Depression: Youth, Counseling and Antidepressants

The advent of modern antidepressant medication has been a lifesaver to many. Recent research demonstrates that a combination of counselling and medication can provide the most effective treatment for youth suffering from depression.

However, there is evidence to suggest that in the early stages of medication treatment, there is an elevated risk of suicidal thought, which for some persons may lead to suicidal behaviour. This is causing a great many people to reconsider their use of medication, even when indicated.

This issue is determining which youth will benefit from one or the other or both treatments. To this end a good assessment will look for exogenous factors and endogenous factors.

Exogenous factors are those things outside of the individual that may contribute to depression. These include; family dysfunction, abuse or neglect, parental separation, school related problems and relationship problems. If it can be determined that one or more of these kinds of factors are at play, then counselling alone may be sufficient to treat depression.

Such counselling includes family therapy, or in the case of separated and fighting parents, mediation to help them resolve their conflict, so that the youth is no longer subject to their turmoil. If the youth is in a difficult interpersonal relationship, then counselling for the youth to address the difficulty may be in order. If the youth is abused or neglected, these issues must be addressed and the youth’s safety must be attained.

Endogenous factors generally relate to biological or neurobiochemical factors. If there is a history of depression in the family and there are no known exogenous factors, then medication alone may be the treatment of choice. Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counselling, CBT or Cognitive Behavioural Therapy, is also indicated.

There are times of course when both endogenous and exogenous factors are at play. In these circumstances a combination of counselling and medication could be in order and should seriously be considered.

Parents and youth are cautioned against making their decision solely on the basis of newspaper articles proclaiming the good or the bad about any treatment. Depression is a serious disorder, which left untreated can lead to suicidal thoughts, action, injury and death.

If you or your child is depressed, obtain a good assessment by qualified professionals that will look at both endogenous and exogenous factors and devise a treatment plan accordingly. Further, the counsellor and the prescribing physician should be working hand-in-glove following the individual to manage safety issues and communicating regularly about progress.

It is important to know that with antidepressant medication, it can take a good thirty days before the therapeutic effect is achieved. During this time, counselling may be of benefit to resolve other issues as listed above or to simply provide support until the medication reaches effectiveness.

If you or your child is depressed, get help. It is often advisable to start with your family doctor or community clinic. A physician can make the diagnosis and direct you to treatment.

New Grand Concourse Counseling Center is Hub for Mental Health Services in the Bronx

The Grand Concourse Counseling Center opened its doors this week, creating a centralized mental health clinic in the heart of the Bronx.  The Jewish Board of Family and Children’s Services (The Jewish Board), New York City’s largest provider of mental and behavioral health services, created and operates the clinic. It serves Bronx residents of all ages, from infants to seniors, offering a range of services.

The new Center, at 2488 Grand Concourse, combines The Jewish Board’s Bronx Counseling and Early Childhood Treatment centers with the South Bronx Counseling Center at an easily accessible location for families and individuals alike.

The mental health clinics work with children, adolescents, teens and adults. In addition to counseling and treatment, the clinics’ staff works to make health care less fragmented, especially for clients with complex medical needs. Care coordination services are also available to help children, their families and adults navigate the healthcare system.

At the Early Childhood Treatment Center clinicians serve children from 0 to 5, filling a noticeable void in the Bronx and helping parents understand, recognize and respond to emotional and psychological issues in their children. By engaging entire families, The Jewish Board aims to stop the often intergenerational cycle of emotional suffering and set children on a stable and productive course for life.

The Jewish Board, with its decades-long experience in early child development, trauma, and mental and behavioral health issues, has a long track record of creating path-breaking programs and therapeutic models to support all aspects of a child’s life.

Currently, the mental health and early childhood clinics are helping more than 1,000 people, including more than 200 children.

David Rivel, chief executive officer of The Jewish Board, said: “With the creation of this unified clinic, The Jewish Board’s continues its effort to increase awareness and treatment of mental health issues among New Yorkers of all ages. It is our mission to offer the best services for those dealing with these challenging life circumstances by providing the tools needed to succeed in life.”

For more than 140 years, the Jewish Board of Family and Children’s Services (The Jewish Board)  has been helping New Yorkers realize their potential and live as independently as possible. We promote resilience and recovery by addressing all aspects of an individual’s life, including mental and physical health, family, employment and education. Across the five boroughs and in Westchester, we serve more than 43,000 New Yorkers from all religious, ethnic and socioeconomic backgrounds each year. For more information, please visit www.JewishBoard.org.

Social Work Research Sparks Calls for Change in Adoption, Options Counseling Process

(AAP Image/Tracey Nearmy)

A new study by a Baylor University researcher gives voice to women who have placed a child for adoption and suggests changes to the options counseling process and policies that guide agencies and other adoption professionals.

“There wasn’t paperwork. There wasn’t counseling. There was, like, no requirement for, ‘OK, we have to explain X, Y, Z to you.’ It was basically, ‘OK, well, here’s some life books and call us when you have the baby,’” said one birth mother, quoted in the study.

“Nobody ever asked me what I wanted to do,” said another.

For the past two years, Elissa Madden, Ph.D., assistant professor in Baylor University’s Diana R. Garland School of Social Work, led a team of researchers who surveyed, interviewed and analyzed the responses of birth mothers who had placed a child for adoption and adoption professionals who work with expectant parents. The two-phase study was funded by The Donaldson Adoption Institute’s Lynn Franklin Fund and conducted in partnership with the School of Social Work at The University of Arlington.

“We were very intentional about this study from the very beginning,” Madden said. “We wanted to make sure that we would be able to capture different perspectives – birth mothers who have lived this experience as well as adoption professionals who work with expectant parents each day and understand that side of the process.”

The first phase of the study (released in November 2016), provided survey results and quantitative analysis of 223 birth mothers who had placed a child for adoption within the past 25 years, as well as 141 professionals who help counsel and facilitate adoptions.

This second phase provides a deeper qualitative analysis based on interviews with 28 birth mothers and 20 adoption professionals.

“Perhaps one of the most sobering findings was the fact that several of the birth mothers indicated that they did not fully understand the impact that this decision would have on every aspect of their lives from that point forward, including their relationships with their family, friends, their future spouse and other children they would have,” Madden said.

This latest phase of the study released by The Donaldson Adoption Institute include the following key findings:

• Many of the birth mothers expressed concerns of being judged and feelings of shame stemming from their pregnancies. For some mothers, the sense of shame stemmed from religious beliefs primarily surrounding having had premarital sex as well as the idea of being an unwed single mother.

• It was common for birth mothers to express concern about their lack of financial stability during their pregnancies. Financial concerns were often cited as reasons why birth mothers first considered, and ultimately elected, adoption.

• Many birth mothers experienced a lack of social and emotional support during and after the pregnancy and after the adoption was finalized. This lack of support often manifested when people in their lives avoided talking about the pregnancy or the adoption.

• Adoption professionals reported the use of different terms to refer to parents experiencing a crisis pregnancy who are seeking information about adoption. Slightly more than half of the adoption professionals indicated that they prefer the term, “expectant parent.” Other adoption professionals indicated that they prefer the term, “birth parent.”

• Much of the information that adoption professionals reported discussing with new expectant parents focused on adoption-related concerns rather than full consideration of all of the parents’ options. Less than half of adoption professionals specifically mentioned discussing information related to parenting their child or methods for helping expectant parents’ problem-solve how this might occur.

• Despite the confidence that the professionals reported feeling about their ability to work and communicate with expectant parents, most offered suggestions that would help them strengthen their practice. More than half of the adoption professionals called for additional training on grief and loss related to relinquishment.

“While some of the women we interviewed had very positive experiences during their decision-making and relinquishment process, others indicated that the information and support that they received from the agency or attorney was insufficient to help them fully consider their options and make the best choice for them and their child,” Madden said. “For these birth mothers, the decision to place their child has had a lifelong impact on them and is one that they greatly regret.”

One birth mother quoted in the study said she felt pressure to sign papers immediately after having the baby.

“It was horrible,” she said. “I can tell you right now, if the lawyer hadn’t shown up in my room when I was in kind of a haze from giving birth, I don’t know if I would’ve signed those papers. I should’ve had time.”

