In many different specific fields, counselors can provide their clients with valuable mental health services that can have a positive and profound impact on personal health and well-being. But sometimes, those without proper training, education, and experience are allowed to practice professionally in situations that may be misleading or dangerous for potential clients. In an effort to create a standard of quality for counseling and to ensure that professionals receive the resources and background they’ll need to effectively meet their clients’ needs, many public administrations are considering tighter regulations for counselors. In the state of Oklahoma, it was recently announced that certified drug and alcohol addiction counselors will soon be subject to a new set of regulations that the state says is designed to improve the quality of care and create a rational schedule of pay rates.

The regulations are set to come into effect at various intervals, some as early as July of 2010, and focus on the need for certified counselors to provide only basic services, allowing those with more advanced degrees and qualifications to offer more involved treatment. In particular, the regulations describe a need for counselors hoping to provide psychotherapy services to obtain licensure, which itself requires a master’s degree. Some opponents of the measure suggest that the move is merely a problem of semantics and will prevent local clients from receiving the care they need as specialists become more rare and many area professionals return to their schooling. But supporters note that a higher level of understanding, experience, and knowledge can only ultimately be of benefit to those who receive help from counselors.

With other states and regions considering the establishment of changes in training, education, and licensing requirements, the mental health fields are likely to experience a significant boost in the coming years.

Post-traumatic stress disorder, or PTSD, has been gaining attention recently as its prevalence among military personnel becomes more widely known, but this mental health concern is certainly not limited to men and women in the armed forces. Able to effect people of all ages in many different situations, the issue is often addressed with psychotherapy or medications, or some combination therein, but more effective treatments are actively being sought. In a newly-published study, researchers at the University of Alabama at Birmingham have investigated the brain’s responses to unexpected and unpleasant audio stimuli, mapping how people react to events and how anticipation plays a role in these reactions. The researchers found that emotional responses were far stronger when events were unexpected, and hope to be able to use this information to help shed light on the specific etiology of PTSD.

The late summer and early fall seasons in the Philippines were especially cruel in terms of weather this year, inundating the region with a series of tropical storms and floods that killed scores of people and left many others in a state of devastation. That state, unfortunately, still persists in the areas affected by the disasters, as over a million people live in homes and shelters still racked with floodwaters and debris. While there are many concerns over the potential for bacterial infections and other health concerns to take a toll on those living with the stagnant waters, the World Health Organization has recently noted that the potential for mental health issues to become prominent in the area is great.

Citing the stress and frustration of living in an environment soaked with floodwaters, with little hope of restoring hopes to a dry state before the end of the year, the organization suggested that mental fatigue, depression, and other mental health concerns were likely to take hold of many of those struggling on a daily basis to reclaim their property-–and their lives–from the disasters. Along with local residents and business owners, the organization expressed concern for the emergency aid workers and other helpers assisting in cleanup and provision distribution efforts, many of whom have been working seven day weeks with little to no rest since September.

Surrounded not only by physical hardship but faced by the deaths of friends and loved ones, the victims of the Philippines floods should receive greater medical and mental health care, and measures should be taken to provide adequate services as soon as possible, suggests the WHO. In the meantime, the victims are showing daily that human will and perseverance are capable of working, living, and loving through even the most adverse of circumstances.

Having a stroke is an event that’s likely to cause mental and emotional difficulties; whether it’s apprehension at being hospitalized, loss of memory or function, or any number of associated issues, stroke can greatly impact mental well-being. In some cases, stroke sufferers may develop thoughts and feelings of depression after the incident, and a research team from the University of Toronto has recently revealed review results suggesting that this occurs significantly more often in women than in men. The review focused on a total of fifty six studies and presents strong evidence for a need to provide better mental health services to female stroke sufferers to help prevent the onset of depression, which can make post-stroke living far more difficult.

The World Health Organization, in an effort to identify health issues in need of reform around the globe, has recently released a report on the state of women’s health, particularly in poor and middle-income countries. Citing broad instances of medical health issues such as death during childbirth, the report also notes that stigmas against women participating in mental health services results in a lowered ability of women to take good care of themselves and of their families. The report is hoped to contribute to global efforts to bring mental health accessibility to a larger audience and to focus on the particular needs of women.

