family and hence feels comfortable while undergoing the treatment.

4. The family of the patient can also be helpful by seeing that the patient attends the treatment programs whenever called by the treatment center.

There are some people who think that the addiction can be control only if the addict stays in the center. That is why the number of people going for inpatient addiction treatment in Alabama is also quite a lot. There are some advantages of taking the treatment from an inpatient treatment program.

1. The patient gets immediate medical facilities in case he or she faces any minor or major health troubles.

2. The patient gets professional care and guidance, as there are qualified people in the treatment center to look after him or her.

3. The severe addiction problems will not be treated by outpatient treatment program. Hence all such addicts who are deeply into addiction take treatment in inpatient treatment program.

The outpatient treatment program in Alabama is a best option for those who are in mild forms of addiction. The outpatient addiction treatment in Alabama is a mild kind of treatment. There will be no need for the addict to stay away from the family and friends while taking the treatment. The patients of outpatient treatment program will need to visit the treatment center in Alabama about three to four times in a week.

The outpatient treatment program focuses on counseling treatment and while for those who are into severe addiction urgent medical treatment is needed. Hence for all those who are into major kind of addiction, inpatient treatment program is the only option. Also all those who have some physical and mental conditions cannot do well with outpatient treatment program. It is better all such addicts choose inpatient treatment program and takes proper medical help without any further delay.

In any case taking a treatment for the addiction is a must. If the addict and his or her family will keep on denying the addiction then they will have to see major consequences in latter life. It is very important to take proper counseling before choosing the right kind of treatment program. If the addict is not agreeing to take a treatment program then the family can take help of the intervention program given by the treatment center in Alabama. Intervention program will also help you in deciding the proper kind of treatment option and will also help you to get admission to the desired treatment program.

Mesothelioma treatment options for malignant mesothelioma can relieve pain and provide hope for the future. In many cases, new mesothelioma treatment options can increase mesothelioma life expectancy beyond original expectations. Even if advanced malignant mesothelioma has reached a seemingly incurable stage, participating in clinical trials gives a breath of hope to the future generations of mesothelioma cancer patients.

Treatment for malignant mesothelioma can start with surgery, although this is not always recommended in mesothelioma treatment options since older patients may have a difficult time with surgery. The objective is to remove the tumor, or at least most of it, and slow down the disease. With advanced mesothelioma, the tumor has often tragically spread throughout the body and has invaded life-giving organs, making surgery more risky than living with cancer itself. However in the early stages of malignant mesothelioma, a localized tumor is more likely to be successfully removed.

Radical surgery is a mesothelioma treatment option for advanced malignant mesothelioma that has been used in small clinical trials, but has resulted in almost half the patients (48%) living at least five years past their predetermined mesothelioma life expectancy date. “Extrapleural pneumonectomy” involves removing the internal body parts that mesothelioma cancer cells love to invade. Surgery removes the parietal pleura (pleural mesothelioma), the pericardium (pericardial mesothelioma) and the diaphragm, as well as the removal of a lung. This surgery is combined with pre and post operative chemotherapy and radiotherapy. Cancer Research UK is funding a “MARS” clinical trial (mesothelioma and radical surgery) to formally undergo pilot testing. Since the patients must be followed for five years, the results are not yet available and the success of these mesothelioma treatment options has yet to be discovered. UK medical reports do claim that US trial results have thus far demonstrated that a heavier dose of radiotherapy after the EPP surgery extends mesothelioma life expectancy.

Mesothelioma treatment options almost always include chemotherapy. Progress is seen in mesothelioma treatment when chemotherapy is combined with drug therapy. There are clinical trials for mesothelioma treatment options around the world that are seeking to find the chemotherapy and drug mix that can prolong mesothelioma life expectancy. Clinical trials are listed at many cancer organizations and research hospitals, and many seek mesothelioma patients wanting mesothelioma treatment options for advanced malignant mesothelioma. In advanced malignant mesothelioma, participating in a clinical trial can be a lifesaving mesothelioma treatment option.

Mesothelioma treatment options for advanced malignant mesothelioma can also be found in clinical trials for anti-angiogenic therapy. Anti-angiogenic mesothelioma treatment options are biological therapies that revolve around blood vessel growth. A cancer needs its own blood supply to grow. Two primary chemicals contribute to growth, VEGF and FGF-2. Mesothelioma patients with advanced malignant mesothelioma have higher levels of VEGF compared to patients suffering from other cancers. The theory the clinical trials are hoping to prove is that blocking VEFG will stop the blood vessel growth that supports the cancer growth.

Mesothelioma treatment options for malignant mesothelioma also includes clinical trials in phototherapy, immunotherapy, gene therapy and other therapies. Medical specialists are scrambling to find the mesothelioma treatment options for malignant mesothelioma that can protect and cure the projected increase in mesothelioma patients of the future. Participating in clinical trials can extend mesothelioma life expectancy and provide hope for future generations.

