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Monday, July 25, 2016

Progress in psychotherapy on the ground, in the office

I have been studying schema therapy this week and the model is based on five childhood needs which continue into adulthood. 

The first need is for connection and acceptance and how we end a session makes a big difference to our inner child. I usually say something like, "I've got five more minutes and then I'm going to have to finish. Is there anything else you wanted to address before we finish today?" or sometimes I'll ask, "Did you get what you wanted out of our meeting today cause I'm gonna have to stop in about five minutes?"

The second childhood need is for autonomy and competent performance. To provide positive feedback about how things are going should enhance this sense. I said to my client yesterday, "I just can't get over the positive changes you have been able to make since the first time we met in March" and then I mentioned a few of things that are different in a positive way. We agreed that making changes with patience and persistence, what I call the two Ps, can lead to success. The two Ps are based on social emotional learning skill models simply put as "emotional intelligence." My client is becoming much more emotionally intelligent and it is paying off.

Noting progress is one thing, but developing models and skills for ways of noting progress is another.

As the Solution Focused Brief Therapy folks suggest, ask "How would you know, how could you tell, if things were going better."

I asked my client and he said, "We aren't fighting so much, and I don't fall for that thing she does."

Wow!!!!

And what is it that is making a difference?

"I just try to stay calm and let it go."

"You rise above it?" I ask.

"Exactly," says he.

I say, "My colleague upstairs told me that when life gives you white water you should get a surf board."

He laughed along with me.

I said, "It sounds like you've taking up surfing."

"When can we meet again, " he says.

Sunday, July 24, 2016

Is FAB ruining your life?

Fears of abandonment (FAB)arise from instability in the early years of a persons life. This instability contributes to insecurities. These insecurities manifest in multiple ways including anxiety, defensiveness, giving up, people pleasing, clinging including stalking, and substance abuse and other mood altering behaviors.

Fears of abandonment is the basis for many of the symptoms that make it possible for mental health professionals to diagnose a person with a personality disorder. A personality disorder is described as repetitive patterns of behavior that are dysfunctional and maladaptive so as to decrease the life satisfaction and fulfillment of the person with the disorder and the people that person has relationships with.

Fears of abandonment can take over a person's life and tell her/him that the world is a unstable place where people wind up leaving you alone to fend for yourself physically, emotionally, socially, mentally, and even spiritually. The fears of abandonment have convinced the person that without connection, acceptance, and belonging with the special other, the person will die.

Fears of abandonment will convince people that they shouldn't fall in love and become attached  because they will be devastated if they lose the relationship.

Fears of abandonment can create jealousy and paranoia when the person experiences the loss of their partner's attention and/or loyalty whether real or imagined.

Fears of abandonment can become stronger and more insistent when there is a physical and/or emotional separation from the person the sufferer is attached to.

Fears of abandonment make a person believe that no one will ever be committed to them and loyal and they are doomed to a life of loneliness and insecurity.

Fears of abandonment can be so tricky and devilish as to make the person accuse others of not being loyal and faithful, thereby pushing and driving them away, and bringing about the very situation of abandonment and rejection they feared. This is called a "self fulfilling prophecy" when the very thing the person feared is brought about by  his/her own self sabotage.

How can one manage FAB to decrease and maybe even eliminate its influence on one's life?

To be continued

Friday, July 22, 2016

Fears of abandonment arise from early life experiences of instability

As human beings we all have a need for connection, acceptance, and belonging. Without it, beginning as children, we experience the world as unstable and unpredictable. How does a child cope with these feelings of insecurity? There are many ways and the predominant way of coping with this instability is influenced by temperament along with other factors.

How do these feelings of instability work for you?

Do you worry a lot that people you care about will leave you or die?
Does it seem that people come and go a lot in your life?
Do you find yourself getting anxious when people are late or tell you they have to go?
Do you find yourself not trusting people and not believing what they say?
Do you find yourself clinging and demanding more togetherness than the other person feels comfortable with and thereby pushing him/her away and your worst fear comes to pass?
Is this fear of abandonment a "viscous cycle" that seems to happen over again and again in your relationships and makes you miserable a lot of the time?

The desire for connection, acceptance, and belonging is normal. The way that people sometimes manage this desire and handle it may not be and cause problems.

What are some constructive ways of managing this desire for connection and acceptance and some destructive ways?

To be continued

Tuesday, July 19, 2016

Talk therapy helps reduce anxiety by naming the fears

Labeling your fears helps to reduce the fear research has shown.

I have told my clients for years that naming the problem helps. I say to them, "If you can't name it, you can't manage it. So naming the problems is 90% of strategy of minimizing and eliminating it." Research bears this assertion out.

