Most of us are familiar with relationships in which one person desperately pursues a partner who creates distance or is unavailable. In a variation on those straightforward roles, some couples do a dance in which one person pursues a distant partner and then the dynamic flips so that the pursuer becomes unavailable or uninterested and the distant partner becomes the desperate pursuer. If we’re watching such relationships, it can seem impossible to make sense of what’s going on. And worse, if we’re in one of these relationships it can be totally crazy-making and create an overwhelming sense of despair. So what is going on with pursuers and distancers? Part of the answer to that question lies in what we learned in our early relationships. As children we all have emotional needs to be loved and accepted for who we are, and to be encouraged to develop into individuals. However, to a greater or lesser extent, our parents (or primary caregivers) fail to act according to our best interests and instead act from their emotional needs and insecurities. These failures in turn help to establish our ways of being in relationships.

In general, our ways of being were adaptive in that they ensured we got as much love, care, or attention from our parents as possible. Another facet of how we behave in relationships is about asserting our unmet emotional needs. This facet was also learned based on whether and how it was acceptable or safe to express our needs as children. In our current relationships unmet needs can be legitimate adult needs combined with carried unmet needs from our past.

Pursuers

We all have a lifelong need for connection and intimacy. However, if as adults we feel desperate for love, connection, or validation, our parents may have been incapable of being close to us or acknowledging that we were special and unique beings. If our parents were abandoning or rejecting, as adults we may feel desperate to establish and maintain connections even if they’re unhealthy. Needing to desperately pursue love may reflect some of the following:

We have a fear of abandonment or rejection tied to a traumatic absence or loss of love in our childhood. This fear can be intense and visceral and feel like our very survival is being threatened. We need to be chosen by our partner (or any partner) or we feel worthless or that we have no identity. This lack of self-esteem or sense of self is tied to not being validated as a child or to it not being safe to develop and express a unique self as a child. We are recreating the relationship dynamics from our childhood. This compulsion to recreate serves several purposes. When we choose someone unavailable or rejecting we hope for a different outcome. If they choose us, we will prove that our parents were wrong and that we are worthly of love. Recreating childhood relationship dynamics provides a situation in which we can continue to broadcast our unmet needs. It also keeps us from coming face to face with the unspoken messages of not having had our needs met and it keeps us from feeling the grief of not having been cared for or loved well.
Distancers

If we desperately need distance in our adult relationships, our parents may have been too emotionally close or demanding when we were children. Such emotional closeness or demands were not about our needs as children but were about our parents’ needs. Our parents may have needed us to behave in strictly defined ways or to achieve or accomplish things. They may have looked to us to care for them emotionally. They may have controlled us through emotional manipulation or abuse to manage their own anxieties, insecurities, or emotional frailty. Needing to create distance in relationships can reflect some of the following:

We feel like we’re being smothered or engulfed in relationships, tied to never being allowed to develop or express ourselves. Early relationships were about the other person and being close equated to losing or stifling ourselves. We feel like the relationship and its demands will drown us. This sense is tied to our needs not being acknowledged and to inappropriately being asked to manage an adult’s needs as a child. Being in a relationship triggers feeling angry and resentful because we expect to have our needs for love, caring, and nurturing denied based on our early experiences. We have a compulsion to establish and hold on to a separate self, and the only way we know how to or feel safe doing that is through activities and behaviors that put up walls. Some of the ways we may create distance in relationships include substance use, affairs, being grandiose or contemptuous, or pursuing outside interests obsessively.

On-again Off-again

What about those of us who flip-flop between desperately needing a partner and then retreating and creating distance once we have a degree of closeness? If as children we were required to deny our needs, to become needless and wantless, because our parents couldn’t handle our demands or shamed us about having needs, we may have the same desperate need for love talked about above. However, when we approach closeness, we may experience intense anxiety related to:

Close relationships are unfamiliar and uncomfortable
We’ve been taught that it’s not okay to have needs and wants or to have them honored We have internalized shame from being told indirectly that we’re not worthy of having our needs and wants met As we move toward intimacy, we feel that our shameful secrets are going to be exposed, which increases the perceived risk of rejection and abandonment Creating distance in response to these anxieties in turn triggers our desperate need to pursue love and connection, perpetuating the cycle.