Gardening and caring for the different rose types

WATERING

Roses are deep rooted and once they are well established are more capable than most plants of surviving mild drought spells. The first spring and summer directly after planting your rose is very important. During this period if the soil around your rose seems to be drying out give your roses a good soaking. Each rose could get about 2 gallons of water. In following years you will only need to water them if drought seems iminent.

FEEDING YOUR ROSES

As with all plants that provide us with beautiful blooms they need plenty of the correct nutrients. Give roses a good helping of blood, bone and fishmeal in early April, about two handfuls to each rose. In June a handful of specially prepared rose fertilizer will give your roses a huge lift. The magnesium and potash gives the rose a great kick. Just work the fertilizer in gently around the soil at the base of the plant.

MULCHING YOUR ROSES.

Mulching is a very simple task with great benefits. Mulching retains moisture, smothers weeds and generally boosts the health of your roses. Well rotted manure is best but garden compost or bark mulch can also be used.

DEADHEADING YOUR ROSES.

Deadheading spent blooms not only tidys up the rose but actually saves the plants energy and thereby encourages more bloom flushes. A light pruning of hybrid teas will encourage a second flush.

WATCH OUT FOR ROSE SUCKERS.

Shoots that emerge from rootstocks are known as suckers. These will be different in coloring and often by the amount of leaves, than what grows from the stems over ground. Gently scrape away the soil until you can see where the sucker is growing from the rootstock, tear the sucker away cleanly.

CONTROL OF WEEDS.

Mulching is the most effective method of controlling weeds and also the less back breaking.

Hoeing is not as effective and you must take care not to damage the stems.

Sowing other plants underneath the rose is also an option. The least favored option is the application of a rose-bed weedkiller. This will eventually damage the soil and thus your rose.

ROSE DISEASES AND PESTS.

This is an area that turns people off growing roses and really it shouldn’t. Roses have diseases and pests particular to them and as such regular treatment is very effective. The main problems are greenfly, mildew and blackspot.

There are plenty of products that treat these main three problems in one treatment. Performing a regular maintenance schedule starting in April will leave you with very few problems. Do make sure to follow exactly the manufacturers recommendations.

Your roses will respond brilliantly to a little regular maintenance and once you have started your routine there will be very little work attached. Issues will only arise once you neglect your routine and this is what often deters people from growing roses.

Your kitchen remodeling plan may consist of one or several minor renovations. You can choose to apply a new paint, install a new floorings or countertop. Or you may have the fixtures or appliances replaced with new ones. These are a common action of home owners who believe that a complete remodeling job is required to make the place look spacious or better. However, this kind of perception does not always apply to all home improvement solutions. You can still make your kitchen appear brighter and more comfortable even if you do not have the whole space remodeled. This is possible by opting for small improvement jobs. You may only have to add lightings to make the room brighter. Or, you can coat the place with a warmer paint color. With such simple enhancements, you can improve your kitchen’s appearance. The best way to address this home improvement need is to avail of home improvement help from Vista Remodeling

Vista Remodeling, a home improvement company that started in Denver in 1999 is a professional home improvement company which has strings of job well done. It has various house improvement projects, both full-scale and minor. Vista Remodeling can help you help you turn that dream for your home a reality. It has all the necessary expertise in home improvement projects. Vista Remodeling are experts in kitchen remodeling, bathroom remodeling, granite countertop installation, basement finishing, and all flooring solutions

Aside from free consultations, Vista Remodeling also provides free estimates. This is very essential when planning for a home renovation. The company could give you sound advice on how to go about with the budget that you have. You will be surprised on how these experts could make use of a small budget and still come up with quality and classic finish. Being in the business for a long time, Vista Remodeling knows how to work with small to big budgeted projects home improvements. They see to it that even with small budget the quality of work is not compromised. With Vista Remodeling, “once a client will always be a client”, because these experts know how to handle their client, with utmost care and understanding. Even after the work is done, a client is most welcome to seek the support from Vista Remodeling. To make sure that you are given the best service, the company gives its home improvement finished job a 12-month warranty.

Vista Remodeling is here to provide homeowners with solutions for all their home improvement needs. Visit Vista Remodeling official website and avail of the free estimates from the experts as well as free consultation from the professionals. The company has the experts in the field of renovations / remodeling, installation of tiles and countertops. The have the best interior designers in their team and their expertise are made available to all homeowners who would not settle for anything less for their home improvement. Avail of Home Improvement Help from Vista Remodeling call of visit their site today. With Vista Remodeling your home will get the best care of the professionals.

