Are You Serious! I can be normal….? Cope with and rise above mental health challenges

by Cheryl Johnson Wednesday, January 22, 2014

I am not a therapist, but I am a certified WRAP and NAMI instructor and I teach people with mental health issues and their families how to not only cope with, but rise above the challenges that people with mental health issues face. 

My interest in mental health is from a strong family history of people who have either been diagnosed with mental health issues or those who clearly exhibit behaviors consistent with a diagnosis, but do not believe they have issues. 

Those who have sought out treatment (both medical and therapeutic) definitely cope with life on a much higher level than those who have not. You are probably all too familiar with the reasons people choose or refuse to get care. 

What I can testify to is that those who consistently monitor their behavior and track it to their lifestyle habits are acutely aware of how important our lifestyle choices are to living a ‘normal’ life. 

So how do you accomplish this?  Stay tuned…. Each week into February we will explore together tips and suggestions  to supplement the care you are currently receiving to make sure you manage your condition instead of it managing you!

Cheryl Johnson is a certified NAMI and WRAP instructor and regularly teaches courses that provide families and individuals who face mental health challenges information to help them lead full and satisfying lives. To get more information on Cheryl’s work or programs you can be in touch with Cheryl at cherstinane@readwritetechnology.com.

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marriage | Marriage and Family Therapy | Mental Health | relationships, friendships | Self-Awareness | Self-Care | Social Work | Stress | Therapeutic Relationship | Therapy | Treatment Modalities

Unfolding the "Magic" of Therapy

by Sherry Katz Tuesday, January 7, 2014

While often people acknowledge professional therapy creates gains in self-awareness, more confidence handling relationships, and improved ability to manage stress, how these results are achieved appears mysterious. 

What key factors in the conversation happen during a therapy session,  which inspire confidence and awareness in the patient, which were previously either weak or lacking?

 

From years of clinical practice, I summarize the way a therapist listens and responds to a patient, as “bi-lateral listening”. A therapist who helps you reach desired change, listens with both their mind and their heart. 

 

Hearing past the words, gives your therapist a read on your emotions.  If someone tells a story that includes major life shifts, and is matter of fact while doing so, a therapist may ask a question that lifts these shy emotions into the therapeutic dialogue. By giving more attention to emotions and identifying and elaborating on them during a therapy session, the patient learns how to know and explain their feelings.

 

The flip side usage of bi-lateral listening is if a patient during a session talks almost exclusively about their feelings and has little understanding of when feelings arise and how they are effecting both the patient and people in the patient’s life. In this case a therapist most likely would hear the emotions and speak to the cognitive processing of the patient. Your therapist may ask questions that help you collect information and theorize on how you are responding to the ways you express yourself.

 

As you and your therapist repeat this basic listening process during your therapy sessions, you’ll notice greater balance in your own approach and dialogues in your everyday repertoire with others. What starts developing and strengthening is your awareness of the vastness and complexity of your emotions and thoughts, and your ability to moderate when to express your emotions and when to express your thoughts. You may surprise yourself one day with how naturally you articulate feelings in situations you did not know you had any!

 

You may notice as well, yourself taking a new path in conversation rather than a debilitating emotional rerun. This will be your magical moment of recognizing the rewards of working with a professional talk therapist.

 

Sherry Katz, LCSW is clinically trained in systems relational therapy, and practices marriage and family therapy in her solo practice located in Ridgewood, NJ.  Comments and questions are welcome. 

www.newviewsfamilytherapy.com

 

Eating Disorders Triggered by the Holidays

by Janine Vlassakis Tuesday, December 24, 2013

Believe you can and you're halfway there.                                   

Theodore Roosevelt 

The “most wonderful time of the year” can be tough for those suffering from an eating disorder. The holidays can be overwhelming and stressful with so much focus placed on food in social environments.  As a result many, and especially those with eating disorders, become anxious, upset or engage in disordered eating behaviors to attempt to mitigate their anxiety.  Here are suggestions to get through the holidays:

·          Remind yourself or your clients of common self-soothing practices and avoid dangerous coping mechanisms. 

·           Identify or encourage yourself or your client to identify what is “happy” about the holidays.  That simple reminder can help focus on the positive aspects of the season.

·          Families can play an integral part in helping the holidays be joyful. Remind your family or your clients’ family what a trying time this may be.  While food is an inherent part of most events during the holidays, families can help diffuse the focus by planning activities such as a craft or family game to focus on as a distraction. 

·          Remind your family or your client’s family that discussing your appearance may do more harm than good.  Help close family understand that statements such as, “you look so much better!” can translate to “I look fat” in your or your client’s mind.  Ask family to make other family members aware as well, so time with family can be remembered as positive rather than triggering negative emotions. 