Click here to contact Ruth and/or see her GoodTherapy.org Profile

I work part time in a Geri-Psychiatric ward where my title is Recreational Therapist. What that means is that when elders are committed to this hospital ward, usually involuntarily, anywhere from 72 hours to one month they are termed “gravely disabled and in dire harm to themselves and/or others”. Along with individuals that are in a psychotic phase of their schizophrenia and those suffering from bipolar episodes, a large percentage of those admitted to our facility have dementia. When the dementia patients are admitted to the facility, they usually arrive in a stupor of confusion. The confusion is often exasperated because they have not been eating or have been unable to sleep for days. It is tragic to see elders who I imagine once had interesting lives be reduced to corpses that society does not have the capacity to handle, heal, or fully understand.

The procedure after they have been admitted to our facility is that psychiatrists assess their disabilities and prescribe medications that help to calm and re-orient them. While they are adjusting to medication, they often feel nauseous, dizzy, and/or confused. Many sleep for a few days to regain some equilibrium. Also disorienting is that their senses are impaired. Few arrive with their glasses and thus can’t see very well, and many have hearing loss and have lost their hearing aids in the transition. They are frail; a majority of them are in wheelchairs or can only move with the help of walkers.

I have only worked here a short time. As a Marriage and Family Therapist and Registered Art Therapist, I have a strong background working with elders. I co- wrote a chapter about working with Alzheimer’s patients using Art Therapy in a book entitled Art Therapy and Clinical Neuroscience. Even with my experience, I was not quite prepared for the intensity of this environment. For the few weeks I was overwhelmed by the heavy energy I felt witnessing the patients’ suffering. It affected me to such an extent that I experienced many sleepless nights until I was able to adjust to the environment and understand my part in the healing process. I felt such sorrow at seeing people’s terror and witnessing their limited cognitive ability. I felt some relief when I observed them calmed with the aid of psychotropic medicine. That is just one component of healing. I feel totally confused about what the solution to their suffering is. In bygone years we had extended families who took responsibility to their elders care as they became incapacitated. Now, often times families do not have the capacity to take care of their loved ones and so they live in nursing homes and assisted living facilities. When they become out of control (hitting, not eating, not sleeping, depressed, are endlessly screaming, etc.) they are sent to us to be re-regulated. Many are lonely and unable to care for themselves. You often hear the women making statements with great urgency like “I have to go home now to take care of my husband,” or “I need to get home now to take care of my children.” And these statements perseverate for hours.

I am confused, about this system that I feel is broken when it comes to the old and infirmed, but I don’t know what the solution is in making it better. I feel a large component to the healing in our facility is in the job I do with them as a Recreational Therapist coupled with the care the nurses, social workers and doctors provide. As a team, I know we all try our best in offering our compassion, patience and understanding. I feel my job as a therapist is to help care for their souls.

Once the patients come out of the stupor of drugs and medical problems are treated (from thyroid imbalances, UTI’s, body sores, etc.), they spend a few hours a day with me in a small group. I also work with some on an individual basis. When I work with the patients I try to stimulate the right brain activity through creativity, activate long term memories, and in short, stimulate neural connections.

Erikson entitled the last phrase of life for those over 65 years of age Integrity vs. Despair:

“As we grow older and become senior citizens we tend to slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, feel about past, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness.”*

I find that reminiscing is a wonderful healing activity for elders. Reminiscing promotes individuals taking pride in their lives well led. People with memory loss lose their long term memories last, so when coaxed to talk about their youth, families, adventures, interests and careers they brighten up as the memories flood their minds. I am always trying to stimulate their brains and endorphins by introducing topics that they can embellish with stories of their lives. These memories bring back pride to these people because these rich memories reinforce that their lives have meaning, and at one time it was interesting, loving, and fulfilling.