This activity in Narrative Therapy is called "externalizing the problem." The narrative therapy slogan is "The person is not the problem. The problem is the problem. So what's the problem."

Finding a name for the problem takes some creative effort sometimes, but once it's named, it is much easier to deal with it successfully.

Dr. Freud, the father of psychoanalysis said, "You can either talk it out or act it out. It is always better to talk it out." This study of labeling or naming the problem is further evidence that talk therapy works.

For more on this research click here.

Monday, July 18, 2016

Can you provide a non anxious presence to others?

Amy Banks writes in her book, Wired To Connect, "A new field of scientific study, one I call relational neuroscience, has shown us that there is hardwiring throughout our brains and bodies designed to help us engage in satisfying emotional connection with others." p.3 Dr. Banks then goes on to describe four neural pathways which she describes as the smart vagus nerve, the dorsal anterior cingulate cortex, the mirroring system, and the dopamine reward system.

The first neural pathway has to do with the sympathetic and parasympathetic nervous system more commonly known as the "fight/fright/flight" response when we are threatened and/or stressed.

Banks asks us to consider our relationships with the 5 people we spend the most time with or spend the most time thinking about and on a scale of 1 - 5 with 1 being none, 5 being always and 3 being half the time, rate how we experience these relationships one at a time with these questions:
I trust this person with my feelings: This person trusts me with his/her feelings; I feel safe being in conflict with this person; This person treats me with respect; In this relationship, I feel calm; I can count on this person to help me out in an emergency; In this relationship it's safe to acknowledge differences.

In Bowen theory, the concept of anxiety is very important. People have different set points of anxiety with some being very high strung and others very laid back. On a scale of 1 - 10 how anxious are you most of the time? What would help you lower your usual level of anxiety and tension? There are many ways of doing this from chemicals, whether medications or other drugs licit and illicit, and behaviors such as relaxation and meditation and "chilling out."

In your relating to other people to what extent are you a non anxious presence? It is providing a  non-anxious presence which Edwin Friedman, one of Murray Bowen's students, believed to be the most important therapeutic contribution of a psychotherapist. The question is how does a person achieve a low level of anxiety so that he/she can be a non anxious presence with other people?

To be continued


Saturday, July 16, 2016

The eight dimensions of wellness

What are the 8 dimensions of wellness? On a scale of 0 - 10 with 10 being 100% and 0 being nothing at all how would you rate your wellness on each of these 8 dimensions? A perfect score when everything is perfect in your life would be an 80. A score of less than 40 or a 5 on any dimension indicates that there is work to be done to improve the quality of your wellness.


Friday, July 15, 2016

President Obama provides wisdom and solace to a nation in mourning after the Dallas police killings.

President Obama's eulogy for the five Dallas police officers killed is well worth watching and seems good for the mental health of the nation. I recommend it to you.


Thursday, July 14, 2016

Mixing Pot and Tobacco Increases Dependence Risk

From MedlinePlus on 07/06/16:

TUESDAY, July 5, 2016 (HealthDay News) -- People who mix marijuana with tobacco are at greater risk for dependency and less motivated to find support to quit these drugs, researchers report.
One billion people around the globe use tobacco and 182 million people smoke pot, making these two of the world's most popular drugs, according to the World Health Organization and the United Nations Office on Drugs and Crime.
For more click here.
When I have been asked by clients to help them quit pot and they also smoke cigarettes, i strongly suggest that they quit smoking tobacco also and help them figure out a way to do that that will work best for them. If the client is willing to make a tobacco quit attempt, they usually are more successful at also quitting pot.

Wednesday, July 13, 2016

Is faith the basis for good mental health?

"It's all about the bio-psycho-social-spiritual model," said Fred. "The functioning of human beings is not simple. It's not like there is a silver bullet or a magic key. It's more complicated and nuanced than that."

"What about God's grace?" said Martha.

"That too," said Fred. "That's the spiritual part. In a Course In Miracles it is called a 'miracle' which is simply a shift in perception from the world of the ego to the world of godliness, the Tao."

"Well, Jennifer is doing better," said Martha.

"Could it be the medication?" asked Fred.

" It may help a little with her anxiety so that she can focus more on other steps to manage things better," said Martha

"What does she say is the thing that has helped her the most," asked Fred.

"That I believed in her and that things would get better. It was my faith in the process which she claims has made the difference for her," said Martha.

"And where do you get such faith?" asked Fred.

"From my grandmother," said Martha. "I know it is expected that I say from my graduate studies, my internship, my experience, my supervision, what I've learned from my other patients, and these things are helpful, but the most important thing is what I've learned from my grandmother."

"What do you mean?" asked Fred.

"When things would be tough, she would say, 'don't fret about it. Things will be all right in the end, and if they're not all right, it's just that we're not at the end yet. I used to think she was crazy, but she was the one with faith in the basic goodness of life and I learned to be faithful from her."