As difficult as these dynamics are, it is possible to move beyond them. Healing requires understanding the legacy of our childhood relationships, grieving what we didn’t receive, learning to honor our needs and wants in our adult relationships, and practicing taking risks with closeness, intimacy, and vulnerability. Author and therapist Pia Mellody talks about the distancing/pursuing dynamic in terms of Love Dependency (or Love Addiction) and Love Avoidance. She does an excellent job in several of her books explaining how these tendencies get established in our childhood relationships and the process of recovery (see my Recommended Reading List at www.hlcounseling.com).

By: Heather Leavesley

In general, a thigh lift surgery is more common in women than it is in men. The reasons for this are that in women the thigh region is a common place for the collection of fat cells over many years. As a matter of fact, when surveyed, many women insisted that out of all the things they could change on their body, the thighs would be one of the first. The thighs in particular have a habit of harboring sagging and loose skin as well as the most dreaded thing for women, cellulite.

Many women are bothered by their thighs and it has even been known to prevent them from wearing shorts or even a bathing suit. The thighs rub together every time you walk and are particularly susceptible to sores for just this very reason. Many women will go out of their way doing exercise or anything they can in order to loose the excess fat cells located in their thighs. It is for these and many more reasons that thigh lifts are so popular and will continue to increase in their popularity. A thigh lift in general can help all of these types of conditions and more.

A thigh lift cost varies and can range anywhere from $2,000 all the way up to $9,000. The variation in the approximated cost of course has to do with how much fat you have in your thighs and want to have removed. The obvious is that the less fat you may have also means the lower the costs. These costs may also vary depending on your location and the competition between different plastic surgeons in you area.

A thigh lift not only can help you loose the hard to drop weight from the inner thigh region, but it can take care of the sagging skin and cellulite that has given you so many issues over the years. In return, you will be able to wear bathing suits and short again as well as receiving an improved self esteem from the procedural outcome.

Remember that when deciding to have a thigh lift, you must have realistic expectations from it. A thigh lift is not a cure all for your weight problems and much like a liposuction it carries with it many associated risks.

By: Dr. Jim Greene

Organizations, such as the Mayo Clinic and Intermountain Healthcare, provide the best quality health care at the lowest cost. America’s health-care problems could be eased and even solved if high-quality, low cost medical care was universal.

Unfortunately, providing the best health care services is not contagious, like a virus. There is a wide variation in quality and cost, even with examples of providers who work hard at providing the best quality and lowest cost. Culture, economics, and commitment are a few of the reasons for the wide variety in health care.

Six of the best healthcare organizations are researching the best strategies for the most common and costly medical conditions. They are working together to compile data on the best strategies, then will share that information and encourage other providers to adopt the best strategies system.

James Weinstein, director of the Dartmouth Institute for Health Policy & Clinical Practice is heading the new project. The project participants are Mayo, Intermountain, Cleveland Clinic, Dartmouth-Hitchcock Medical Center, Geisinger Health System and Denver Health. Weinstein states, “If you always do what you’ve always done, you’ll get what you’ve always gotten. That’s not very good and we can’t afford to do it any more.”

The six organizations involved in the project serve over 10 million people and are sharing data on the medical conditions they are researching. The data involves clinical protocols which will help in determining the treatment strategies that are the most cost-effective. These organizations will then send their findings to other health care systems throughout the U.S. There are other organizations who are considering joining in the research.

The first of eight medical condition treatments to be studied is total knee replacement surgery. There are approximately 300,000 knee replacements done each year. The cost of this surgery can range from $16,000 to $24,000. There is a wide variety in the rates of the number of people who have the procedure, in complications and readmissions. The data on total knee replacements is expected to be ready in February 2011.

Diabetes, heart failure, asthma, weight loss surgery, labor and delivery, spine surgery and depression are the other seven to be studied after knee replacement.

The cost and results of treatment for the medical conditions is not the only information that will be gathered. The project is also looking at patient preference regarding the different treatment options

The Dartmouth Atlas is a collection of data that has been compiled from Medicare claims which document the variation in cost and delivery of care. This data was collected from every region in the U.S. Regarding the current project data, Weinstein stated, “We’ll collect the data at Dartmouth and we can benchmark it against the Dartmouth Atlas. We’ll look at what the best outcomes are at the lowest cost. We’ll share that data with each other and publish the recommendations for others around the country to consider.”

The new health care law combined with the interest from employers in controlling health costs should increase the interest in and use of the recommendations created by this project. Weinstein says, “The more we make this public and share this, the better off we’ll be as a nation.”

By: Wojciech Ciszewski