Almost daily I do some type of art with them utilizing paints, colored pencils, markers, or pastels to create simple abstract marks on paper. I’ll also have them create collages, manipulate clay, or create stories with miniature toys (my adaptation of sand tray work). Some elders are able to be more sophisticated than others. Seldom are they able to create a figurative statement in the work. They enjoy the act of just moving their hands across the paper, often with my help. Many are able to admire their final product. Sometimes we talk about feelings that are generated from the art making. I often place the finished works on a bulletin board so it can be admired by them as well as the staff. It gives them great pride to see their work displayed.

Other activities I do include stretching (influenced from my yoga teacher training), simple visualizations and body awareness exercises. I always play music which is very calming and healing. Sometimes we play percussion instruments to a CD playing in the background. For those able to stand, we dance, and those chair bound, we move our limbs to the beats of the music. Music played is eclectic; from staples from the 40’s, 50’s and 60’s, world music, classical sounds and easy listening contemporary sounds.
All of these techniques work; most of the patients leave the room after our session with a smile, have less anxiety and confusion, and hopefully a small sense of intellectual connection. Many of them thank me for the “great time” they had. Often when I return the next day, I find the elders are sitting in the recreational room waiting for me to begin the activities.

Last Monday when I arrived, I noticed a new patient, Lydia (not her real name) sitting on a geri-chair in the hallway where patients are often placed so nurses can monitor them. She was a small woman, shrunken by age with osteoporosis that has concaved her spine. Her eyes were closed and she was un- responsive to my attempt to say hello. I read her chart, she was 85, a Hungarian immigrant and dropped off the night before by her nephew because of her depression and advanced state of dementia. After a few days, when she was again able to walk and now respond to me, I escorted her into the recreational room. In reading her chart I had learned that once knew nine languages. As we began conversing I realized she had difficulty creating full sentences in English. I wondered if she had had a stroke that caused aphasia, or as dementia patients often demonstrate with the progression of the disease, had lost the ability to speak in her second language. To stimulate our work together, we began creating a cooperative drawing, where I would make marks then encourage her to do the same. She took the paint brush in her hand and at first; with my help, she was able to move it across the paper. Soon the painting became self-generating. Once we had made a connection, over the next few days her story unfolded. When words didn’t come, she made hand signals and I was able to fill in the blanks. Between her minimal words, hand movements and my interpretations, I learned more about her.

Lydia said she was not 85, but over 100 years old. She was brought up in a wealthy, cultured, Jewish family in Hungary. Her father was a lawyer. She had attended college and taught school both in Hungary and Austria. She had travelled all around Europe and big smiles would light up her face with memories of the places she visited: Paris, Vienna, Budapest and London. She talked about traveling in ocean liners and on trains. She had fond recollections of going to Costa Rica and Panama. She relished in the pleasure of her memoires. I’m not clear if she had come to the U.S. before the war or after the 1956 Soviet invasion of Hungary, or how the holocaust affected her and her family. She did say her father lost everything when he came to this country and stated sadly that he never recovered. She was married twice and never had children. As we talked about her past the topic of her clothes came up. “Oh,” she said, “I was very elegant; I wore long white gloves, beautiful hats, and jackets with fur collars.” She has sparkling blue eyes, a very wrinkled face, and remnants of reddish blond strands in her thick grey, shoulder length hair. I imagined that she was quite a “looker” in her day. Lydia said, “Life was good then, but now it was not so good and she wanted to die.” I was empathetic as I listened to her story unfold. I really do understand; once she had a full independent life with choices and now she was infirmed and committed to a psychiatric ward. Her intellectual abilities are diminished and she spends many hours of each day sleeping in a chair. Everyone had died except for an indifferent nephew who had dropped her off at the hospital and hasn’t been back to visit since.

