As I write this blog entry another holiday season begins. I have to make a confession, for the most part, I hate November to the end of December. Is nothing worse than driving into a store parking lot after Black Friday begins? Almost every fender bender I've witnessed occurred in parking lots during the holiday season. As I write this, I have just finished manhandling the fake Christmas tree out of my root cellar and the required decorations (all in large, heavy plastic containers), I admit it's great exercise and thanks to my functional fitness routine, it gets easier and easier every year. I still don't find it enjoyable though.
This time of year creates a lot of stress and general anxiety. People can sometimes have unrealistic expectations about the holiday season. As a mental health counselor, I have discovered how people can have these unrealistic expectations which turn into negative thoughts about themselves. On more than one occasion I have meet with people who have told me, "I get so depressed this time of year, having to see relatives I don't like, buying presents I can't afford and getting junk I will never use." Former clients of mine also remark how they "run around like a chicken with its head cut off" trying to buy presents for friends, family and co-workers or gearing up for various holiday celebrations. So in anticipation of the most stressful time of the year, I offer a few brief words of advice and encouragement to my fellow celebrants:
1. Come up with a Plan. Remember in the A-Team when BA Baracus asked Hannibal, "what's the plan, Hannibal?" Well, BA did this to relieve his anxiety. This season is a little less anxiety provoking if you can plan ahead, such as making a To-Do List (they have apps for that now!), your stress will be greatly reduced.
2. Tired of getting (and giving) cat sweaters? Create an Amazon Wishlist for yourself and ask others to do the same. This does two things, first it allows you to get things you want and things others want (no one has to go through the dreaded post-holiday return lines) AND you can probably get it all online (no risking life and limb via store parking parks).
3. Slow down! Try to be more mindful this season, if you find yourself rushing, STOP and breath. Don't be afraid to take a time out for yourself to exercise, meditate or just watch a few reindeer related cartoons.
As for those relatives of yours, you know who I'm taking about: the Cousin Eddies' of the world. Try to feel a little compassion for them, after all its the holidays!
Zoltar may know the future but has he got a state license???
I can't believe the past experiences clients tell me about their last "counselor" sometimes. Yes, I am putting it in quotes because based on some of the stories I've heard, these so called professionals should not be allowed to have human contact with others...seriously.
So I thought I would put together three basic traits you should look for in a professional/mental health counselor. I would hope this person would have more than three, such as: being passionate about their work (I have met many who are jaded and burned-out), who seek new opportunities to build their knowledge base (some just obtain enough continuing education to meet the bare minimum that is required to keep their license active) and are optimistic (don't get me started on some of the angry, manipulative counselors I have worked with in the past). So from my perspective, here are the three basic minimum traits:
1. The professional you seek is a mental health provider licensed by the state you are seeing them in. Therefore, this precludes such professionals as mediums, shamans, exorcists, astrologists, channelers, energy (crystal or otherwise) therapists, rebirthers, psychics, palm readers, breathworkers and witches. I'm sure there are more but those are the ones that come to me at this moment. Now these people may be helpful to you BUT if they use or abuse you through unethical behavior, you don't have much of a legal leg to stand on. If I commit an act that the state board of counseling considers unethical, I lose my license and then become homeless, at which point I may consider becoming a Paleolithic Witch Doctor (trademarked).
2. The professional is an active listener. I know, I know you hear it in television and movies all the time, phrases such as "uh huh, tell me more, go on, how did that make you feel?" Well, there is a reason! These are active listening cues, that is why we use them! We do this in order to gather more information and help you process your thoughts and feelings. If the professional you go too doesn't even make eye, appears more interested in something across the room, has a glazed over look in their eyes or spends the entire time talking about themselves, politely excuse yourself in order to go to the bathroom and RUN, RUN FAR AWAY!. Also, I can't tell you how many times I have had people tell me I'm a better counselor than "that last guy/gal". "Why do you say that?" I ask. "Well, Aaron, my last counselor would fall asleep during our sessions." Yikes!!!
3. The professional will go over informed consent with you during the first session. Informed consent basically covers what type of counseling your professional specializes in terms of theoretical orientation, cost of services (if not covered by insurance), limitations of counseling (i.e. if you want to change, your going to have to do most of the work), U.S. HIPPA laws, expectations of services (both expectations for the client, as well as the professional), and possibly anything else your professional deems relevant to services. It should always be in writing! If you walk into your first session and your professional simply says, "Have a seat. Okay, let's get started." Again...Run!