As part of the study, the researchers made several policy recommendations, which include:

• Mandate adoption agencies and adoption attorneys to develop and/or provide free access to pre- and post-relinquishment services for expectant and birth parents. These services should include individual and family counseling provided by a licensed clinical professional.

• Mandate that adoption agencies and adoption attorneys must provide expectant parents with a standardized, informed consent that details the possible outcomes associated with relinquishing parental rights to a child for adoption, as well as potential outcomes that the child may experience.

• Increase and standardize education for expectant parents and prospective adoptive parents about the strengths, limitations and legalities of post-relinquishment contact, including the rights of adoptive parents to decrease or eliminate contact in some states.

• Mandate biannual ethics in adoption continuing education for adoption professionals. This curriculum should address ethical challenges related to working with expectant parents, birth parents, extended family members, prospective adoptive parents and other adoption professionals. The curriculum should also emphasize the importance of options counseling, including full informed consent and access to supportive services.

Paradigm Shift Urgently Needed In Education

classroom-testing

Childhood stress levels are at an all time high. According to the Healthy Young Minds report, around 10 percent of the world’s children today are suffering from diagnosable mental health problems; mainly anxiety, depression, and stress. That’s around 220 million children and young people suffering. And what’s worse, this number is expected to rise. The World Health Organisation states that by 2030, depression will be the number one global health risk. If we don’t act now, this will have a profound negative impact on the world. Our global economy and humanity will feel the brunt of this crisis.

This is a cry for help. Will we answer the call? 

The way to combat this childhood suffering is by creating a paradigm shift in how we currently educate our children. One which addresses both the universoul nature (our inner essence) and intellectual development of children. In the 21st century, children need hope and inspiration. They need guidance toward inner peace as much as they need guidance towards academic achievement.

Parents – including myself – are increasingly stressed and under pressure from longer working hours and less down time. Social media and the internet have shaped a sense of urgency and immediacy in replying to emails; which means the work life has been seeping deeper and deeper into the home life. This makes it nearly impossible to switch off. Children are like sponges. They feel and sense what’s happening around them. It’s no wonder children are also becoming stressed and under pressure themselves.

What is the meaning, purpose and function of education? 

The general purpose of education is to teach children to think critically. In order to attain standards set by the national curriculum, schools put children under pressure to achieve certain outcomes. The Guardian recently reported that stress caused by exams is at an all time high with a 200% rise in requests for counselling specifically because of exams says the NSPCC.

The irony is that whether a child will become a happy and functioning adult with social and emotional capacity is not measured through academic achievement. We might have children coming out of the education system with great intellect but if they are suffering from stress, anxiety, and a lack of emotional competence it does more harm than good. Currently, not enough time is spent on what makes us human beings.

Shifting education in the 21st century

Educators can be pioneers in transforming humanity by providing a curriculum enriched with both universoul and intellectual objectives. Love, empathy, compassion, forgiveness, tolerance, responsibility, harmony and a concern for others are at the crux of the values of humanity and yet it’s missing from education.

Schools need an ethos that promotes children’s universoul well being by providing yoga, meditation, mindfulness, and promoting happiness in schools, as Wellington College has been successfully running since 2006. Teaching children about altruism is another fundamental character trait in healthy social development.

Stress is inevitable in life but if children and young people are able to learn how to understand and manage their own emotions they will become emotionally, mentally, socially, and physically more healthy.

For the sake of our common humanity we must act now. Our future depends on it.

Violence in my Rear View Mirror

By Tracy Cerff

broken-mirror

Too often we hear it said that a woman should ‘just leave’ a violent relationship. It is far easier said than done. Hindsight is a gift not afforded to all of us. The majority of assaults and deaths of women in domestic violence crimes have been committed after they have left the relationship.  The Australian Institute of Criminology put these horrendous crimes between 80-100 women each year, saying the majority of them were being killed in their own homes.  I remember clearly the day I ended my relationship with a former partner and how difficult and almost deadly it was.

As usual he took me in through the back entrance and insisted I sit down, politely pulling out a kitchen chair for me from the large dining table which seemed odd even then, as I had never seen anyone in the home to use it. I remember the warmth of the sun sneaking its way in the backdoor. To my dismay, but relief, he left it slightly open. It was the only comfort amongst the coldness I felt and the echoing of his voice inside my head.

We reached his home, the sun shining hot on the heavy, heritage bricks. He invited me into the house, in his ‘ordering voice’, to come inside for one last drink together. I wanted to run a thousand miles. I followed him in knowing I had to make it a quick stop or perhaps I wouldn’t be leaving at all.

Although we had just had a fiery argument in the car before arriving, he was eerily calm now and had begun to peel a mango with a sharp kitchen knife, which I’m sure I stared at for too long. He was remarkably back in his happy space again – he often changed his emotions without notice. Me however, I was stiff with fear as I now dreaded being in his presence, in his house – in his life.

From the other side of the room, while I silently watched him peel his mango, he tried to coax me to share it with him – how kind, I sarcastically thought. One mouthful and I would have physically puked. I so wanted to hide the fear I could sense he detected in me as he would see it as his prize, a triumph. I meekly declined his offer.

Deciding to now play a hero role, he came and lifted me from my pedestal – my place where he put me at the table. As he stood me up he mockingly snickered that I should lighten up and give him a hug. I stared at the shadow cast from us both open the half opened door. That doorway that gave me hope – with the warmth of the sun and openness to the outside world.

The shadow told a different story. Not one of a loving embrace for sure, rather a thrilling scene from a movie where we were the main actors. I could see the portrait of us both entwined, with the knife in his tight clenched hand against my skin. I was so frozen in fear that I couldn’t feel the actual knife itself. I knew I needed out or this was it.

With whatever scrap of strength I could summons, I hugged him as he wished and shakily lied, “I really have to get going or I’ll be late for my appointment and I don’t want them calling me”. Without hesitation, I pulled away from his grasp and grabbed my bag off the side of the chair praying it wouldn’t get caught. I don’t know why he allowed me to go, but I just knew to keep going – I did what I had to do to survive and it worked.

At my appointment I must have still been as white as a back-washed wall, as the Doctor was very concerned about my anxiousness, offering me the details of a counsellor near to my home. I never shared a word to him of the incident. I did however gratefully accept the details. I was one of the lucky ones, so many are not as fortunate.

My experiences have led me to a deeper understanding of the vast complications that women face when they find themselves in a similar situation. Unfortunately my story is not unique. It is far too common and made even more complex when there are children involved and when women don’t have the means or funds to safely leave the situation. My work in counselling and education opens doors for me to empower women, men and young people to plan their future, a future without violence and control at their hands of another.

Observations of a Danish Social Worker on Social Work Practice in the United States

cancer-patient

I was working as a social worker in Denmark for some at a highly specialised university hospital until I moved to the United States, and I have been wondering about the differences and similarities in working with cancer patient in both places. With 10 years of experience working with cancer patients, their families and palliative care in Denmark, I can see how different Denmark is from the U.S. health and social system. I don’t think it will be fair or even possible to do a one to one comparison of the two countries.

In Denmark, the government plays a major role in providing citizens with fundamental social security and access to healthcare, which dates back to the 1800s. With a comprehensive social security system, most of the welfare state tasks is financed by taxes. In the United States, I have learned most of the social support is provided through non-profit organisations and healthcare is mostly secured by insurance. So with such big differences, I thought it would be interesting to see if there are any common denominators.

In my search for work in the United States a question I often get is do you have experience in working with Afro/American women? In the beginning I wondered a lot about that question, but then it made me really think about how do I define myself as a social worker. Working as a social worker here in the United States at a clinic for low income women with cancer I met many different ethnicities.

Mohammad, a 50-year old man, who was working as a bus driver when I first met him. Originally he was from Iraq, but came to Denmark as a political refugee. He was married and had four children. Mohammad’s wife didn’t speak Danish and she didn’t work. I met Muhammad because he was diagnosed with Colon Cancer and wasn’t able to work much longer.