When Lydia talked about dying, in a philosophical moment I said, “The yogis say that we are given a certain amount of breaths in each lifetime, and when we have taken the last breath allocated, we are ready to die.” Her face brightened, “yoga” she said, “I studied yoga”. She made many hand motions when words did not come to her lips to express her excitement at the recognition of her past. I explained that I was also a yogi and demonstrated some simple postures; she smiled with glee and shook her head in yes motions as she mimicked what I did as best she could from her chair. She was coming more and more to life. In attempting to recollect for our conversation the yoga world of earlier days, I mentioned Krishnamurti and she acknowledged she had gone to Ojai to hear him speak many times. As synchronicity would have it, I realized that in the CD collection I brought to the ward there was a Donna DeLory CD of Sanskrit chants. I played it for her. The first cut was the Gayatri.

Gayatri is seen as a Divine awakening of the mind and soul, and within it a way to reach the most Supreme form of existence, and the way to Union with Brahman. Understanding, and purely loving the essence of the Gayatri Mantra is seen by many to be one, if not the most powerful ways to attain God. Krishna declares in the Bhagavad-Gita (Song of the Lord) that of mantras, He is Gayatri.

Gayatri Mantra means: “Oh God, the giver of life, remover of pains and sorrows, bestower of happiness and creator of the universe you are most luminous, pure and adorable. We meditate on Thee. May you inspire and illumine our intellect that we may perform noble and virtuous actions”.**

Bliss filled her face, “oh, oh, oh”, she muttered and then she began uncontrollably weeping. We joined hands, smiled, looked each other in the eyes, and wept together. She mouthed the words to the chant and pointed to her heart. In trying to understand her she said – to the effect, “This was what life was all about, the beauty, the knowledge, and now my life is meaningless” and she continued, “look where she is (referring to the hospital and the other demented patients) and no one understood who she once was.”

As I remember this magical moment in time I again weep for the beauty of the prayer, the love of God and the luminosity that we shared. The next day when I saw her she was sleeping in a chair and it was difficult to arouse her. When she was able to again connect with me, she took my hand and we talked; she beamed recalling the memory the day before. We had bypassed the aging brain that no longer functioned properly in real time and together, we found a connection to the “source”.

The late George Carlin wrote a humorous and poignant essay entitled “Views on Aging” in which he ended his reflection with, “Life is not measured by the number of breaths we take, but by the moments that take our breath away.”

This magical moment in time took my breath away. As I get more involved in this work, it becomes clearer and clearer to me why I have such passion for working with elders, even when I am overwhelmed by their confusion and suffering and recognize that these experiences also force me to come face to face with my own mortality. I realize I have a strong calling to help bring elders to the light. I pray that whoever I am able to touch in my work can carry this connection with them until they are ready to leave their bodies and pass into the next dimension.

“Death is one of two things… Either it is annihilation, and the dead have no consciousness of anything; or, as we are told, it is really a change: a migration of the soul from one place to another.” ~ Socrates

References:

* Wikipedia’s Erikson’s Stages of Psychosocial Development
** http://www.sathyasai.org/devotion/prayers/gayatri.html

©Copyright 2009 by Ruth Subrin, M.A. MFT-AT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Ruth and/or see her GoodTherapy.org Profile

Of the several million emergency calls that were made in the UK between 2008 and 2009, a significant portion involved mental health difficulties. While ambulance professionals and other caregivers are often able to identify such difficulties in clients, they are not typically endowed with the training or understanding to provide meaningful services, and simply refer people experiencing mental health crises to emergency room and general practice physicians. Many workers note having observed that on the whole, those clients seeking help for mental health issues are forced to wait longer to receive treatment, and if that if they do remain within emergency room waiting areas until they’re seen, they are less satisfied with the treatment given.

In effect, this creates a “revolving door” for mental health clients who, despite earnestly requesting professional care, may not be given the attention or tools needed to aid in recovery or find a specialist who can. Such are the issues outlined in a recent report tendered by the Ambulance Service Network and the Mental Health Network, published with the NHS Confederation. The report, a joint effort contributed to by both agencies, suggests that collaboration between emergency service responders and mental health specialists, including better education about mental health concerns for ambulance personnel, may greatly improve the quality of care received by those in need. Through curtailing the consistent use of emergency services due to a lack of adequate treatment, the measure may also help the UK cut health care costs.