This has been a public service message brought to you by me!
Recently, I decided to update and expand my little ADHD library at home and came upon More Attention, Less Deficit by Ari Tuckman, PsyD. a noted psychologist who specializes in working with ADHD and other executive function issues. This book was recommended to me a long time ago by another clinician whom I highly respect in this area but I had forgotten about her book recommendation and life went on. Well, I have finally gotten around to buying it and reading it and I'm very glad I did!
I work with many adults who struggle with ADHD issues and often they ask me for book recommendations and I really didn't have any I liked before reading this book. All the books I have in my library are written for the professional in the mental health field and I just didn't feel like an average reader would want to have to deal with all the professional jargon these books usually entail and they tend to be long winded as well. Dr. Tuckman's book is written specifically for adults wanting to learn more about the diagnosis of ADHD, as well as the various types of treatment available for this issue.
There are many reasons why I like this book, one is the actual book itself. How Dr. Tuckman physically laid it out is amazing! Since this is a book written for people who may struggle with distraction concerns and short attention spans, every chapter has a summary of the topics covered in that chapter up front. Therefore, one can make sure that the information in that chapter is helpful or it can be skipped all together. Also, if one is pressed for time, one can focus on the information that is needed in that chapter and ignore the rest of the topics. I thought this was genius, since so many clients I have worked with in the past discussed how much of a struggle it was for them to complete a book from cover to cover. This book is designed so that one can easily skip around, it's all about obtaining the exact information the reader needs. Each page of the book is perforated in order to easily track what a reader has already read, another specific layout that helps the ADHD reader.
Another reason, I like the book, is that as a clinician, I see and hear so many myths in terms of what ADHD is as well as treating this brain based disorder. Dr. Tuckman goes to great lengths to dispel these various myths. I like that he is upfront about where the research is with nontraditional treatment and the lack of scientific evidence in this area, as well as the current deficiencies in the area of proper diagnosis. For instance the Amen Clinics that are starting to pop-up all over the United States are purporting to be be able to diagnose ADHD (as well as other mental health concerns) with a brain scan of a specific client, unfortunately, it is not that simple and cannot beat a full clinical history interview (as of yet anyway, maybe future technology will change this).
In summary, I would recommend this book both to my fellow clinicians, as well as to people who want to learn more about ADHD, especially if they have been recently diagnosed ADHD and want to increase their knowledge base. Dr. Tuckman clearly took great pains to make sure this book was highly accessible to everyone and that practical advice could be easily gleaned from his years of experience in this area.
For many people coming up with a creative idea is not an issue. The 'roadblocks' if you will come when that idea has to be translated into action, especially if those actions tend to be repetitive and mundane. Take writing as an example, especially creative writing. In order to develop a "good" novel, the writer has to spend many hours revising and editing what has already been written. An author may write draft after draft until he or she is satisfied with the work. Why do I bring this up?
Many people with issues around executive functions, struggle with "doing the work" as professional writer Steven Pressfield phrases it. Distractions, excuses and annoyances can derail any creative project but even more so when one struggles with executive functions issues. To that end, I highly recommend creative people who struggle with this issue to read Pressfield's "Do the Work." This is not a book filled with platitudes and pithy little feel good encouragement sayings. Pressfield makes you charge this "resistance" (as he phrases it) head on and barrel through it, like a grappling athlete on crystal meth! He has some great ideas about pushing through the monotony and finishing your project. It is a true 'Call to Arms' for creative types!
Another issue with translating creativity into reality is our own self-defeating thoughts. I have worked with so many people in the past who allow their own irrational thoughts to get in the way of their creativity. They allow those thoughts like "I can't do this" or "you're not good enough for this project" to take over and sap them of motivation and effort. However, in my experience, very little of what we actually think is actually real, it is usually just our fear distorting our reality. As the Benet Gesserit say in Dune: Fear is the mind killer!
So ignore those irrational thoughts and push those distractions aside and do the work!
How does one deal with a traumatic situation? Why do some people suffer from severe depression or PTSD when exposed to a trauma and others do not? Although there has been a lot of research in this area since 9/11 and the wars in Iraq and Afghanistan, for the most part, the answer to these questions still remain a mystery. So many variables in terms of a person's resiliency. Yes, there are various theories, some are psychological based and others neurological (brain) based but at this point no one really knows for sure. The National Institute of Mental Health, a part of the U.S. National Institute of Health and Human Services has put together a very basic list of factors that tend to either reduce or increase the possibility that someone may develop PTSD after a traumatic event, it can be found here.