·          If you or your client is taking a break from treatment over the holidays, be sure to address any concerns about being away and social situations.  Be sure to strategize and discuss skills to continue recovery. 

·          Arrange a time to start back into therapy after the holiday to continue treatment in the New Year.

·          Be mindful and encourage clients to be mindful of the positives of this time of year.  Focus on time spent with people supportive in recovery, and to create new happy memories to reflect upon next year.

Janine Vlassakis, M.Ed. is the Mid-Atlantic Professional Relations Coordinator for the Cambridge Eating Disorder Center.  Her role at CEDC is to provide clinicians and other professionals with information about the levels of care which CEDC offers.  In addition, with her background in counseling and education, she speaks regarding various topics relating to the complexity and treatment of Eating Disorders.  

 

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relationships, friendships | Self-Care | Social Work | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #5

by Staff and Faculty of the QPR Institute Sunday, November 24, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.  

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says eighteen veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers.  According to the Centers for Disease Control and Prevention, in just one day, more then 101 of our fellow Americans will die by suicide.  Perhaps this clinical tip will save just one.

Clinical tip #5 -- Communicating Suicide Risk

The nature of modern clinical care by multiple providers requires clear communication to assure consumer safety.  Not only do prescriptions need to be clearly written, but progress notes must be legible to all providers of care.  In the root cause analysis of 400 consumers in active care who attempted or died by suicide while inpatients, communication failures ranked at the top of the list of contributory causes (National Center for Patient Safety, 2006).

To improve communications between clinicians regarding suicide risk, there is little consensus about a) how to assess immediate risk or b) how to determine its severity.  Still, risk stratification decisions and clinical judgments must be made every day as these assessments necessarily guide our interventions, monitoring levels, and frequency of contact. For a variety of reasons, suicidal consumers may not be entirely helpful in disclosing their suicidal intent, desire and plans.  If, after an assessment, you are not confident of your conclusions, it may be helpful to others on your team to add a chart note to this effect.

An explanatory note of “low confidence” would be warranted when the consumer:

·      Has been uncooperative and refused to collaborate in the assessment process

·      Has or may have psychotic symptoms, especially paranoia

·      Is or has been recently intoxicated

·      Has a history of impulsivity

·      Is faced with an uncontrollable external event, such as the serving of divorce papers or an arrest warrant 

In sum, a note of low confidence in the assessment suggests higher risk and that reassessment is indicated in the near term (not more than 24 hours), as well as the need for a second opinion, greater vigilance, and more frequent observation.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses!

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRInstitute.com

 

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relationships, friendships | Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #4

by Staff and Faculty of the QPR Institute Wednesday, November 6, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc., says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers. According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide. Perhaps this clinical tip will save just one.

Clinical tip #4 -- Reassessing suicide risk

 

Suicide risk changes with time and circumstances.  A single, initial assessment of suicide risk is seldom adequate for safe practice.  Suicide risk assessments should be repeated both a fixed intervals and during times of increase stress. Based on the literature and the clinical experience of several of the QPR Institute faculty, we suggest four non-exhaustive circumstances where re-evaluating suicide risk is indicated:

 

Changes in health status, e.g., diagnosis of a life-threatening illness, exposure to HIV, continued experience of chronic pain, and when the consumer is faced with significant surgery or has suffered a significant physical injury.

Stressful life-transitions, e.g., loss of a major relationship, change in living arrangements, treatment transitions (between therapists or programs), threats to housing, income or access to care.

Response to treatment, to include side effects of psychotropic medications, non-therapeutic response to medication or other intervention failures, including impasse in therapy or conflict with therapist

Substance abuse dramatically increases suicide risk.  Relapse from recovery, binge drinking or drugging, relapse of one’s sponsor, and any significant use of intoxicants, even by non-addicted consumers.

 

A number of other circumstances suggest the need for a reassessment of suicide risk.  These include reports by third parties that suicide warning signs have been observed, any report of violent behavior, the sudden loss of a loved one through death, divorce, desertion and especially suicide.  Finally, anytime a consumer of any age is facing what may be a personal and public humiliation, suicide risk may be sharply elevated.

 

Basically, suicide risk increases dramatically with multiple successive losses, co-morbidity of illnesses, acute environmental stressors, and anytime the consumer begins to feel he or she is becoming a burden on others or care providers.  If in doubt, reassess!

 

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals includingMental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses!

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRInstitute.com

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relationships, friendships | Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Suicide Prevention Blog Series: Clinical Tip #3

by Staff and Faculty of the QPR Institute Thursday, October 31, 2013

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Release) we bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc., says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers. According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide. Perhaps this clinical tip will save just one.