Being diagnosed with cancer is mostly associated with uncertainty, hopelessness and anxiety of not having any control. Many cancer patients also experience stigma, shame and blame depending on the diagnose. Besides that most people are filled with fear of the disease, many also have concerns of what the diagnose means in relation to work, social life, economy and everyday life. A life threatening disease is an extreme and potentially stressful triggering life event which requires psychological coping.

The best results in our line of work I believe is created by being humble in the approach to the patient and by having a natural curiosity towards the patient’s life story. We must first and foremost see the patient as a person who comes to us for help because they are in a place in their life where they cannot stand alone, and we need most of all take a look at the patient’s individual experience of his or her situation. Whether the individual can adapt to the new life situation depends partly on their degree of resilience.

The first couple of times I met with Muhammad he didn’t say much, I would just talk with him about life in general, so he wouldn’t feel I pressured him into speaking about his situation. In my experience, working as a social worker, a patient in a situation like Muhammad’s is going through a lot of emotions. They may have the feeling of loneliness, lack of understanding from their surroundings, social isolation and financial difficulties.

Moreover they go between accepting the situation, to denial or to have some degree of acceptance. Every time I met with Muhammad I told him you can always come back. I would ask him how his treatment was going and asked about his life in general, this was to not only define him by his diagnose and the disease. Then after a couple of meetings he brought his wife and from there the contact to the family became more frequent. I was Mohammed and his family’s social worker until he died 4 years ago.

Sabrina a young mother of three, was diagnosed with melanoma cancer metastasis to the brain and because of some insurance issue, she had not gotten her treatment and scans. Sabrina’s husband was providing for the whole family and wasn’t home a lot which made Sabrina feel very alone in her situation. Also, Sabrina was going to die and she knew and recognized it.

Speaking with a patient in Sabrina’s situation you need to find out what is most important for her to talk about. Is it emotional support or is it more practical support she needs. First of all, I believe that we should all have an open heart, open mind and listen to the stories the patient has to tell, without race or color in mind.

It is important as a social worker to start a conversation with a patient and imperative to distinguish between the problem and the condition for knowing when to take have a solution-oriented approach, and when we do not need to act, but do something else for the patient. Problems such as financial aid, help to clean, help to care for the children and figuring out what the insurance and pension rules are, can be solved. Conditions are more definable as distressing life events, something the patient has to live with. A burden or a grief to be worn like that I am not able to work longer, I have to die from my children and the disease itself. These circumstances affect the patient on a more emotional and spiritual level.

However, it can be difficult to distinguish between problems and conditions as the patient will often ask questions or talk about the difficult life conditions in a way that invites to problem solving. The patient’s narrative and questions must be recognized and unfolded before we can assess whether it is something we must act on or not. It can be difficult to distinguish in practice, since a situation may contain aspects of both conditions and problems. Here, we must be careful not to solve problems before we acknowledge the losses that the patient has in their changed conditions of life.

I think it’s very important to remember to be truly present with people. We bring knowledge, skills, and compassion to listen in a unique and dedicated way. We need to bear witness to people’s physical and emotional pain without abandoning them or being judgmental in any way. Our role is to create a safe space for the patient to share their joys, regrets, fears, strengths, and sorrows.

I do believe parallels can be drawn between the experiences with patients that I’ve had in the United States and in Denmark. When everyday life is shaken by serious life-threatening disease and families are affected, concerns that arise in both countries are similar in nature regardless of social status and ethnicity.

However, it has surprised me that there is so much focus on ethnicity, especially when I see basically the same problems regardless of race and social status.

It is my experience from what I’ve seen here so far, that here it is more about what ethnicity do you have and what social class do you belong to, that determines how the approach to the patient will be.

A different culture, ethnicity or religion it self does not necessarily accompanied by challenges or the need to have a specific kind of approach.

A cancer – regardless of diagnosis – contains significant psychosocial impacts. In addition to the diagnosis of specific problems, patients often live with fear of relapse, depressed mood, attention and memory impairment, reduced work ability, problems in relationships which, individually or together, may adversely affect rehabilitation and retention of social and cultural status.

It’s essential for a good dialog and contact that we listen with an open-mind and acknowledge the problems coming up during the conversation. Also, it is equally important to see the patient as an individual and avoid judging or being distracted by the patient’s cultural or religious appearance. Otherwise there is a risk that factors such as racism and prejudice will get in the way of the patient receiving the best help.

Using Superhero Powers with Clients

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Is it a bird, is it a plane? No, it’s Superhero Therapy!

Not to be mistaken for when superheroes happen to go into therapy, Superhero Therapy is a technique which can be used to support people who are in distress. This technique can be used across models, professions and theoretical orientations. Dr Janina Scarlet’s account of Superhero Therapy’s origins can be found here, and this current article is going to examine the practicalities of how Superhero Therapy might work.

In short, Superhero Therapy involves using a client’s favourite superheroes for support, inspiration, strength and compassion. They do not have to be ‘traditional’ superheroes – other fantasy/sci-fi characters may participate such as Harry Potter, Matilda, and Sabrina the Teenage Witch (or her cat). Many superheroes have flaws and struggles, and they all inevitably get things wrong. They aren’t always sociable, or even likable.

So what are the practicalities of using the Superhero Therapy technique?

Firstly, at face value it is a great way to get to know people without having A Very Serious Discussion About Feelings. Finding out what someone’s interests are is an important and human part of any therapeutic process, and at the same time it can provide valuable information in the context of casual conversation. In this case, the focus would be light information-gathering and relationship building. For example in one touching story, Drax from Guardians of the Galaxy was related to by a young boy diagnosed with autism. These characters can be a way of reaching people.

Secondly, superheroes might be used as a way to externalise a problem. This technique is popular in narrative and social constructionist perspectives of distress. An example could be a person describing their anger as being like The Hulk – unstoppable, the desire to smash. Somebody may feel that they ‘go Gollum’ when the critical voice in their head starts to remind them they are going to fail. Having no boundaries and people-pleasing could be externalised as being like the Genie from Aladdin.

By giving the problem a name and a character, it is separated from a person’s sense of self. This supports people toe to develop a different and less blaming relationship with distress. To do this, a therapist might spent lots of time fleshing out the character with all five senses. They would keep drawing parallels between the character and the experience of distress.

Cognitive Analytic Therapy and psychodynamic approaches might use creative techniques to delve into unconscious processes. One might look for what the superhero represents, e.g. being strong or clever or popular – perhaps it is an unmet need? Links may be made between the superhero and actual/idealised caregivers, and whether the superheroes represent people who already exist in the client’s life.

The superhero could represent the client, or somebody they wish they were. What is that draws the person to the character, what stories about the superhero stand out? (e.g. stories of triumph, or loss, or conflict). Additionally, the person’s relationship to the superhero is important – is it one of admiration, sexual desire, envy?

Superhero stories might also be used as part of Cognitive Behavioural approaches. Cognitive Behavioural approaches often focus on one’s thinking patterns, and how they can colour one’s life. Examples include ‘all or nothing’ thinking (e.g. ‘you come first or you’ve failed’) and  generalising (‘I ALWAYS get it wrong’). Superheroes could be used to evaluate such patters (e.g. if panic attacks mean you’re not strong, does that mean Iron Man isn’t strong? Would The Doctor be a bad person if he gave up his guilt? Does Storm always forget about her past and ‘move on’?).

Finally, superheroes can be a resource for ideas and inspiration. How did they get out of some tricky situations? What were the pros and cons, and who helped them? Sometimes in therapy, a client might be asked what their friend would say to them (e.g. “Would your friend call you stupid and useless?”). But some people have few to no positive relationships in their life, and superheroes might be another way to source creative ideas (“What would Lara Croft say about facing your fears?” or “What did Jean-Luc Picard do when he was stuck?”).

One could also source some personal experiments from superheroes (“Imagine you’re in the Triwizard Tournament and your next challenge is to go to a social gathering…”), or ideas for how to care for themselves (“What would you need to survive the Hunger Games?”), or even some life philosophies (“You’ve already made the choice, now you have to understand it” – The Oracle, The Matrix). A client could read a section of a comic or film script aloud with a therapist, to get a feel of what it’s like to be that superhero. They may create subtle gestures to release their powers as Spiderman releases his web. The possibilities are many.