Regardless, various crisis and emergency response organizations have decided to try and treat trauma victims as soon as humanly possible, in order to decrease long lasting psychological trauma. An action I applaud. Currently, the gold standard for this type of crisis counseling is Psychological First Aid (PFA). Here is an interesting definition from the Minnesota Dept. of Health. The first sentence descibes this type of crisis counseling as being an "evidence-informed approach." It is not the first time I have heard this statement about PFA. What does that mean exactly??? Is this the same as an "Evidence Based Practice" or EBP? Such as Cognitive Behavioral Therapy, which has multiple studies to show it's efficacious results in treatment.
I hope not. If this is the case, then this statement is false. No studies have been made about the efficacy of PFA. Yes, many U.S. government entities and non-profit organizations use it as a training tool for first responders, including the World Health Organization and the Red Cross. The Verge raises this problem in an article I recently read about this issue, it can be found here. Only now has a study been created looking at this specific type of short term counseling (and a small study at that).
I believe this study is a great start but I have a few concerns. The first is that the study is ONLY treating victims of crimes with PFA, not people affected by natural disasters (which the Red Cross mainly work with in their relief efforts). The second issue I have is what happens if they find that there is no difference between the control group and the group receiving PFA (or even worse, if the control group experiences even fewer long term psychological distress issues)? It seems many government organizations have already invested time and money in training and equipping their personnel with this type of counseling. As someone with a lot of experience in various governmental organizations (federal, county and local), I know from first hand experience, it can be difficult to get governmental entities to change course, once that course has already been laid out.
If you're familiar with the name above then you can appreciate that classic line from the movie Animal House, the exact quote can be found here. Why do I bring this comedic line up today? Well, research is starting to show how our body and consumption behavior DOES impact our memory, especially later in life. Recently, a study was conducted with mice at a university medical center in Chicago. A short and concise summary of the research can be found here. Now, keep in mind this is ONE study so many more need to be conducted in order to confirm this hypothesis but it opens up some intriguing questions about this amorphous thing we talk about in the mental health field called memory and how diet may affect it. Based upon personal experience I know how my memory is affected when I do not get enough rest. Although we know quite a bit about how the brain, specifically the hippocampus stores long and short term memory via a biochemical process called engrams. How does nutrition affect this process? Does a consistent healthy diet impact this process versus an unhealthy diet? If so, how?? As a person who is interested in whole body wellness, I look forward to following this type of research. I would also like to see more research on how consistent exercise impacts certain types of brain function, such as memory creation and retention. Regardless, please try and not go through life fat, drunk and stupid. After all these are behavior patterns you can control, if you want.
Technology is changing us…no doubt about it in my mind, some of these changes are positive and some not so much. Today, I was reading a medical news story from Reuters. This particular piece was discussing the state of mental health in Europe, specifically how best to initially diagnose someone with a mental illness. A new internet software program is being used in the Netherlands to conduct initial diagnostic interviews, without a clinician present. Proponents for this program believe that people will be more truthful due to the supposed privacy. Also, they claim that the results of the electronic assessment system are as valid as a face to face clinical interview. The news story from Reuters Health can be found here, if you want to read it in its entirety.
Now don’t get me wrong, I’m not a Luddite. I use technology all the time when I’m using various behavioral therapy techniques with people, however, we need to be careful to not allow a tool to replace the tool user. Recently, I bought some college lecture CDs on effective communication skills (it’s always good to review the basics every so often). The lectures reminded me how so much of human communication (the vast majority in fact) is transmitted through body language. For instance, several times while working with people, I have asked them, “how are you feeling?” The response to this question sometimes is a somber, deadpan faced (what we in counseling would call ‘flat affect’) “okay.” Now, folks, “okay” can mean anything from “life is pretty good” to “I’ve been considering suicide lately.”
As a clinician, body language can tell me what “okay” really means. What’s more, is that even after completing this online questionnaire, the respondent usually does not see a mental health clinician in person, the next phase is normally conducted by telephone. A mental health specialist will consult with the respondents about their answers to the assessment, again, missing out on all of that critical information revealed via body language (that being said, I have also witnessed medical professionals in the past that merely read a list of questions and never once look up at the person being interviewed, as the clinician ticks off the answers).
Unfortunately, due to the lack of mental health specialists around the world, tools such as this are going to become more common place. As I said earlier, I’m all for technology, when it is used as a tool to enhance counseling. Such a tool might be useful for education purposes in my mind but NOT for treatment purposes.