Clinical Tip #3 -- Quick and Effective Response can Save Lives ...

The vast majority of all residential and inpatient suicides occur by hanging.  From the restrictive closure of the air passage, unconsciousness occurs in 30 seconds, death in four minutes.  Saving a life from a hanging attempt requires quick and efficient action.  Emergency rescue tools have become a standard piece of equipment for responding to such events, including the now widely used "911 rescue knife." These are specially designed knives with a hooked and protected blade that allow the victim to be cut down quickly and without injury.  Because the blade is located inside the frame of the tool it cannot be utilized as a life-threatening weapon in the hands of a potentially violent person.  Fire fighters and paramedics have used them for years to cut seat belts off trapped victims.

If you work in a residential or inpatient facility, consider securing 911 rescue knives and training staff in how to access and use them quickly.  When a consumer is found hanging, every second counts.  Once a victim is discovered any time lost trying to remove a ligature by hand - and especially if unassisted - may delay rescue and lead to a preventable injury or death.  More precious time may be lost if staff cannot locate the knife or, once in hand, they are unfamiliar with how to use it.  Good safety management practices require knowledge and practice.  If fire drills save lives, so can "cut down" drills.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers. For more information please visit our full library of advanced courses! 
Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRinstitute.com

Suicide Prevention Blog Series: Clinical Tip #2

by Staff and Faculty of the QPR Institute Saturday, October 26, 2013

 

In honor of the launch of the HelpPRO Suicide Prevention Therapist Finder (see Press Releasewe bring you this five part series of clinical tips with the most up to date research and thinking on suicide prevention.  

Paul Quinnett, PhD, President and CEO, The QPR Institute, Inc, says 22 veterans will take their own lives today.  So will someone's daughter, a brother, a co-worker, and far too many working men and grandfathers.  According to the Centers for Disease Control and Prevention, in just one day, more then 105 of our fellow Americans will die by suicide.  Perhaps this clinical tip will save just one.

Clinical Tip #2 -- Documenting Reasons to NOT Hospitalize

When deciding not to hospitalize a patient at risk for suicide, it is important that the clinician conduct a risk-benefit analysis.  The reasons for hospitalization may include the relative assurance of a safer, more controlled environment, a beneficial milieu, multidisciplinary staff evaluation, initiation of stabilizing medications, etc.  The reasons not to hospitalize a suicidal person might include potential loss of self-esteem, stigmatization, risk of losing a job, fostering unwanted dependency, failure to benefit from prior hospitalizations, etc.  When confronted with a possible hospitalization, the patient may also express a willingness to participate in outpatient treatment and adhere to a medication regimen. 

Whatever your reasons to not hospitalize a consumer who has expressed suicidal ideations, prior plans or suicide attempts, it is strongly recommended that the primary care provider seek consultation and/or supervision regarding the decision and to carefully document the reasons for this decision.  In a world of increasing litigation for suicide malpractice, and if a bad outcome is experienced, an uniformed jury will need to be convinced that 1) you thought the problem through, 2) you weighed the risks and benefits carefully with the patient and his or her family, and 3) you took a reasonable and prudent course of action.

The QPR Institute (www.QPRinstitute.com) provides Online Advanced Suicide Prevention Courses for a wide range of professionals including: Mental health professionals, school counselors, crisis line workers, substance abuse professionals, EMS/firefighters, law enforcement, primary care providers, nurses and correctional workers.

For more information please visit our full library of advanced courses!

 

Paul Quinnett, PhD., Founder & CEO QPR Institute, www.QPRinstitute.com

 


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Self-Care | Social Work | Suicide Bereavement | Suicide Prevention | Treatment Modalities

Prescribed an Antidepressant by a Doctor? Go See a Therapist.

by Lindsey Webster Wednesday, May 23, 2012

Long before I chose counseling as my profession, I dealt with my own personal mental disorder; social anxiety. The disorder had taken over my life when I was in high school. It got so bad that I missed several days of school due to anxiety attacks; including the first day of my senior year. After many years of suffering, my mother took me to our family physician to discuss the issue. My doctor asked me a few questions about my anxious feelings and wrote me a prescription for a relatively new drug called Fluoxetine (a.k.a. Prozac). 

After a few months on the drug, I noticed that my anxious feelings had changed, but not necessarily for the better. I had lost my fear of social situations, but I had not lost the anxiety. It was almost like living two lives at once. I now enjoyed going out with friends and meeting new people, but I still had excessive sweating, heart palpitations, racing thoughts and shaky hands. The drug was masking my fear but not addressing the reasons behind my anxiety. 

When I went to college, I was told about the student clinic that offered free counseling. Over time, I had become more knowledgeable about my disorder and realized that I needed to see a therapist, so I booked and appointment. What ensued was an amazing transformation in my outlook on life. 