However, no superhero is flawless, and neither is Superhero Therapy. Having a fun topic that both therapist and client can share may be useful and validating. However, assuming shared knowledge could be detrimental if the therapist doesn’t remain curious and exploratory. A mere mention of certain characters might bring up certain things for different people – Poison Ivy is one person’s sexual object, but another person’s environmental activist or powerful scientist. As such, and given the excitement and wonder of the superhero world, it’s important that the therapist not get too caught up in the magic and their own memories or interests.

On the flip side, the therapist may never have heard of the client’s superhero. This may be particularly regarding minority ethnicities, women, and LGBT+ (minority gender and sexuality), whose superheroes may not yet be as mainstream as the likes of Iron Man, John Connor, Flash Gordon, James Bond, Kickass, Hercules, Batman, Thor, Daredevil, Neo, Superman, Marty McFly, Green Lantern, Sherlock Holmes, Dr Who, Spiderman, Dr Manhattan, Indiana Jones, Luke Skywalker, and so on.

Of course, not all superheroes are straight white males, and having the client describe their superhero if the therapist is unfamiliar is actually a great opportunity. The danger would simply be assuming a narrow range of what ‘superhero’ might mean to someone, especially when describing superhero therapy to the client. A therapist should at least be aware of a range of examples of what ‘superhero’ could be, if only to support the client to think about who their heroes are and why (some clients would of course need no prompting!).

These issues link directly into wider conversations about social justice at large – for example, the representation of certain groups of people such as the ‘crazy’, females, effeminate men, ‘criminals’, and those who are not white. Superhero Therapy is affected by the problems or puzzles that naturally fall into the helping, social domain. By dint of being part of our culture, superheroes reflect the real world in which they are born.

It’s possible that the application of Superhero Therapy is an invitation for more of us to be superheroes, to be empowered, to find out what it is that we are good at and where we fit. A common theme of superhero stories is that of the civilian population having solidarity and compassion for each other (albeit usually in defiance against an evil tyrant.. is that too far from reality?). Even villains are usually not ‘all bad’ and some of them try to solve social problems, albeit in a morally questionable manner (e.g. Magneto, the aforementioned Poison Ivy).

In conclusion, the practicalities of the Superhero Therapy technique are diverse and worth pondering. The concept of Superhero Therapy is naturally flexible, but the process still requires the personal touch of understanding the client (and it cannot be assumed that every geeky client will connect with superhero therapy). It combines general everyday interests with deep-set beliefs, hurts and vulnerabilities, and can be a powerful tool. However, as any therapist or support worker should know, with great power comes great responsibility. That responsibility extends right out into societal, social justice. It is up to the practitioner to avoid treating this like a surface-level and superficial task, and to truly explore its potential.

Self Care: Placing An Oxygen Mask On Yourself Prior To Assisting Others

Traveling with friends and family to events is something I like to do for two reasons. One is the fact that I like to share experiences with others who might not otherwise have the opportunity to travel. If I can help them create new memories and expand their minds I always try to. Two, I simply prefer to have company when I travel for speaking engagements or HipHop performances.

But there’s one specific time I recall that I’m sure my travel companions may have wished they had missed out on my excursions.

Primarily filled with judges and lawyers, this 1000 person audience threw me for a loop and off my game. What happened was both humbling and embarrassing. It also opened my eyes to some internal emotional work that I had yet to address. I wish it wouldn’t have unfolded on stage, but everything happens for a reason and this was no exception.

I stayed up until 5AM the night before the big conference preparing my notes and pacing in my hotel room, undoubtably irritating both my sister and friend/videographer who were sharing the two room suite that had been provided to us. I was noticeably more nervous than usual. Rightfully so, it was an entirely new audience. This nervousness led up to a level of self-exposure that was not planned nor pretty.

Keep in mind that keynote speaking is my full time career. These organizations don’t hire me just because of my fancy website or produced videos, they hire me because I have personal experience in the system and spent 15 years working as a Registered Nurse and child welfare advocate prior to launching my platform and publishing my book. Hopefully this tells you that this mishap was not due to inexperience, but rather a lack of awareness in the self-care department. It was not something that was obvious.

A small dog suffering from smoke inhalation was rescued by firefighters and given oxygen by firefighter/paramedic Mark Hubert. Photo by: Gigi Graciette (shared by OCFA)
A small dog suffering from smoke inhalation was rescued by firefighters and given oxygen by firefighter/paramedic Mark Hubert. Photo by: Gigi Graciette (shared by OCFA)

I have spent nearly a decade engulfed in self-development and improving my approach to self-care so it was not for lack of trying. It was simply something that went under the radar. I think that we all have little things that sift through the cracks of our diligent efforts time and time again. Which is why we need to regularly and consistently be reminded of the importance of self-care.

No matter how many times you have flown, the flight attendants always remind you to take care of yourself first. If the cabin loses oxygen then make sure you have your oxygen mask on prior to assisting others even children. You’re no good to anyone if you die before getting to them. And that is what happens when we keep letting little things slip through the cracks.

We die a little inside and aren’t able to be the great people we were meant to be for our friends, family, and clients. How many social workers do you know that need a social worker? Probably a lot. Remembering this can save your life and your relationships.

Therefore, at the risk of exposing my own insecurities to yet another large audience, I offer this story to inspire your own self-reflection in hopes of allowing you to be better prepared to face the unknowns in your life and work. Allow yourself to care for your own hidden emotional barriers before making a fool out of yourself in front of friends, co-workers, and most-importantly family members and clients.

During my presentations, I often speak about my relationship with my mother and the impact it had on me as a child as she was absent and often emotionally abusive. Shortly before this presentation, I learned more about the truth behind my mother’s behaviors during my childhood. I learned that she had been labeled with multiple mental health diagnoses and placed on several psychotropic medications that impaired her ability to function, much less parent.

It gave me a sense of relief. So much of my life, I had hatred pent up in my heart for her inability to provide love, compassion, trust, and understanding. But, this new knowledge gave me a new direction for that anger. It allowed me to blame others or simply blame the system.

During this presentation, I spoke about those new findings. Self-exposure is generally very moving, right? I thought so too, but I found that to be the case only if done strategically and with purpose.

There was no purpose for my ranting about the corruption of the system. I was simply ranting.

Afterwards, a lady who looked my mom’s age and as if she may have had a rough life herself gave me a note. She told me to open it when I get back to my hotel room, and I did. It read: “I’m glad your aunty was there for you when I wasn’t able to be. I’m sorry that I wasn’t able to be who you needed me to be. I love you very much. -signed, Mom”

I didn’t know it, but those were the words I had been longing to hear my entire life. And this woman knew it. Something tells me she was in my mothers shoes most of her life and possibly was once in my shoes as well.

Sitting in that hotel room, I broke down in tears immediately upon reading those words. She got it. She found a gaping wound and she picked up on it from my ranting on stage when I should have been providing actionable steps for the audience.

50 percent of the reviews from this event were negative. I obviously didn’t follow through with what the audience needed. I am embarrassed to say that, but hopefully this is a reminder that it is okay to need help. It is okay to take time away. Self care is essential, and it is okay for the counselors to seek counsel. Actually, it is necessary so that you don’t cause 50 percent of the people in your life to feel negative about your interactions with them.

We are here to help others, but we must help ourselves first.

What’s the Deal with Online Therapy?

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Marlene M. Maheu, a therapist, uses video conferencing to communicate remotely with patients. She has served on task forces to address issues of online therapy. Credit Sandy Huffaker for The New York Times

Online counseling or “web therapy” is an emerging practice in the world of social services.  Although online counseling is not a substitute for traditional psychotherapy, it has many benefits, including flexibility, anonymity, comfort, and convenience.  Perhaps you are nervous about going to therapy—with online counseling you can test it out for as little or as long as you’d like in many different modalities.

Many services are offering “Skype” or video counseling using secure software, or voice phone calls directly with a therapist, or even text message/email therapy that is not offered in “real time”—giving you and the therapist both a chance to respond when most convenient for you.  Whichever modality you choose, the world of online counseling can introduce you to therapy in a non-invasive, comfortable manner at your own pace.