What do you think, would you prefer an online assessment or one done face to face with a professional?
I’m back!!! I apologize for the delay since my last entry, as I stated, I started a new position and have recently moved my household to another part of the state, I’ve had to prioritize my time, which I am not always particularly adept at doing.
Recently, I have been working with a few people who are struggling with grief and loss. Since we are all born with an expiration date, how do we deal with those in our life who depart before us? We spend much of our daily life ignoring our mortality. There is even a theory in the social sciences known as “Terror Management Theory” which explains why and how we go about suppressing our anxiety about our mortal demise. At some point in our lives, someone very close to us will die and then we can no longer deny the inevitability of death. The grieving process we go through is very normal and expected but it can be difficult, especially the first time.
In our postmodern culture, where many people no longer rely upon traditional institutions and cultural rituals to assist in the grieving process, how does one mourn? I have found that for many of my younger clients, this process can be difficult and confusing to negotiate and many of them want TO DO SOMETHING but do not know what to do. One time honored method in grief counseling is to ask the grieving person to write a letter, a letter to the deceased person. This letter will contain everything the griever thinks and feels about the deceased. I usually ask the griever to write what the deceased has taught them about life, themselves and specific positive memories. In my mind, everything is a learning experience, including death. Since I work with so many millennials, I usually ask them to craft an email, rather than write a letter (when was the last time you ACTUALLY wrote and mailed a letter to anyone!). I have my clients print it off and we process it in our sessions together. Sometimes, I even ask people to create a personal ritual once we have discussed the email. This ritual could be anything from burning the email, posting it on a social network or even emailing it others who may take comfort in it (I even had one client email it to the deceased person's email address). This entire process is about allowing ourselves to mourn not only the loss of the departed but our mortality as well and again to learn from it. Have you developed your own personal ritual to mourn the loss of a loved one?
Sorry for the delay since my last post. Recently, I have had a few changes occur in my professional life. You may have noticed that I changed my website very drastically. I am in the process of closing my private practice in the City of Fairfax. As of May 31st, I will no longer see clients there. I have recently been offered a position in a higher educational institution in another part of Virginia. However, I have had some people ask me to continue blogging, since they have found some of the information I share as being useful. I have decided to do this. The blog topics will vary but will relate in some way to resiliency and building psychological resiliency. Hopefully, you will continue to find this information useful and incorporate it in your life. Thank you for all the great feedback! I look forward to continuing to have discussions.
So here in my office in Fairfax City, I can observe the change in seasons (finally!). Winter is receding and along with the cold temperatures and wintery mix (we don’t really get show showers here in Northern Virginia). The days are growing longer (it’s nice being greeted by the sun when I walk outside my office at close of business) and warmer. One of the other tell-tale signs that the season has changed is the increase of people at my gym. Along with the warm weather, people start thinking about vacations and long weekends, especially at the beach, so people head to the gym to start toning up.
Maybe you have thought about doing this as well. So how motivated are you to do this? Several years ago, a group of psychology researchers decided to look at this very question: how does a person go about changing behavior? The stage based model they came up with after conducting their research was the Transtheoretical Stages of Change Model. This model has been used extensively for smoking cessation programs, as well as alcohol abuse treatment .
The model has five distinct stages that a person may experience when considering their behavior, however, not everyone will quickly progress from one stage to another, relapse is always a potential and one may progress from one particular stage to another very quickly and suddenly slow at the next stage. After all, we’re talking about human behavior here, not computer programs. I encourage you to read about each distinct stage. So rather than regurgitating what you can read on Wikipedia or some scholarly journal, I have taken each stage and given common examples of people’s different responses when in these stages (based upon my clinical experience), so here goes:
Precontemplation – “Problem? What problem?! What are you talking about, dude?!” Contemplation – “Okay, there’s some sort of issue going on. But I’m not sure we agree on what it is. And even if we do, I’m not even sure I want to do anything about it!”
Preparation – “Alright…there’s a problem. We can finally agree about what it is, and I’ll concede that it probably has something to do with me. I’m thinking I’m ready to do something about it. I just need to figure out what that is.”
Action – “Okay, I’ve worked super hard to figure out this thing. There’s a problem. I contribute to it, or at least I can see my part. We’ve mapped out what to do about it. Here goes nothing!!!”
Maintenance – “This change thing is hard. But I’m willing to keep working at it. This needs to keep going, I like it”
Do YOU see yourself in any of these stages? What are your thoughts about this theoretical model?