If you are looking for God, look for God within loving relationships.

Tuesday, July 12, 2016

Good overview of current research on Borderline Personality Disorder

Published on Jun 15, 2016 The Brain & Behavior Research Foundation June Meet the Scientist Webinar featured Dr. Sarah Kathryn Fineberg, Instructor in the Department of Psychiatry at Yale University. She presented on "Social Learning in Borderline Personality Disorder."

Monday, July 11, 2016

Julia Galef gave an interesting talk at TED in February, 2016 entitled, "Why You Think You're Right - Even If You Are Wrong."

She describes what she calls the "Solider Mindset" and the "Scout Mindset."

The "Soldier Mindset" operates with what she describes as "motivated reasoning" which selectively perceives facts and ideas that increase the person's chance of winning and rewards their need to be right.

The "Scout Mindset" rather than needing to be right, is interested in the accurate picture of reality even when it is unpleasant or inconvenient.

The contributing factors to "scout mindset" are not intellectual and cognitive as much as emotional. People with "scout mindset" tend to be more grounded (secure), more curious, and more open. These traits of goundedness, openness, and curiosity predict good judgment.

Ms. Galef states that whether one engages in more of a "soldier" or a "scout" mindset is based on what a person yearns for. Is the person more invested in defending his/her beliefs or seeing the world as clearly as possible?

The ability to consider and reflect on how people process their thoughts and beliefs is what is called "meta cognition". "Meta cognition" simply means thinking about thinking. Meta cognition is what Piaget, the psychologist who mapped out cognitive development, calls "formal operations." Formal operations, or meta cognition, is considered to be a sign of maturity and wisdom.

People who engage in meta cognition tend to be more mentally healthy than people who have not grown to this stage of maturity.

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Sunday, July 10, 2016

How good is your vagal tone? Do you tend to be reactive or responsive then faced with attack?

<iframe width="560" height="315" src="https://www.youtube.com/embed/du035tg-SwY" frameborder="0" allowfullscreen></iframe>

Calming ourselves down when we are anxious and depressed has to do with the part of our nervous system called the smart vagus. This is the part of our brain which an override our sympatheic nervous system or the fight/flight response. The ability to manage our emotional responses well to the interactions with others is referred to by neuroscientists as "good vagal tone." In therapy I make a distinction about being "reactive" and being "responsive." "Reactive" is when the sympathetic nervous system has been triggered with a fight/flight response. "Responsive" is when we can back off, take emotional distance, get things into perspective, calm down, and then decide how to deal with things in a purposeful and deliberate way.

How does one develop good vagal tone? The suggestion in this short video is to imagine what is called "the pin" or the factor which might be motivating the annoying/hurtful person's behavior. In every day words, we shouldn't take what we perceive as annoying or attacking behavior by others "personally." The annoying or attacking behavior of others may be motivated by factors which have nothing to do with us. So we need not fight or flight we can simply observe or perhaps even try to soothe the other who is having a bad day.

Wednesday, July 6, 2016

The U.S. is a low tax country and may weaken our overall public health and well being

People in the United States complain about their taxes and it becomes a hot button issue in every political campaign from the local to the national level. However, in reality, Americans have one of the lowest tax rates of any first world country. Is the U.S. view on taxes dysfunctional because it focuses on the "me" instead of the "we" and thereby weakens our strength as a nation and our overall well being?


Monday, July 4, 2016

Improving race relations involves overcoming our fears of "the other" and learning more about "the other" with an attitude of curiosity and respect.

Dr. Kenneth Hardy speaks at the 2016 Psychotherapy Networker Symposium on March 18, 2016 on "The View Of Black America". He describes some very important ideas in this brief video clip which only lasts about 6 3/4 minutes.

 He describes the "assaulted sense of self" in which black parents described their children in terms of what they are not such as "not a bad kid," "not in a gang,", "doesn't wear baggy pants," instead of in terms of what they are as white parents do.

Hardy says that black kids are aware of race at age three while white kids may not become aware of race until they are 20 or 33. This early awareness annoys white people who ask black people, "Why to do you always bring up race?" It's because it has been a conscious issue for black people much longer in their lives than for white people and, as Hardy, says, black people bring up race because white people don't.

Hardy points out that with the brutalization of the black body by police, black people experience devaluation when they see Michael Brown's body left in the street in Ferguson for over 4 hours indicating a lack of dignity and respect not only for Michael Brown's corpse but for his family and community.

 I have, over the course of my career, been to plenty of workshops and classes on cultural diversity with the intention of enhancing the cultural competence of service providers. A lot of these efforts such as "sensitivity training" and "raising people's consciousnesses" has been well intended but also ineffective.