However, online counseling is not appropriate for everyone.  Online counseling likely does not include prescribing medications, which can be essential to the recovery of severe mental illnesses.  It is also not appropriate for anyone who is currently suicidal or homicidal, or anyone who is currently experiencing psychotic symptoms. If this is the case, you should immediately call 911 or your local emergency authority.

Another draw and danger of online therapy: anonymity. Many people avoid treatment for reasons of shame or privacy. Some online therapists do not require patients to fully identify themselves. What if those patients have breakdowns? How can the therapist get emergency help to an anonymous patient? Read More

Most importantly, anyone who needs intensive support or hospitalization is not a good fit for online counseling. Online counseling should be used as additional support and not a replacement for those needing intensive treatment.  Another limitation of online counseling is the difficulty in interpreting voice tone, body language, and other forms of non-verbal communication in traditional therapy methods.

Although online counseling is not appropriate for everyone and some professionals are still skeptical about it, there are studies showing online counseling can be just as effective as face-to-face in person therapy with a better attendance rate.

The Journal of Affective Disorders reported a University of Zurich study divided a group of 62 patients in half and found that depression was eased in 53 percent of those given online therapy, compared to 50 percent who had in-person counseling. Three months after completing the study, 57 percent of online patients showed no signs of depression compared to 42 percent with conventional therapy.

In an April 2012 edition of Psychiatric Services, it was reported that in a four-year Johns Hopkins study that included close to 100,000 veterans, the number of days that patients were hospitalized dropped by 25 percent if they chose online counseling. This is slightly higher than the number of hospital visits experienced by patients who used face-to-face counseling.

Lastly, according to the American Psychiatric Association in 2007, patients in Ontario, Canada were assigned to face-to-face or live video counseling and experienced statistically the same clinical outcome and level of patient satisfaction. The only difference was that the cost of providing the online service was 10% less per patient.

Overall, online counseling permits the client to access therapy when it’s convenient for them and without having to leave the comfort of their home.  It could be a type of counseling that can reach more people in need which is necessary and important.  What do you think?

Mental Health Advocacy Must Remain A Top Priority

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As of 2013, May is officially mental health month which was set in motion by President Obama, and it has made a huge impact in only a couple of years. This movement has caused other public figures to jump on board to help raise awareness to combat the stigmas associated with seeking treatment. Advocating for mental health awareness is a mindset that we all should aspire to follow.

Although mental health awareness month is officially over, we must be diligent throughout the year in creating awareness on mental illness. Mental health stigmas are a real problem, and they still exist all over the world. In America alone, there are about 8 million people suffering from severe mental illnesses and only around half of those are treated.

But why should we fight these mental health stigmas?

Fear of discrimination and the attached stigmas often keep sufferers and their families from facing their mental health problems. This deters them from seeking help, which is very problematic. Mental health is just as important as physical health.  Additionally, access to mental health treatment and insurance coverage can also be a barrier to seeking treatment. Mental health treatment should be viewed similarly to how physical ailments are addressed because the two are often times entwined.

Fortunately, as awareness of mental health issues spreads and stigmas recede, more and more medical professionals are choosing careers in mental health. We are learning more about the benefits of helping people care for their mental health, including longer life expectancy, increased productivity, improved financial stability, and happier personal lives. As a result, public and private organizations are recognizing the importance of providing access to affordable mental health care. In the U.S., this progress is evident in the inclusion of mental health care coverage requirements in the Affordable Care Act. Read More

What can we do to combat these backwards beliefs?

Simply put, we need to advocate for change. If someone refers to a person with a mental illness as ‘crazy’ or ‘insane’ it is completely justifiable to point out that it is not alright to use such shaming language. It is important to question how using those kinds of harsh words can segue into negativity and generalizations that are frankly not true.

Online communities such as BringChange2Mind and StigmaFighters offer those struggling with mental problems a judgment-free outlet for taking the steps towards acceptance of themselves and overall wellness. Although May is over, advocating for mental health equality must remain a top priority. We all deserve to live happily and feel healthy.

Be a voice of reason by advocating mental health all year-long and you will make the world a much better place for literally millions.

A New Approach to Counseling for Meeting Your Client’s Needs

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People attend counselling because of distress and want relief as quickly as possible. With traditional counselling approaches, people see the counsellor for the standard 50-minute session, one at a time, week after week. It often takes the counsellor 2 to 3 and even 4 sessions to gain enough information in order to begin being helpful which means distress may continue at least that length of time.

Even then, many therapeutic approaches have the counsellor saying very little apart from reflecting back the client’s own feelings or validating their concerns. Many people come away from this kind of experience having changed very little. While they may feel validated or supported, issues of distress can continue.

My approach to counselling is different.

Rather than coming back week after week, the first session is a long one; usually a good three hours straight. Through a structured interview process, I obtain the information necessary to understand the problem and situation as fully as possible to be helpful sooner – often on the basis of the one meeting.

At the end of that first meeting, folks are given very direct and forthright feedback. They are provided practical and direct information and guidance to help resolve matters causing the distress. They may or may not take heed of the feedback, but those that do, tend to do better than those who do not. This remains their choice. Due to the nature of this approach, remarkably, many people attend this one meeting only because it has been sufficient to address the issues for which counseling was sought.

If folks return, it is generally 3 to 6 weeks later, after they have had time to work with the feedback. Even if folks do return they are rarely seen beyond 3 or 4 times. People can improve sooner and then at less overall cost given the time to really get somewhere in our meetings.

Because of this approach, I rarely have a waiting list. I see many many people, for a short duration. This means you can be seen quickly. Again, when in distress, being seen quickly matters.

Do we tackle tough problems? Absolutely.

Because of the questions I ask directly, we address issues of abuse, drugs, alcohol, and violence, just to name a few. Connections are made between untoward childhood experiences and current life problems. Do not draw the conclusion that fewer sessions mean real issues don’t get addressed.

Whereas in traditional counseling approaches, the counselor seeks to develop something referred to as the therapeutic relationship, whereby over numerous sessions the client eventually feels comfortable enough to raise their issues on their own, in my approach, I ask directly about those experiences known to create distress so they can be discussed openly. To do this requires the counselor to be comfortable with this approach which in turn makes the client feel comfortable and safe to acknowledge those matters asked about.

By way of example, imagine going to your doctor and your doctor asking you, what do you think your diagnosis is; what do you think is the problem; what do you think you should do; how to you feel about that….

No one would want that. People expect the doctor to take your pulse, listen to your chest, look into your ears, take some blood and then tell you what is wrong and what needs to be done about it.

To add, I wouldn’t want my surgeon kicking me off the table saying we’ve run out of time and we’ll take the scalpel out next week; and I don’t want my clients to expect that when they are in distress. That is why I always set aside a good three hours for my appointments. By the way, I only bill for actual time used even though I provide up to 3 hours per meeting.

This is so different than what happens in the counseling world and no wonder many people’s experience of counseling is that it drags on and often with limited results – at least as told to me by many of the folks I see, which is not to say traditional approaches aren’t helpful overall.

But again, people attend counselling because of distress and want relief as quickly as possible.

See people beyond the standard 50-minute session. Provide time to really explore in a single meeting a person’s past and present by asking direct questions, much as a physician would do to understand the problem. Be informed on matters of abuse, violence and addictions as well as power imbalances, child development and the dynamics of relationships under different circumstances. Be helpful sooner.

If you are a therapist or counselor and would like to learn more about my approach, it would be my pleasure to discuss or provide a workshop. If you as a counselor or therapist are challenged by a particular situation with regard to a client and would like a consultation, please call.

If you are a person in a tough situation or coping with troubling behavior or feelings or relationships, it would be my pleasure to be of assistance. Expect a no nonsense approach. I would like to help you sooner.

Helping Children with Autism Spectrum Disorder

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According to the National Center for Children in Povery (NCCP), “One in 10 youth has serious mental health problems that are severe enough to impair how they function at home, school, or in the community.” There are no two children with Autism Spectrum Disorders (ASD) or any disorder that affects them the same. So, how do we know how to treat each individual child?