So before you go ahead and spend much money on your home improvement project, consult first with the Vista Remodeling services to make sure all of your home improvement needs are taken cared of.

Dyadic Developmental Psychotherapy (DDP) is an evidence-based and effective form of treatment for children with trauma and disorders of attachment[1]. It is an evidence-based treatment, meaning that there has been empirical research published in peer-reviewed journals. Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a six level system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results of Dyadic Developmental Psychotherapy with other forms of treatment, ‘usual care’, 1 year after treatment ended. It is important to note that over 80% of the children in the study had had over three prior episodes of treatment, but without any improvement in their symptoms and behavior. Episodes of treatment mean a course of therapy with other mental health providers at other clinics, consisting of at least five sessions. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of those studies would have resulted in Dyadic Developmental Psychotherapy being classified as an evidence-based category 2, ‘Supported and probably efficacious’. There have been two related empirical studies comparing treatment outcomes of Dyadic Developmental Psychotherapy with a control group. This is the basis for the rating of category two. The criteria are:

* 1. The treatment has a sound theoretical basis in generally accepted psychological principles.

Dyadic Developmental Psychotherapy is based in Attachment Theory (see texts cited below

* 2. A substantial clinical, anecdotal literature exists indicating the treatment’s efficacy with at-risk children and foster children.

See reference list.

* 3. The treatment is generally accepted in clinical practice for at risk children and foster children.

As demonstrated by the large number of practitioners of Dyadic Developmental Psychotherapy and it’s presentation as numerous international and national conferences over the last ten or fifteen years.

* 4. There is no clinical or empirical evidence or theoretical basis indicating – that the treatment constitutes a substantial risk of harm to those receiving it, compared to its likely benefits.

* 5. The treatment has a manual that clearly specifies the components and administration characteristics of the treatment that allows for implementation.

Creating Capacity for Attachment, Building the Bonds of Attachment, and Attachment Focused Family Therapy constitute such material.

* 6. At least two studies utilizing some form of control without randomization (e.g., wait list, untreated group, placebo group) have established the treatment’s efficacy over the passage of time, efficacy over placebo, or found it to be comparable to or better than an already established treatment.

See ref. list

* 7. If multiple treatment outcome studies have been conducted, the overall weight of evidence supported the efficacy of the treatment.

These studies support several of O’Connor & Zeanah’s[2] conclusions and recommendations concerning treatment. They state (p. 241), “treatments for children with attachment disorders should be promoted only when they are evidence-based.”

Dyadic Developmental Psychotherapy, as with any specialized treatment, must be provided by a competent, well-trained, licensed professional. Dyadic Developmental Psychotherapy is a family-focused treatment[3].

Dyadic Developmental Psychotherapy is the name for an approach and a set of principals that have proven to be effective in helping children with trauma and attachment disorders heal; that is, develop healthy, trusting, and secure relationships with caregivers. Treatment is based on five central principals.

At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first few years of life. These experiences disrupt the normal attachment process so that the child’s capacity to form a healthy and secure attachment with a caregiver is distorted or absent. The child lacks a sense trust, safety, and security. The child develops a negative working model of the world in which:

Ø Adults are experienced as inconsistent or hurtful.

Ø The world is viewed as chaotic.

Ø The child experiences no effective influence on the world.

Ø The child attempts to rely only on him/her self.

Ø The child feels an overwhelming sense of shame, the child feels defective, bad, unlovable, and evil.

Reactive Attachment Disorder is a severe developmental disorder caused by a chronic history of maltreatment during the first couple of years of life. Reactive Attachment Disorder is frequently misdiagnosed by mental health professionals who do not have the appropriate training and experience evaluating and treating such children and adults. Often, children in the child welfare system have a variety of previous diagnoses. The behaviors and symptoms that are the basis for these previous diagnoses are better conceptualized as resulting from disordered attachment. Oppositional Defiant Disorder behaviors are subsumed under Reactive Attachment Disorder. Post Traumatic Stress Disorder symptoms are the result of a significant history of abuse and neglect and are another dimension of attachment disorder. Attention problems and even Psychotic Disorder symptoms are often seen in children with disorganized attachment[4].

Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms[5]. Many of these children are violent[6] and aggressive[7] and as adults are at risk of developing a variety of psychological problems[8] and personality disorders, including antisocial personality disorder[9], narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder[10]. Neglected children are at risk of social withdrawal, social rejection, and pervasive feelings of incompetence[11]. Children who have histories of abuse and neglect are at significant risk of developing Post Traumatic Stress Disorder as adults[12]. Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average)[13] (MacMillian, 2001). The effective treatment of such children is a public health concern (Walker, Goodwin, & Warren, 1992).