The frustration of being unable to secure meaningful mental health care, especially when the often-difficult impasse of reaching out for help is conquered, is an unfortunate experience to which many in the UK can relate. With this collaboration, however, such experiences may be phased out.

Click here to contact John and/or see his GoodTherapy.org Profile

Peter Strong, PhD. is an expert in the treatment of PTSD. His theory in the treatment of PTSD is “The key to changing habitual reactivity is to learn how to relate to the underlying emotional energy that compels you to react.” Peter also bases his practice near Boulder, Colorado on using core mindfulness in the treatment of PTSD.

Interestingly, Peter Strong PhD. and this writer make use of the mindfulness treatment strategy. For many years while treating people with schizophrenia I taught core mindfulness as part of my group therapy. Surprisingly, many who practiced learned to tune out the voices they were hearing. The first step what leads up to the reaction of hearing voices? And what many have said they have done. One popular technique many began to practice was using the self talk “Stop, This isn’t me, This is My Illness.” For a few this began to really work, and then the few who really applied it were ready to take it a step further. What I taught them next was the brain receives its information was through their five senses. What one saw, felt, heard smelled sometimes could trigger a reaction. Interestingly, this small group really got into this as they were realizing and experiencing saying “Stop, this isn’t me” seemed to help. I then would take them for a walk to get into the moment. By totally focusing on the experience of what the rose smelled like, what the trees looked like, what the chirping of the birds sounded like, and what the lemonade tasted like, people with schizophrenia began to experience the voices weren’t as loud. That by focusing on the experience of the moment they were also slowly training their minds new habits which could lead to tuning down the volume of the voices. Continuing to practice focusing on the wind against their chin and hearing the birds they slowly began to experience when they would even talk to another person their voices would become softer and not as noticeable. By learning to turn down the voices by practicing in the moment techniques, many began to stay out of the inpatient unit.

I had one case of a person who was on the list to go to the state hospital because of multiple inpatient episodes in one year. After time spent building a relationship, establishing trust and teaching the person to experience what happens to the voices while saying “Stop” “This isn’t me” This is my illness” and began practicing and experiencing the moment, the person began to realize the voices weren’t as loud. Today this person in no longer a risk for more intensive treatment. In fact, there have been years now without an inpatient episode.

Practicing core mindfulness works. Dr. Peter Strong is absolutely right! If practicing core mindfulness can work with the voices of schizophrenia it certainly can work with the reactions of PTSD. In fact, often the intrusive houghts and intrusive images related to trauma are often misdiagnosed as psychosis when in reality intrusive thoughts are based upon trauma. The difference is that the intrusive thoughts of PTSD are more focused and related to trauma. Psychotic voices are part of a disorganized thought process and are more outside of the body like one would hear sounds through a set of headphones. Intrusive thoughts are inside one’s head.

Just as Peter Strong writes, PTSD is a reactive disorder. The brain uses the same senses to send and receive information as in core mindfulness training. In the transmission of information to the perception part of the brain, traumatic thoughts and memories emerge from the amygdala, the part of the brain where they are permanently stored. This process is also connected to one’s fight or flight response and one’s sense of perception. When a dog sees fire, the dog runs away. The dog smelled the smoke long before it saw or felt the heat of the fire. The same is true with humans. The transmission of information from the sensory system is about self protection. That self protection is heightened in a person with PTSD.

I have a case of a 35 year old woman who suffers from moderate to severe symptoms of PTSD and provided writer with a release to share her recent experience with Core Mindfulness Therapy and this writer. She was terminated from a job she had for 2 years and she had difficulty finding a new job. She was recently hired by another company and had a PTSD reaction when she saw the word job performance review as her previous company used performance reviews making a paper trail which led to her termination. She saw the word review and instantly was overcome with the intrusive thought “I am going to be fired!” The review was a standard procedure used on all new hires. Once she had her 30 day review, she had the feeling of being watched, of evidence being collected to justify firing her. She also began to be very hyper vigilant and hyper aroused and became very sensitive and as she put it “paranoid.”