Watching her grow up, we all knew my sister was just a little bit different. She doesn’t like hugs, she hates clothes that are anything but loose, and the littlest of things can stress her out to the point of crying. Later, we found out my little sister had a mix of anxiety, Attention Deficit Hyperactivity Disorder (ADHD) and some Asperger’s tendencies.

She has been teased and made fun of, her dad tries forcing her out of it and it only causes more problems. Some people don’t seem to understand this is not a condition to grow out of and forcing change will only work to exacerbate her challenges. She has both a school counselor and an out of school counselor in which she sees on a regular, and it appears to be helping. Also, art and music have been a great therapeutic benefit along with taking care of the family pets. Some children may require medication, however, there are a number of other therapies that maybe instrumental in help you developing a holistic mental health plan for your child.

Counseling:

Although talk therapy would be relatively impossible for autistic children, a school counselor or a counselor in general is nice to have. A counselor can be another person that a child can trust to help them get through whatever it is that they are dealing with. They can also do other therapies, that do not include talking, while in a session that could help the child learn and grow.

A school counselor should not only be supportive for the child but for the family of the child also. A child with a disorder is more likely to be teased and bullied, which can both be hard on the child and the family. A counselor should be another person the family can look to for support in times of need.

Animal-assisted therapy:

One kind of therapy that has been showing great improvements in children and adults is animal-assisted therapy. It has helped result in educational, mental, motivational and physical improvements. Children can easily make bonds with animals which teaches them and later helps them form bonds with other people as well.

According to everydayhealth.com “more research is still needed to determine the effects and confirm the benefits of animal-assisted therapy specifically for children with autism, a number of studies have suggested it could help.” Even though the research is not completed yet, studies have shown that it is helping ASD children cope with the struggles of life.

Art and Music:

Art and music is another way for a child with ASD to express themselves. A lot of children don’t know how to express themselves with words but give them music, an instrument or something to draw on and you might just figure out how they are feeling.

According to the American Art Therapy Association , “Art therapy is a mental health profession that uses the creative process of art making to improve and enhance the physical, mental and emotional well-being of individuals of all ages.” Art therapy is benefiting people by helping them manage behaviors, reduce stress, resolve conflicts and improve interpersonal skills.

All of these combined have really helped my little sister and have made her life so much easier. She has formed deep bonds with her animals, spends her free time drawing and coloring and her counselor has been helping her open up to more of the family and become more connected.

Don’t Be Afraid to Tackle the Mental Health Issues Associated with Grief

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Story’s Angel of Grief

Not long ago I was given a book on grief, one of those self-published books that anyone can write and sell on Amazon.  The basic premise being promoted by the author is that grief can “be defeated” if one just has enough faith whatever spiritual religious tradition they embrace.  If one is struggling with grief, the author says, they need to have “increased faith,” and “quit stewing.”  “Too much latitude is encouraged especially in terms of time for grief”, according to the writer.  “One cannot rest in peace if his or her loved ones are stewing in excessive grief.” In other words, the author is saying that if someone is grieving the death of a loved one, he or she simply needs to “get over it.”  That really made me feel angry.

I am a Presbyterian minister, a board certified professional chaplain, and a person with specific expertise in counseling and particularly grief and bereavement.  This particular book’s author, on the other hand, was written by a person who is not educated or credentialed as either a religious leader or a counselor/psychologist.  Yet, the author tells grieving people to choose a faith (or consult a medium – seriously, that’s what is written) in order to “participate” in their grief in a way that “will be shallow and brief.”

I’m also a bereaved parent and even though it has been ten years since the death of our daughter, I still grieve for her.  Grief is a journey and an event that affects our lives forever.  It does not mean we cannot continue to participate in life and find joy, but the reality is that after a loved one’s death we look at life through a different lens.

Recently I read an article in the American Journal of Psychiatry about a study done by Columbia University’s Mailman School of Public Health that revealed that there is a link between sudden grief and the onset of mental health disorders like mania, post-traumatic stress disorder (PTSD), and depression.

The article did not surprise me at all.  Our daughter’s death was sudden and traumatic.  At the time where I was working in a large teaching hospital where every day I was called to the emergency department  to provide care to families whose own loved ones died after car accidents and other traumas.  I found myself feeling overwhelmed.

While my faith in God didn’t waver – I knew God didn’t cause the accident; it was caused by the careless decision of an adult who chose to speed and accelerate through a red light – I sure was angry with God.  I knew that was normal too.  However, it still created a significant amount of spiritual distress along with the emotional distress of grief.

Fortunately, I mentioned this one day in passing when I was with a good friend.  She stopped the conversation and asked me to tell her more.  She gently suggested that while my feelings were normal, I was also showing signs of depression beyond the grief as well as symptoms of post-traumatic stress.  “You’re doing so much to take care of everyone else; you need to take care of yourself.”

Because of her willingness to listen and look for the signs, she was able to see what I couldn’t see for myself.  My grief, which I thought I was managing (“and you are doing so very well,” she said) was something I didn’t need to work so hard to cope with it on my own.  We agreed on a plan: I would go and talk with my family physician, who was just as supportive, and we too agreed on a plan – counseling, a short course of medication, and becoming a participant in a grief support group for a time rather than being a leader of one.

There are times when grief’s accompanying depression, anxiety, emotional and spiritual distress becomes too difficult for the bereaved person to bear.  That’s when the right resources need to be activated.  Families, friends, and co-workers need a basic knowledge of grief in order to normalize the bereaved person’s experience and provide them support.  We also need to understand when a bereaved person needs additional mental health support when the trauma becomes difficult to manage.

That plan didn’t “cure” my grief or take away the sadness that I still carry with me (as the author of the book I read says must happen).  There are times when it comes back with a vengeance.  During most of those grief-bursts I find I can manage with the resources I have in place that work for me:  meditation, exercise, activating my support system – however there have been a couple of times when I’ve gone back to my doctor for help in identifying appropriate short-term interventions.

Of course, there are other examples of mental health issues that we can face in our daily lives.  Stress has been shown through studies to be on the rise due to a number of factors.  Living with a chronic or life-threatening disease, caring for a sick or elderly family member, post-traumatic stress, or dealing with the magnitude of responsibilities one has to make ends meet can all cause emotional and spiritual distress.  Sometimes these lead to mental health issues that need further attention.

I was fortunate that I had a friend, who while not a professional health provider, knew enough about basic mental health ten years ago to recognize that  I was struggling.  She didn’t try to talk me out of my grief, placate me with platitudes, or take the easy way out my ignoring my comments altogether.  Instead, she listened and took the step of faith and friendship to tell me I needed to check in with a professional about what I was feeling.

Knowing the indicators of a potential mental health challenge is something that all of us, professionals and non-professionals alike, need to be aware of.  In fact, it is something that I would urge we set aside time to learn more about.

Educational opportunities are becoming more and more available within our communities and online.  Many are being designed for those who don’t work in professional care fields, but who want to become more informed about mental health issues, what signs need to be looked for, and how to respond.  Check your community organizations, not just mental health centers, but also community colleges who are offering short-term, free, or low-cost programs.

Professionals who encounter mental health situations on a regular basis and those who work with the general public, including educators, health care providers, and religious leaders, need to make learning more a priority of their continuing education.  There are an increased number of programs now available.

Because of what I have learned from my own experience, I have been able to help others by now teaching health professionals what they need to look for in order to care for not only their clients’ bodies and minds, but also their spirits.  Those who are experiencing grief, serious illness, post-traumatic stress, or facing the end of their lives need the understanding, support, and resources necessary not only to cope, but to find meaning and comfort.

Let us not be afraid to talk about, learn more, and recognize mental health issues – not just in those we love, but also in ourselves.  Read.  Take a course.  Be part of the discussion.  Make a difference.

The Language of Effective Social Work

I find it fascinating that we, as social workers, proclaim we want to help people make better choices and choose healthier behaviors on their own, but then we speak to them as though they don’t have any power. In the past, I have noticed some of my colleagues experience trouble connecting with those we serve due to their language. The language portrayed two completely false ideas as if it was the honest truth such as our clients had no options/say-so in their own lives or we are psychic and know exactly what was going to happen to them at any given moment in the future.