Left untreated, children who have been abused and neglected and who have an attachment disorder become adults whose ability to develop and maintain healthy relationships is deeply damaged. Without placement in an appropriate permanent home and effective treatment, the condition will worsen. Many children with attachment disorders develop borderline personality disorder or anti-social personality disorder as adults[14].

FIRST PRINCIPAL. Therapy must be experiential. Since the roots of disorders of attachment occur pre-verbally, therapy must create experiences that are healing. Experiences, not words, are one “active ingredient” in the healing process.

For example, one eight year old boy who had Reactive Attachment Disorder, Bipolar Disorder, and a variety of sensory-integration disorders wrote about his past therapy and attachment therapy this way (More details of this story can be found in the book Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell):

My first therapy was with Dr.Steve. The therapy was FUN!!!! We ate lots of snacks. I had a bottle. We played lots of cool games like thumb wrestling, pillow rides, giant walk, Superman rides, guess the goodies, eye blinking contests, hide and go seek goodies. I had to follow the rules and play the games just like Dr. Steve said.

Dr. Steve taught me how to play and have fun with my Mom. But I still didn’t know how to love. I would still get real mad and try to hurt Mom and break things. Inside I still thought I was a bad boy. I was still afraid Mom and Dad would get rid of me. I had lots of tantrums at home. Sometimes I would still get out of control and break things and try to hurt Mom. I was getting even worse when I got mad.

Stuff Dr. Art Taught Me

I learned about my feeling well. Sometimes I stuff too many feelings like mad, scared and sad into my feeling well. Then the well will overflow and I could explode with behaviors. But I can stop that by expressing my feelings. Then the well can’t overflow because I let some of the feelings out.

I also made pictures of my heart. I was born with a nice heart but then when I went into the orphanage I got cracks in my heart. My heart cracked because they couldn’t take good care of me. I was a baby and I needed someone to hold me and rock me. But they couldn’t because there were too many babies. Then I put 16 bricks around my heart. I was protecting my heart so it wouldn’t get hurt anymore. But the bricks kept the love out too. I wouldn’t let Mom’s love in. I had lots of mad in my heart.

My hard work in therapy got rid of all the bricks. Then Mom’s love got in. The love made the cracks heal. Now I have a bright red heart with no cracks.

I really liked Dr. Art now and am proud that I am strong. I still don’t need therapy. I still let Mom’s love into my heart!!!!!! Sometimes I send e-mail’s to Dr. Art. I tell him how good I’m doing.

I started missing Dr. Art and told Mom. Mom was confused and thought I wanted more therapy. I told Mom “I don’t need therapy. I just want to have lunch with Dr. Art.” So I sent Dr. Art an email to let him know that I wanted to have lunch with him. Then one day we had lunch together.

Sometimes it’s still hard. I still get mad and sometimes I don’t express my feelings well. Sometimes when Mom helps me ? I can express my feelings and say “I don’t want to pick up my toys. It makes me mad that I have to ? but I will”. When I say that it doesn’t make me feel mad anymore. It helps me to listen to Mom. But sometimes when I get mad I pout and stomp my feet and run to my room if I forget to express my feelings. But now I let Mom help me so that I can talk about my feelings and do what she says

It’s been a really longtime since I tried to hurt Mom or break things when I’m mad. I feel good about love now. I know that my Mom and Dad love me. I know that I love Mom and Dad. I don’t feel like I’m a bad boy anymore.

Effective therapy uses experiences to help a child experience safety, security, acceptance, empathy, and emotional attunement within the family. A number of techniques and methods are used including psychodrama, interventions congruent with Theraplay, and other exercises.

SECOND PRINCIPAL. Therapy must be family-focused. Therapy helps the child address the underlying trauma in a supportive, safe, secure environment in “titrated” and manageable doses so that what the parents have to offer can get in and heal the child. It is the parents’ capacity to create a safe and nurturing home that provides a healing environment. Being able to have empathy for the child, accept the child, love the child, be curious about the child, and be playful are all part of the “attitude[15]” that heals. Parents are actively involved in treatment.

THIRD PRINCIPAL. The trauma must be directly addressed. Therapy helps healing by providing the safety and security so that the child can re-experience the painful and shameful emotions that surround the child’s trauma. Revisiting the trauma is essential if the child is to begin to revise the child’s personal narrative and world-view. It is by revisiting the trauma and sharing the anger and shame with an accepting, empathetic person that the child can integrate the trauma into a coherent self.

FOURTH PRINCIPAL. A comprehensive milieu of safety and security must be created. Traumatized children are often hyper-vigilant, insecure, and deeply distrusting. A consistent environment that is safe and secure is essential to creating the experiences necessary for the child to heal. This milieu must be present at home and in therapy. Good communication and coordination among home, school, and therapy is another important element of effective treatment. “Compression-wraps,” invasive and intrusive stimulation designed to evoke rage, “re-birthing,” and other provocative techniques are not part of Dyadic Developmental Psychotherapy. These intrusive and invasive techniques are not therapy, not therapeutic, and have no place in a reputable treatment program.