The most important thing I have learned over the years is what is called the Platinum rule as distinguished from the Golden rule. The Golden rule is "Do unto others as you would have them do unto you," while the Platinum rule is "Do unto others as they would have you do unto them." In order to practice the Platinum rule, the person must know the other person's values, beliefs, practices, and preferences. This requires curiosity and courage to put oneself into unfamiliar culture and relationships. Many people are too frightened to extend themselves outside their comfort zones and so the major challenge in improving race relations is overcoming our fears of "the other."

 

Sunday, July 3, 2016

"We" instead of "me" creates a higher quality life

Do cultural norms and attitudes make a difference in the public health of populations? The answer to this question is clearly "yes." What are some of those cultural norms and attitudes that make a positive difference? Michael Moore describes the norms and attitudes in Norway and says that Norwegian attitude toward "we" instead of "me" is so different from the United States that most Americans wouldn't believe that Norwegians actually believe and behave in these healthier ways.


 

Saturday, July 2, 2016

The problem of patient medical record - Treating records or treating patients?

From Medline Plus on 06/28/16:

TUESDAY, June 28, 2016 (HealthDay News) -- Doctors say they're drowning in electronic paperwork, feeling burned out and dissatisfied with their jobs thanks to countless hours spent filling out computerized medical forms, researchers report.
Electronic health records are a cornerstone in the effort to modernize medicine. But, new systems designed to chart a patient's progress and instruct their future care have proven to be very time-consuming, the study found.
"While some aspects of electronic records can improve efficiency, computerized physician order entry is a major source of inefficiency and clerical burden for physicians," explained lead author Dr. Tait Shanafelt, a Mayo Clinic hematologist and oncologist. "Tasks that used to be accomplished with a verbal or written order in less than 30 seconds can now take more than five minutes."
As a result, physicians using these electronic records reported higher rates of burnout and increased frustration with the amount of computerized paperwork they must do, Shanafelt and his colleagues found.
The survey of more than 6,300 active physicians found self-reported burnout among:
  • About 57 percent of doctors using electronic health records, which serve as a computerized version of a patient's medical history. Only 44 percent of those who didn't use electronic health records feared burnout.
  • Between 56 percent and 59 percent of doctors who use computerized physician order entry (CPOE), an electronic system doctors use to share instructions for patient care. Only 45 percent of doctors not using CPOE suffered from burnout.
The doctors also were more likely to be dissatisfied with their daily amount of clerical work if they used electronic records, the survey revealed.
Patients ultimately are the ones who suffer if doctors are constantly stressed out, Shanafelt said.
"Physician burnout has been linked to decreased quality of care and medical errors, as well as an increase in the likelihood physicians will cut back their work hours or leave the profession," he said.
Dr. Wanda Filer is president of the American Academy of Family Physicians. She said doctors find electronic health records to be a nuisance because the systems often have been designed to help bill insurance, rather than to aid medical care or help doctors manage their workflow.
For example, patients who go to a family doctor often need care for multiple health problems, requiring many different prescriptions, laboratory tests and care recommendations, Filer said.
"The EHR [electronic health record] is often designed for a quick clinical encounter like a head cold and becomes very clunky when you need to document more detailed information," she said.
"Trying to enter and manage vast amounts of clinical data has become incredibly time-consuming, pulling physicians away from their real purpose, which is patient care," Filer explained.
Paper work is a major stressor for behavioral health providers because documenting data regarding patient encounters and patient's situations takes so much time and often the requirements and expectations of different stakeholders are contradictory. The patient record first and foremost should be used as a clinical tool for good patient care, but increasingly, insurance companies, lawyers, regulators, criminal justice, child protective, disability claims evaluators have gotten in on the act. For whom is the clinician keeping the record? How can the information recorded be taken out of context and misconstrued for various purposes?
The advent of electronic health records, EHRs, have only accentuated the problems and potential harms that can be done with a patient record.
As stated in the quoted article above one of the major stressors and job dissatisfiers for health care providers is having to keep and maintain a patient record. These health record requirements directly affect the provider's mental health.
Over 47 years of practice, I have developed some of my own practices in regard to health records that have served me and my patients well. First, I keep very little information in patient records unless there is a clear reason that would serve my patient interests. Otherwise, I do not put anything in the record. This rule of thumb is "less is better," and "when in doubt, leave it out." I have other rules as well which I will share in future articles.

To access the Medline Article, "Doctors swamped by 'E-medicine demands." click here.

Friday, July 1, 2016

What are TRAP(Targeted Regulation Of Abortion Providers) laws?



How do TRAP laws negatively impact women's, and children's, and family's mental health? The Supreme Court did nullify the latest of Texas' TRAP laws.