We tell them that they have to do something or need to be somewhere. As Morgan Freeman/Joe Clark proclaimed in the movie Lean on Me, “I don’t have to do nothin’ but stay [insert your race here] and die!” Some of us may still talk to our clients in the exact same way. Whatever we choose to call this pattern of speech  ‘aggressive’, ‘controlling’, even ‘male’, I’ve found that I am much more successful and a more effective practitioner (and a healthier wife, sibling, child, friend, and co-worker) when I lean towards making a few simple changes in the way I talk to others.

Try to Avoid Telling People What They Can and Can’t Do

notlisteningDoes anyone have to go to treatment? No.  Do people need counseling? Not at all.

However, these things could be very helpful, may have some benefit, and could help people achieve their goals in life.Can you see the difference between “You have to go to treatment or you’ll never get better” and “You might want to consider entering treatment. I’ve seen it help a lot of people get their lives back on track.”?Let’s listen to ourselves, our clients, and our peers for the following phrases in bold, and see if we can start using (and encouraging others to use) the words and phrases in italics:

You have to   –   You might like to…, You might want to consider…

She should   –   It might have been more helpful to…, Maybe a better choice would have been…

You can’t   –   You might run into some problems if you…, I haven’t seen people be very successful when they…

I know   –   I get the impression that…, It seems as though…, I can understand if…

He always   –   I often see him…, I’ve noticed that he usually…, I can’t remember a time when he didn’t…

Addicts never   –   People suffering from an addiction often don’t…, Alcoholics generally don’t…

I’ve especially noticed a resistance to more aggressive language from people who have issues with authority figures, due to their past experiences with them. However, when we interact with them with an attitude that expresses the fact that they have all the power, and every right, in the world to get up and walk out our door, they seem to feel less of an urge to actually do that. They don’t have an overly controlling figure to “rebel” against. Think about how it takes two to tango, just like it takes two to argue. Let’s try to steer clear of being that opposing force that they use to push themselves away from us and, in many cases, a healthier lifestyle.

Being someone that is there to help, versus someone who is there to control someone else’s life, can be really helpful in building stronger, more effective helping relationships with the people we assist. As a bonus, speaking in a less controlling manner to our spouses, family members, and co-workers can often have a similar effect. The relationship becomes more open, more relaxed, and people feel more comfortable sharing their problems (and successes) with us.

Steer Clear of the Habit of Prophesizing

I’ve found it helpful to avoid telling people what is going to happen to them. Sharing what I have seen or experienced in the past, or even giving them and idea of my fears for them should they make a certain choice is one thing. However, I’ve seen many a practitioner guarantee (they sometimes even literally use that word) that something catastrophic or fantastic is going to happen to someone if they make a certain choice.

“If you don’t go to treatment, you’ll die.”

“If you try to live independently, you’ll fail. Schizophrenics need assisted living–it’s a fact!”

“If you stay in treatment for 30 days, you’ll live a happy, healthy rest of your life.”

“If you don’t go to the therapy group for help, your wife’s gonna leave you–plain and simple.”

“If you quit using heroin, you’re going to have so much more money!”

“You don’t stand a chance without Narcotics Anonymous.”

“If you start a business, you’ll just shoot all the profits up your arm.”

While I understand that most of us have been in the field long enough to have seen multiple examples of people struggling with addiction after leaving treatment or having a hard time living independently with a mental illness, there are (many) exceptions to those situations. So, if we decide to essentially promise someone that something will happen, when we really have no way of knowing, the second that terrible thing doesn’t happen to them, or it doesn’t happen to someone who our client knows, we become somebody who has no credibility. It’s hard to trust somebody without credibility, so we have just severely injured our relationship with that person. Try using phrases like “I’ve never seen,” “It’s not impossible, however,” and “Feel free to try, but I’ve never heard of” in order to express humility. We can still give the person the caring warning and advice that we want to offer without delivering it like Ms. Cleo.

Here are some tweaks to the above example sentences to make them more realistic:

“I’ve seen lots of people avoid going to treatment and it often leads to them living a really hard, chaotic life, or even dying. I’d hate to see that happen to you.”

“Trying to live independently can be hard for people who don’t have any mental health concerns. I’m worried about you wanting to live on your own, but let’s look at some ways we might be able to make that more feasible, such as hiring an aide to check in on you or getting you on some medications.”

“Though there are no guarantees, I’ve seen people do a lot better in their recovery when they have some form of formal treatment.”

“I know your wife threatened to leave if you didn’t get help, and I can’t predict what she’s going to do, but her and I both are encouraging you to attend a bipolar support group. Is not going really worth the possibility that she might actually divorce you?”

“Stopping your heroin use can really increase the amount of money you have left to save or spend as you please.”

“I’ve seen kicking a habit be a real struggle for some people, but they often seem to do a lot better when they have the support of the people at Narcotics Anonymous.”

“It’s not impossible, however, I have witnessed several incidences in which people suffering from addiction who do actually gain a profit from running a business slip back into using because they have large sums of money that they’re handling on a daily basis.”

Conversion Therapy on Minors Made Illegal in New Jersey

by Polly-Gean Cox, LCSWA

Monday August 19th, Governor Chris Christie of New Jersey declared the practice of conversion therapy on minors  illegal in the state of New Jersey by signing into law bill A3500. Christie was found  in support of the American Psychological Association’s (APA) findings of conversion therapy in which results of conversion therapy were found to pose critical health risks including but not limited to depression, substance abuse, social withdrawal, decreased self-esteem end suicidal thoughts.

“I believe that on issues of medical treatment for children we must look to experts in the field to determine the relative risks and rewards. I believe that exposing children to these health risks without clear evidence of benefits that outweigh these serious risks is not appropriate.  Based upon this analysis, I sign this bill into law.” Read More…

New Jersey is the second state to declare conversion therapy illegal since California in 2012.

So What is Conversion Therapy?photo

According to the American Psychological Association, sexual orientation conversion therapy also known as reparative therapy refers to counseling and psychotherapy to attempt to eliminate individuals’ sexual desires for members of their own sex.  

How Did Conversion Therapy Originate?

In the 1920’s Sigmund Freud’s research on sexuality laid the foundation for future researchers to engage in Conversion Therapy. In the 1940’s and 50 Edmund  Bergler saw homosexuality as a perversion and believed he could “cure gay people with a punishment based therapy. When the original  Diagnostic and Statistical Manual DSM was released in 1952, homosexuality was listed as a mental illness in which aversion therapy, and conversion therapy was considered the best practice treatment method. It wasn’t until 1973, when homosexuality was removed from the DSM as a mental illness. Reparative therapy is no longer used or supported by several mental health organizations and looked upon as a harmful practice.

According to a statement issued by the  National Association of Social Workers:

“Aligned with the American Psychological Association’s (1997) position, NCLGB [NASW’s National Committee on Lesbian and Gay Issues] believes that such treatment potentially can lead to severe emotional damage. Specifically, transformational ministries are fueled by stigmatization of lesbians and gay men, which in turn produces the social climate that pressures some people to seek change in sexual orientation. No data demonstrate that reparative or conversion therapies are effective, and in fact they may be harmful.”

Despite the removal of homosexuality from the DSM, conversion therapy is still practiced by several religious institutions. This therapy is harmful and has dangerous ramifications, and it is considered by many professionals a legalized form of child abuse. I urge the rest of the United States to follow California and New Jersey’s footsteps on this issue because no child should endure this treatment.

Please watch the following video as Sam shares his experience with conversion therapy. Caution this may be difficult to watch. 

[youtube]http://www.youtube.com/watch?v=Qf5dqzcy3bc[/youtube]

 

Is Your Candle Burning from Both Ends: Examining Burnout and Self-Care

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“You can’t help others until you first help yourself”. “Don’t burn your candle from both ends”.

I used to hate those cliches, but when it comes to therapist wellness, it’s true.

My first experience with burnout happened just 3 short months after graduating with my Master’s degree. I move across the country, and I dived head-first into the real-world of therapy. My eyes were opened to a whole new world of disillusionment that I could never have been prepared for.