She said one of her jobs is sorting. Her boss thinks she doesn’t sort fast enough and the more pressure she feels the more immobilized she becomes and the more “stuck” she feels. This is a PTSD reaction to a symbolic event. She would say in previous sessions that PTSD feels like a time bomb in her head encased by a brick wall and she never knew when the time bomb would go off. In this instance the time bomb was ignited by taking a 30 day post hire review.

In her session, we processed the precipitating event. She then explained what bugged her the most was focusing on a performance review with a corrective action rather than a regular 30 day post hire review.

One of the things we did was go for a walk. As she walked I asked her to focus on feeling her feet as she took each step. Total focus was in the moment, being aware of where she was walking, and emphasizing she is safe. I then asked her as she made each step to inhale counting up to four steps, then hold her breath for four steps, then exhale slowly for the next 8 steps and do this for a cycle of ten. Then she sat down and we processed how she was feeling as compared to the beginning of the session. She stated, “Much more relaxed and focused.” Her face had more color, she was breathing more slowly, and she was taking deeper breaths rather than short constricted breaths. I then asked to focus on the moment by experiencing what the wooden bench felt like, the warm wind against her face, to smell the smell of the air, and to look at the trees. I asked her to focus on the experience of the moment and to maintain the focus for 3 minutes. Even three minutes for a person in a PTSD reaction could be very difficult to accomplish. However because of the trust established between writer and the client she felt safe and she had a very positive outcome.

There was some resistance when I asked her to practice core mindfulness at least five times during the day. She said people would look at her like she was weird. Writer responded by saying, “As you walk just focus on your safety and feel your feet touch the ground. As you take a drink totally focus on the taste of the drink, as you sit in your chair totally focus on the feel of the chair fabric and no one will know”.

She then said, “I get it and I will practice what you just taught me.” She is also going to practice her daily self hypnosis which she got away from. I made a parting comment, “You look so focused and I bet you could sort right now with the speed of lightning.” Her response was, “Yes I am relaxed and focused, and yes I could! It is when I am pressured that I react!” Writer then asked her to keep a voice journal and to tell me at the next session of any differences at work

Teaching her to practice a combination of breathing exercises and core mindfulness is also helping her practice a new behavior of being more in control of the way her brain habitually reacts to similar events. The more she practices core mindfulness the more her brain will be trained to respond rather than to react. Core mindfulness re-teaches the brain how to respond to information received by the sensory system of touch, vision, hearing, taste and smell.

She is learning to understand the “Why” behind the “time bomb encased with bricks” She is teaching herself and forming a new habit of responding to familiar stressors by practicing breathing exercises, self hypnosis and core mindfullness behaviors. The more these new behaviors are practiced the more reprogrammed the brain becomes to respond rather than to react.

©Copyright 2009 by John Lee, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact John and/or see his GoodTherapy.org Profile

The National Alliance on Mental Illness has just released the results of a much-anticipated survey entitled, “Gaps and Guideposts” on its site. The survey involved scores of Americans in three distinct categories: those who did not know anybody affected by depression, those who identified as caretakers of adults with depression, and depressed adults themselves. Seeking to discover Americans’ familiarity with depression and treatment options, the survey also uncovered a rising rate of acceptance of depression’s ability to affect people of all profiles and lifestyles, and of psychotherapeutic treatment to help conquer symptoms.

There are hardly ever circumstances in which someone hopes to become sad or be overcome by a bad mood, but new research developed at the University of New South Wales may give some people pause when considering how their mood affects their performance. A group of researchers tested news store patrons on their recollection abilities regarding a few odd items left on a counter inside the store, and found that their recall was superior on wet and gloomy days as opposed to bright and dry ones, just one of several experiments suggesting that minds may gain an advantage through the experience of a less than sublime emotional state. Though performance-enhancing sadness isn’t exactly being recommended to the masses, those troubled by bad moods may be able to find something good about their challenges as a result of the work.