Fifth Principal. Therapy is consensual and not coercive. At our center we are very clear that physical restraint is not treatment and is not used in treatment in any manner. Treatment is provided in a manner consisted with the Association for the treatment and Training of Children’s White Paper on Coercion in treatment.

DETAILED DESCRIPTION OF TREATMENT

Dyadic Developmental Psychotherapy is a treatment developed by Daniel Hughes, Ph.D., (Hughes, 2008, Hughes, 2006, Hughes, 2003,). Its basic principals are described by Hughes and summarized as follows:

1. A focus on both the caregivers and therapists own attachment strategies. Previous research (Dozier, 2001, Tyrell 1999) has shown the importance of the caregivers and therapists state of mind for the success of interventions.
2. Therapist and caregiver are attuned to the child’s subjective experience and reflect this back to the child. In the process of maintaining an intersubjective attuned connection with the child, the therapist and caregiver help the child regulate affect and construct a coherent autobiographical narrative.
3. Sharing of subjective experiences.
4. Use of PACE and PLACE are essential to healing.
5. Directly address the inevitable misattunements and conflicts that arise in interpersonal relationships.
6. Caregivers use attachment-facilitating interventions.
7. Use of a variety of interventions, including cognitive-behavioral strategies.

Dyadic Developmental Psychotherapy interventions flow from several theoretical and empirical lines. Attachment theory (Bowlby, 1980, Bowlby, 1988) provides the theoretical foundation for Dyadic Developmental Psychotherapy. Early trauma disrupts the normally developing attachment system by creating distorted internal working models of self, others, and caregivers. This is one rationale for treatment in addition to the necessity for sensitive care-giving. As O’Connor & Zeanah (2003, p. 235) have stated, “A more puzzling case is that of an adoptive/foster caregiver who is ‘adequately’ sensitive but the child exhibits attachment disorder behavior; it would seem unlikely that improving parental sensitive responsiveness (in already sensitive parent) would yield positive changes in the parent-child relationship.” Treatment is necessary to directly address the rigid and dysfunctional internalized working models that traumatized children with attachment disorders have developed.

Current thinking and research on the neurobiology of interpersonal behavior (Siegel, 1999, Siegel, 2000, Siegel, 2002, Schore, 2001) is another part of the foundation on which Dyadic Developmental Psychotherapy rests.

The primary approach is to create a secure base in treatment (using techniques that fit with maintaining a healing PACE (Playful, Accepting, Curious, and Empathic) and at home using principals that provide safe structure and a healing PLACE (Playful, Loving, Acceptance, Curious, and Empathic). Developing and sustaining an attuned relationship within which contingent collaborative communication occurs helps the child heal. Coercive interventions such as rib-stimulation, holding-restraining a child in anger or to provoke an emotional response, shaming a child, using fear to elicit compliance, and interventions based on power/control and submission, etc., are never used and are inconsistent with a treatment rooted in attachment theory and current knowledge about the neurobiology of interpersonal behavior.

The usual structure of a session involves three components. First, the therapist meets with the caregivers in one office while the child is seated in the treatment room. During this part of treatment, the caregiver is instructed in attachment parenting methods (Becker-Weidman & Shell (2005) Hughes, 2006). The caregiver’s own issues that may create difficulties with developing affective attunement with their child may also be explored and resolved. Effective parenting methods for children with trauma-attachment disorders require a high degree of structure and consistency, along with an affective milieu that demonstrates playfulness, love, acceptance, curiosity, and empathy (PLACE). During this part of the treatment, caregivers receive support and are given the same level of attuned responsiveness that we wish the child to experience. Quite often caregivers feel blamed, devalued, incompetent, depleted, and angry. Parent-support is an important dimension of treatment to help caregivers be more able to maintain an attuned connecting relationship with their child. Second, the therapist with the caregivers meets with the child in the treatment room. This generally takes one to one and a half hours. Third, the therapist meets with the caregivers without the child. Broadly speaking, the treatment with the child uses three categories of interventions: affective attunement, cognitive restructuring, and psychodramatic reenactments. Treatment with the caregivers uses two categories of interventions: first, teaching effective parenting methods and helping the caregivers avoid power struggles and, second, maintaining the proper PLACE or attitude.