Seeing a therapist to supplement the medication was the best decision I could have ever made. Before, I was taking a pill every day and ignoring all the anxious thoughts that still went through my mind. For three months I went to see the school therapist once a week. We would discuss the reasoning behind my anxiety and different ways to look at things. During these sessions, I learned a great deal about myself and about other people. I learned that everyone experienced anxiety every now and then and that most people were too worried about themselves to notice me (my biggest fear was that other people were staring at me). 

Talking through and accepting these simple truths was what eventually brought me out of my fear of social situations. By the end of my college years, I add successfully weaned off the medication. It took me years, but I finally felt comfortable in my own skin. I don't think this would have been possible had I not paired medication with counseling. 

Due to my own personal experience, I firmly believe that anyone who has been prescribed an antidepressant or other mental illness medication should seek counseling from a therapist. Yes, medical doctors can diagnose patients with mental disorders and prescribe the appropriate medications, but using a medication without taking part in therapy is like trying to lose weight through diet only and no exercise; they supplement one another and increase your chances of success.

Lindsey Webster has been a rehabilitation counselor for 15 years and also owns the site Masters in Counseling. She likes to write about different topics related to counseling and careers.

Photo Credit: Steve Snodgrass Flickr

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Treatment Modalities

Understanding Neuropsychology

by Dr. Stephanie Monaghan-Blout Psy.D. Thursday, April 12, 2012

brain

Neuropsychological evaluations are used to gain a better understanding of a range of problems that involve the brain. For instance, people who have had a head injury, a stroke, or brain tumor may be referred for a neuropsychological evaluation to assess the impact of the injury on cognition, memory, language, and motor coordination. Neuropsychological evaluations are also performed with children or adults to gain more information about problems such as learning issues, attentional problems, autism, and even emotional conditions such as anxiety or mood disorders. Referrals for neuropsychological evaluations come from primary care doctors as well as neurologists; primary care physicians; mental health providers such as psychiatrists, psychologists, and social workers; speech/language therapists; and educational tutors. 

Neuropsychologists use indirect methods to study brain functions and their relationship to behavior. The "tools" of the neuropsychological evalauation look like puzzles, drawings, language activities, checklists and computer games. However, these tasks have been carefully designed to measure some function that is important in learning and problem solving, and then administered to a large number of people. The results are transformed into standardized scores that allow for the direct comparison of people of different ages and backgrounds. Using the pattern of strengths and weaknesses revealed by these scores, the neuropsychologist can then identify problems, make recommendations for needed services and even design interventions to improve functioning in key areas of a person's life, such as school, work, and interpersonal relationships. 

A neuropsychologist is a licensed psychologist who has completed two years of additional training in the administration and interpretation of neuropsychological measures and the development of treatment regimes to address areas of concern. Neuropsychologists may work in a hospital setting as part of an interdisciplinary team of medical doctors, physical therapists, speech and language therapists and other specialists. They may also work independently in private practices. Some neuropsychologists work in research settings where they use technology such as brain imaging to learn more about brain structure and functioning. 

Neuropsychological evaluations can vary in length and complexity, depnding on the setting and the referral questions. The actual testing time can range from less than an hour in an inpatient unit for someone who has suffered a stroke, to five hours or more in an outpatient unit if the question involves learning issues. The cost of evaluation can also vary widely depending on the amount of testing, scoring, provision of feedback and extensiveness of the written report. Insurance coverage for neuropsychological evaluations varies between insurance companies and plans, and it is important to check with your company to ascertain benefits for different conditions. 

Dr. Monaghan BloutStephanie Monaghan-Blout, Psy.D. Formerly an adolescent and family therapist, Dr. Monaghan-Blout specializes in the assessment of children and adolescents with complex learning and emotional issues. She has a particular interest in working with adoptive children and their families as well as those contending with the impact of traumatic experiences. She is a member of the Trauma and Learning Policy Initiative (TLPI) associated with the Harvard Law Project, and is working with that group on an interdisciplinary guide to trauma sensitive evaluations. 

Dr. Monaghan-Blout obtained her doctoral degree at Antioch New England Graduate School. She completed an internship in pediatric neuropsychology and child psychology at North Shore University Hospital in New York and a postdoctoral fellowship at HealthSouth/Braintree Rehabilitation Hospital. She joined Children's Evaluation Center in 2003, and NESCA at its inception in 2007. Dr. Monaghan-Blout is currently a member of the Board of Directors of the Massachusetts Neuropsychological Society

Dr. Monaghan-Blout is the mother and stepmother of four children, and the grandmother of four (and counting). She is also an avid ice hockey player. 

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Treatment Modalities

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