I experienced an episode of burnout, and I know it won’t be my last.  Along the road to getting my licensure as a Licensed Professional Counselor (LPC), I encountered things that would make even the most resilient people burn out, if not get a little crispy around the edges.

  • I saw ethics violations and fraud that hurt clients and the entire mental health system is full of corruption.  I reported a provider to a licensing board, lost my job and relocated.
  • I’ve had 5 jobs in just over 2 years. I worked overtime at roughly $15 an hour with student loan debt weighing heavily in the back of my mind. One agency I worked for, closed suddenly overnight after a few weeks of my pay checks bouncing. I also had to pay for weekly supervision in order to keep my associate license.
  • I worked in homes with roaches, smells and sights that seemed to be right out of horror movies. I saw the effects of child abuse and sat back and felt hopeless when CPS couldn’t help. Poverty, inequality and suffering were in my face every day.
  • I got physically and verbally attacked by clients. I was providing services in rural areas where guns were prevalent and cell-phone service was not.
  • I frequently felt undermined by administrators. I was told that the letters after my name didn’t matter, even though I had worked so hard for them. I was told I needed to “earn my stripes” even though I had education, experience, and a license.
  • I was on-call for emergencies 24 hours a day, 7 days a week, 365 days a year. I came to associate my ringtone with crisis and would cringe when I heard it.

These things do not make me a martyr. These are the typical experiences of a new therapist.  I share them in the hopes of increasing awareness, decreasing the isolation and shame other therapists feel. I hope to open the door to discussions about how we can make systematic changes to make things better.

Improving the workplace for counselors, and in turn, improving services for clients with mental health needs will be a forever on-going process. This topic could easily be it’s own post, book, or series of books.

In the mean time, how will you stay healthy, engaged, and able to serve your clients?  Here is what has helped me along the way:

  • Embracing the inevitable and learning to recognize the signs of burnout. Burnout will happen. Be ready and keep a look-out.  It can mean feeling exhausted, numb, hopeless, helpless or depressed.  It could mean feeling anxious, panicked and unable to sleep.  Other signs include relief when clients cancel sessions, dreading going to work in the morning, client-blaming, or being sarcastic, cynical and resentful.
  • Receiving lots of supervision from other therapists.  One-on-one direction from therapists with more experience than me was priceless.  Group supervision also helped decrease my sense of isolation and boosted my confidence.
  • Becoming a regular therapy client. I believe therapy is effective for helping people cope with a stressful life.  That is why I’m a counselor, and it is also why I am not afraid to seek counseling for myself.
  • Taking steps toward basic self-care. Keep eating, exercising and sleeping habits healthy. Avoid alcohol and drugs.
  • Maintaining relationships with family and friends. Build your social support network. Stay connected to your community.
  • Taking time off. Get out of town or turning off the phone. It’s ok to un-plug and relax, even if it is just for a few minutes.
  • Seeing the big picture.  Every therapist has a vision and a reason they entered this field.  Remind yourself of it.

Stand up Against the Stigma of Mental Illness: The New Normal

Social isolation, discrimination, and labeling are a part of the everyday struggles faced by the mentally ill. 1 in 4 American adults suffer from a mental illness. 1 in 17 people will have a serious mental illness such as schizophrenia, major depression and bipolar disorder. The stigma of mental illness ensures the majority of affected individuals will face negative consequences in recognizing and coping with their mental health needs.

anit-stigma-campaign-namesErving Goffman defined mental illness as a blemish of character and a way to deviate from social norms. However, many of the definitions of mental illness fail to grasp that there are many other aspects to mental health. The three most influential social factors to mental illness are family stability, the placement of neighborhoods and society’s relationship to mental health problems. Mental illness does not solely arise from one’s environment. There are also biological and genetic predispositions that contribute to one’s mental health. One thing that is certain, as a society, we can change the way mental illness is perceived.

Social isolation or exclusion has been one of the most detrimental affects of the stigma, which is brought upon by labeling. The labels placed on the mentally ill by society, which the media reinforces, are dangerous, crazy, and inadequate. Due to these labels, those with mental illness get isolated from the rest of society. The practice of socialization then inevitably creates an “us vs. them” mentality, those people, the sane and the insane. Confided by these labels and exclusions, mental illness sufferers also struggle with finding their place in society.

Stand up against the stigma of mental illness is what society needs to create a new normal. This new normal will accept the importance of mental illness and will recognize treatment as equally important with physical illness. This new normal will place mental and physical health on the same spectrum. The new normal will make talking about mental illness a part of everyday conversation, and it will allow people to no longer be ashamed.

Hopefully with  the acceptance of the new normal, it will bring about affordable mental health treatment, better counseling centers in high schools and colleges, and a society that is better educated on the issues of mental illness.  With a new normal, those with mental illnesses can finally feel like they are a part of society and live without fear of  isolation, discrimination, or labeling.

Listen to Episode 1 of my podcast Anxious Ramblings:

Anxious Ramblings is a biweekly conversation about mental illness. This show will challenge society’s views on the mentally ill and help to fight against the stigma. Anxious Ramblings explores the good, the bad, and the ugly side of living with a mental illness. Here we speak about all the crazy thoughts in your head that you’re afraid to say out loud.

For this episode of Anxious Ramblings, I introduce my story with Generalized Anxiety Disorder and speak about the stigma regarding mental illnesses. The episode concludes with me sharing responses from people who want to tell the world about their mental illness.

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Partner Intimacy Issues: Porn, Sexual Obsession, Abnormal Behavior, and Counseling

We’re not talking about the old Playboy or Penthouse from years ago. That stuff of yore is tame in comparison to what is more easily and readily available without the embarrassment of taking it off the store shelf. We are talking about the effortlessly accessible hardcore porn from the Internet, ready for the asking, within the comfort of your own home.

With the accessibility and availability of porn from the Internet, there is no filter like the neighbor or grocery clerk looking over your shoulder to cause any embarrassment or discomfort. Without these kind of natural filters, anything goes.  Apparently, anything does go.

sexualissuesMore to the point, the more obscene and the more counter-culture, the greater the audience as the material appeals to voyeuristic tendencies. What starts as a sneak peak, turns into a long gaze followed by the hunt for more graphic and more outlandish material.

The titillation of simple soft core porn wanes and then comes the voyeur  to the consumer, and eventually seeks material that is increasingly disturbing as a deeper obsession-like desire develops for extreme forms of erotica.

Trailing behind is the partner of those persons obsessed by ever increasing extreme forms of erotica and sexual gratification. In the context of an intimate relationship, the partner is subjected to greater demands for sexual experimentation. Eventually the request goes beyond the partner’s comfort. A conflict develops with the partner feeling blamed for not meeting the sexual needs of the one whose secret passions are fueled by an undisclosed obsession with far more outlandish forms of sexual behaviour brought on by exposure to material from the Internet.

For the one seeking the more outlandish forms of sexual behaviour, their time on the Internet has desensitized them and shifted their thinking in terms of more unusual forms of sexual expression. Further, the usual forms of sexual expression or intimacy are now minimized or dismissed as too simplistic and certainly unsatisfying.

When couples grappling with a conflict of sexual behaviour are seen in counselling, the issues may be disguised as a myriad of other conflicts. If the issue is raised, it is often done sheepishly particularly with one being blamed as a prude while the other whose sexual preferences has shifted presents as being normal and reasonable.

From a gender perspective, this is most frequently but not exclusively seen with the woman presenting as prudish and the man as normal. There is the air of power and control issues as typically the fellow seeks to meet his needs for sexual gratification over the needs and comfort of the woman. Careful exploration of this dynamic may show other indicators or power and control issues in which some are precursors to sexual issues.

Counselling should be aimed not only at facilitating communication between the couple with respect to mutually acceptable sexual behaviour, but it should also be aimed at addressing any co-existing power and control imbalances. In addition to counseling, it may be necessary for the sexual adventurer to step away from the porn to reduce the impact of sexual exploration from the Internet. In other words, controlled access to the Net. Monkey see, in this case, is not monkey do. It is not likely that your partner will want to participate in the sexual behaviour you see on the Internet. Don’t push it and address what has become your own sexual obsession.

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