Treatment of the child has a significant non-verbal dimension since much of the trauma took place at a pre-verbal stage and is often dissociated from explicit memory. As a result, childhood maltreatment and resultant trauma create barriers to successful engagement and treatment of these children. Treatment interventions are designed to create experiences of safety and affective attunement so that the child is affectively engaged and can explore and resolve past trauma. This affective attunement is the same process used for non-verbal communication between a caregiver and child during attachment facilitating interactions (Hughes, 2003, Siegel, 2001). The therapist and caregivers’ attunement results in co-regulation of the child’s affect so that is it manageable. Cognitive restructuring interventions are designed to help the child develop secondary mental representations of traumatic events, which allow the child to integrate these events and develop a coherent autobiographical narrative. Treatment involves multiple repetitions of the fundamental caregiver-child attachment cycle. The cycle begins with shared affective experiences, is followed by a breach in the relationship (a separation or discontinuity), and ends with a reattunement of affective states. Non-verbal communication, involving eye contact, tone of voice, touch, and movement, are essential elements to creating affective attunement.

The treatment provided often adhered to a structure with several dimensions. It is pictured in Figure 1, below. First, behavior is identified and explored. The behavior may have occurred in the immediate interaction or have occurred at some time in the past. Using curiosity and acceptance the behavior is explored. Second, using curiosity and acceptance the behavior is explore and the meaning to the child begins to emerge. Third, empathy is used to reduce the child’s sense of shame and increase the child’s sense of being accepted and understood. Forth, the child’s behavior is then normalized. In other words, once the meaning of the behavior and its basis in past trauma is identified, it becomes understandable that the symptom is present. An example of such an interaction is the following:

Wow, I see how you got so angry when your Mom asked you to pick up your toys. You thought she was being mean and didn’t want you to have fun or love you. You thought she was going to take everything away and leave you like your first Mom did, like when your first Mom took your toys and then left you alone in the apartment that time. Oh, I can really understand now how hard that must be for you when Mom said to clean up. You really felt mad and scared. That must be so hard for you.

Fifth, the child communicates this understanding to the caregiver.

Sixth, finally, a new meaning for the behavior is found and the child’s actions are integrated into a coherent autobiographical narrative by communicating the new experience and meaning to the caregiver.

Past traumas are revisited by reading documents and through psychodramatic reenactments. These interventions, which occur within a safe attuned relationship, allow the child to integrate the past traumas and to understand the past and present experiences that create the feelings and thoughts associated with the child’s behavioral disturbances. The child develops secondary representations of these events, feelings and thoughts that result in greater affect regulation and a more integrated autobiographical narrative.

As described by Hughes (2006, 2003), the therapy is an active, affect modulated experience that involves acceptance, curiosity, empathy, and playfulness. By co-regulating the child’s emerging affective states and developing secondary representations of thoughts and feelings, the child’s capacity to affectively engage in a trusting relationship is enhanced. The caregivers enact these same principals. If the caregivers have difficulty engaging with their child in this manner, then treatment of the caregiver is indicated.

Children who have experienced chronic maltreatment and resulting complex trauma are at significant risk for a variety of other behavioral, neuropsychological, cognitive, emotional, interpersonal, and psychobiological disorders (Cook, A., et. al., 2005; van der Kolk, B., 2005). Children and adolescents with complex trauma require an approach to treatment that focuses on several dimensions of impairment (Cook, et. al., 2005). Chronic maltreatment and the resulting complex trauma cause impairment in a variety of vital domains including the following:

Ø Self-regulation

Ø Interpersonal relating including the capacity to trust and secure comfort

Ø Attachment

Ø Biology, resulting in somatization

Ø Affect regulation

Ø Increased use of defensive mechanisms, such as dissociation

Ø Behavioral control

Ø Cognitive functions, including the regulation of attention, interests, and other executive functions.

Ø Self-concept.

Dyadic Developmental Psychotherapy addresses these domains of impairment. Dyadic Developmental Psychotherapy shares many important elements with optimal, sound social casework and clinical practice. For example, attention to the dignity of the client, respect for the client’s experiences, and starting where the client is, are all time-honored principles of clinical practice and all are also central elements of Dyadic Developmental Psychotherapy

In summary, therapy for traumatized children who have disordered attachments must be experiential, consensual, and provide an environment of security, acceptance, safety, empathy, and playfulness.

[1] Becker-Weidman, A., (2006) “Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy,” Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, 147-171.

Becker-Weidman, A., (2006). “Dyadic Developmental Psychotherapy: A multi-year Follow-up,” in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43 — 61.

Becker-Weidman, A., (2007) “Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy,” http://www.center4familydevelop.com/research.pdf

Becker-Weidman, A., & Hughes, D., (2008) “Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment,” Child & Adolescent Social Work, 13, pp.329-337.

Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287–304.

[2] O’Connor, T., & Zeanah, C., (2003) Attachment Disorders: Assessment strategies and treatment approaches. Attachment & Human Development, 5, 223-245.

[3] Hughes, D., (2008) Attachment-focused Family Therapy. NY: Norton.

[4] Lyons-Ruth, K., & Jacobvitz, D., Attachment disorganization: unresolved loss, relational violence and lapses in behavioral and attentional strategies. In Cassidy, J. & Shaver, P., (Eds.) Handbook of Attachment. pp 520-554, NY: Guilford Press, 1999.

Solomon, J. & George, C. (Eds.). Attachment Disorganization. NY: Guilford Press, 1999.

Main, M. & Hesse, E. Parents’ Unresolved Traumatic Experiences are related to infant disorganized attachment status. In Greenberg, M.T., Ciccehetti, D., & Cummings, E.M. (Eds.) Attachment in the Preschool Years: Theory, Research, and Intervention, pp.161-182, Chicago: University of Chicago Press, 1990.

Carlson, E.A. (1988). A prospective longitudinal study of disorganized/disoriented attachment. Child Development 69, 1107-1128.

[5] Carlson, V., Cicchetti, D., Barnett, D., & Braunwald, K. (1995). Finding order in disorganization: Lessons from research on maltreated infants’ attachments to their caregivers. In D. Cicchetti & V. Carlson (Eds), Child Maltreatment: Theory and research on the causes and consequences of child abuse and neglect (pp. 135-157). NY: Cambridge University Press.

Cicchetti, D., Cummings, E.M., Greenberg, M.T., & Marvin, R.S. (1990). An organizational perspective on attachment beyond infancy. In M. Greenberg, D. Cicchetti, & M. Cummings (Eds), Attachment in the Preschool Years (pp. 3-50). Chicago: University of Chicago Press.

[6] Robins, L.N. (1978) Longitudinal studies: Sturdy childhood predictors of adult antisocial behavior. Psychological Medicine,. 8, 611-622.

[7] Prino, C.T. & Peyrot, M. (1994) The effect of child physical abuse and neglect on aggressive withdrawn, and prosocial behavior. Child Abuse and Neglect, 18, 871-884.

[8] Schreiber, R. & Lyddon, W. J. (1998) Parental bonding and Current Psychological Functioning Among Childhood Sexual Abuse Survivors. Journal of Counseling Psychology, 45, 358-362.

[9] Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment Styles in Maltreated Children: A Comparative Study. Child Development and Human Development, 31, 113-128.

[10] Dozier, M., Stovall, K.C., & Albus, K. (1999) Attachment and Psychopathology in Adulthood. In J. Cassidy & P. Shaver (Eds.). Handbook of Attachment (pp. 497-519). NY: Guilford Press.

[11] Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment Styles in Maltreated Children: A Comparative Study. Child Development and Human Development, 31, 113-128.

[12] Allan, J. (2001). Traumatic Relationships and Serious Mental Disorders. NY: John Wiley.

Andrews, B., Varewin, C.R., Rose, S., & Kirk (2000). Predicting PTSD symptoms in Victims of Violent Crime. Journal of Abnormal Psychology, 109, 69-73.

[13] MacMillian, H.L. (2001). Childhood Abuse and Lifetime Psychopathology in a Community Sample. American Journal of Psychiatry, 158, 1878-1883.

[14] Allan, J. Traumatic Relationships and Serious Mental Disorders, NY: Wiley, 2001.

Andrews, B., Varewin, C.R., Rose, S. & Kirk. Predicting PTSD symptoms in Victims of Violent Crime. Journal of Abnormal Psychology, vol. 109, 69-73, 2000.

[15] Hughes, D., (2007) Building the Bonds of Attachment, 2nd. Edition, NY: Guilford Press.

Mesothelioma stages are categorized in the medical community for evaluative benefit for the physician, the medical institution, participation in clinical trials, and advancements in mesothelioma treatment options. Staging systems are used to define mesothelioma stages; however, mesothelioma stages are far more descriptive for pleural mesothelioma than for peritoneal mesothelioma or pericardial mesothelioma. Mesothelioma staging systems have changed over time. As medical knowledge increases, mesothelioma staging systems advance.

By sectioning a progressive disease into stages, doctors can evaluate mesothelioma treatment options that have been proven successful. By defining mesothelioma stages in a universal staging system, international mesothelioma life expectancy statistics can be gathered. When a staging system gains international acceptance, it contributes greatly to the advancement of mesothelioma treatment options. Grouping similar variables for evaluation is beneficial to developing mesothelioma treatment options for different mesothelioma stages.

In 1976 the Butchart staging system identified four mesothelioma stages for diffuse pleural malignant mesothelioma by location. At stage one, the tumor is in one side of the pleural lining. At stage two, the tumor is malignant and has entered both lungs, and has the potential to spread. In stage three of Butchart’s mesothelioma stages, the tumor has entered the peritoneum (abdomen region), and at stage four, the cancer has spread through the blood stream.

It was simple, thus gained acceptance. However, it fails to address crucial issues. Medical experts suggest it fails to make survival correlations with mesothelioma stages. The Butchart mesothelioma staging system in its originality is obsolete for mesothelioma life expectancy statistics, however other mesothelioma stages have been developed from it, and many cancer institutions modify it for their evaluative purposes.

In the 1980s Chahinian added detailed tumor stages, lymph node stages and metastases stages to the pleural mesothelioma staging system. This staging system is referred to as TNM and is used within elaborative staging systems. In 1990 the UICC (Union Internationale Contre le Cancer) expounded on Chahinian’s mesothelioma stages. The Butchart, Chahinian and UICC mesothelioma staging systems were based on specific institution experience.

In 1999 the Bingham Hospital introduced a pleural mesothelioma surgical staging system in the Journal of Thoracic and Cardiovascular Surgery. The IMIG (International Mesothelioma Interest Group) in a 1995 Journal of Chest from the American College of Chest Physicians proposed international acceptance for a detailed universal staging system. This staging system demands precise tumor location, and is based on TNM and the International Lung Cancer Staging System.

Medical institutions will use the mesothelioma stages and staging system practical for their internal evaluative purposes. But the mesothelioma patient should be aware when discussing mesothelioma life expectancy and prognosis that mesothelioma staging systems differ, and staging systems still undergo scrutiny. No staging system includes all variables for treatment and prognosis. Factors such as tumor subtypes can make a significant difference in prognosis.

In its basic form, mesothelioma has two stages – localized and advanced. In most staging systems, localized mesothelioma is considered stage one. Stages two through four are advanced mesothelioma stages. Mesothelioma stages are generally defined by location, the severity of the tumor, or surgical needs. The stages of mesothelioma are dependent on the staging system used.

Mesothelioma stages are important considerations in treatment and prognosis. An accepted universal mesothelioma staging system can expedite medical research to find effective mesothelioma treatment options. Advances in clinical research will continue to contribute to the development of defining mesothelioma stages until precise correlations can be made. Until then, staging systems are a universal answer to evaluating mesothelioma treatment.

Kitchen Remodeling is the single most popular home renovation. Kitchens and Baths are often combined in a single project, but according to Michigan Contractors, kitchen remodeling is the most common request. Kitchen remodeling is certainly a very enticing project, but make sure you go about it with a mind to keeping the costs in check; the potential expense involved frightens some people before they even start. Kitchen remodeling costs are always likely to be an obstacle to getting the dream kitchen you have always wanted. Kitchen remodeling is the home improvement job that adds the most value to your house.

It can convert an old fashioned, dated kitchen into the showpiece of your home. The method of how to change the design will depend on your lifestyle and budget. Kitchen remodeling is the home improvement job that adds the most value to your house. In fact, you’ll recover 80-90% of your kitchen remodeling costs in the added value to your house – more if you’re handy enough to do the work yourself.

Kitchen remodeling is something that needs to be carefully planned using the size and configuration of the room. With this one room being the hub of the home, it needs to be designed with the triangle concept, which allows a person cooking to have easy access to the sink, refrigerator, and stove. Its one of the most common home improvement projects in the U.S. When asked which room in their house they would most like to remodel, Americans overwhelmingly chose the kitchen. Kitchen remodeling is one of the best investments when it comes to both everyday use and increase in resale value. In addition, you might be able to save on energy as well by choosing energy efficient kitchen appliances.

It is without a doubt one of the best investments you as a homeowner can make. For most homeowners, the kitchen is the most important room in the house. Kitchen remodeling is a good way for you to increase the value of your home and to put a new spin on your old living areas. It is much more than choosing a paint color and cabinet style. The kitchen is the heart and soul of any house, so its important that your kitchen remodeling project results in a space that is functional, comfortable, and beautiful to take in all at the same time. Kitchen remodeling is one of the most intensive remodeling projects you can undertake in any house. The process involves important design decisions about cabinets, counter tops, lighting, appliances, layout, and finish treatments.

Whether your remodeling project will encompass a total tear-down and rebuild or a change of cabinetry, counter tops and major appliances, you will find yourself paying top dollar for remodeling this most important room in the house. Kitchen remodeling is also an investment in ongoing personal pleasure, increasing connectedness between all members of the family and easing the effort (while increasing the joy) of meal preparation. More homemade meals mean less fast food. Kitchen remodeling is a tricky job that requires taking into account existing architecture, plumbing and wiring, structural elements, and many other important aspects. For a project with so many considerations, it is crucial that you receive a kitchen remodeling professional who can care for all the things affected by the project, in accordance with your vision and budget. Kitchen remodeling is no small decision, so we’re more than happy to answer any and all of your questions to help you feel comfortable with yours.