Click here to contact Evelyn and/or see her GoodTherapy.org Profile

Recovery from an anxiety disorder (and/or depression) usually happens in stages. I mean complete recovery, not only the reduction of symptoms. The first stage is learning how to cope with anxiety or panic attacks. This is achieved by learning and practicing breathing techniques, relaxation and calming exercises, and effective and supportive self-talk. One learns how to not be afraid of, and controlled by, the anxiety and panic. Life-style changes, such as diet and exercise, as well as stress-management strategies that include time management, limit-setting, assertive communication and the appropriate expression of emotions, especially anger, are also anxiety coping skills. Learning how to desensitize to avoidance patterns is part of the learning process for those people with phobias due to the fear of anxiety or panic attacks. Understanding how one developed the anxiety condition is also a necessary step to working one’s way out of the cycle of anxiety because it helps make sense of the problem and points to the areas of emotional vulnerability that
triggered the anxiety in the first place.

Understanding your vulnerabilities to anxiety may happen concurrently with the first stage of treatment or may take place at a later time, especially if one has had relapses. In this second stage one learns the roots of their fears and difficulties, understanding how one’s experiences growing up interacts with one’s temperament coupled with current stressors can lead to an overload of stress and consequently a severe anxiety reaction. (Please refer to last month’s article by me). This is a kind of education of the self where you learn what your emotional triggers are, especially those that create anxiety or panic. Sometimes this is related to trauma in one’s background.

The third stage of recovery is about self-awareness and self-acceptance. By this stage one has an evolved understanding of who they are and the role anxiety plays in their life. It is understood that anxiety is a signal leading to inner exploration. Self-acceptance replaces shame; self-awareness replaces the fear of anxiety. Life’s challenges may be confronted with courage and hope. The meaning and purpose of one’s life usually takes center stage. Not surprisingly, this stage often coincides with mid-life.

It is important to remember these stages are not independent of each other; they usually overlap. Our area of vulnerability is sometimes triggered throughout the life cycle; anxiety is a signal that this has happened. And we continually have the opportunity to strive toward balanced mental health and well-being.

©Copyright 2009 by Evelyn Goodman, Psy.D, LMFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Evelyn and/or see her GoodTherapy.org Profile

Efforts to help people understand the nature of mental health difficulties and of the services available to assist them are crucial aspects of modern efforts within the professional community. Though increasing numbers of people are beginning to accept mental issues as health difficulties and are relying less on social prejudice and stigma, such blocks to understanding are still prevalent in much of the world, and may contribute to the prolonged suffering of clients and their families. A great number of efforts have been made to illustrate mental health and related issues to the public, but on Wednesday, an illustration of a much more straightforward sort was announced. The launch of “the road to god knows…,” a graphic novel by Von Allan, is taking place both on and offline to provide a range of formats and accessibility for those interested in the subject.

Raised by a mother who suffered from schizophrenia and often finding himself without context or reason with which to understand his mother’s behavior, Von Allen has incorporated his life experience into the graphic novel, which seeks to help explain mental health difficulties to readers. The comic-like format is likely to interest a younger crowd, and may perhaps appeal to those uninterested in learning about mental illness from traditional non-fiction manuals or textbooks. “the road to god knows…” will be carried in a number of comic shops, and can also be purchased online, though readers can download and share freely-distributed copies of the work in PDF format, a measure Von Allen hopes will help his graphic novel reach a wider audience.

An unusual yet promising approach to encouraging greater understanding of important issues in mental health, “the road to god knows…” may prove a valuable if unexpected asset to the international mental health community.

There are many pressures and emotional difficulties associated with school, and the issue of bullying is certainly among them. Searching for ways to address this common problem with efficacy and meaningful attention, researchers at the University of Warwick have recently studied the potential of a virtual reality program to decrease victimization among school children. The study administered three weeks of three sessions per week involving the FearNot! virtual school environment, in which children could participate in simulated bullying scenarios and offer solutions for the characters. The program is said to require a longer duration and reminder sessions over time, but may be a good choice for school curricula.

Click here to contact Tina and/or see her GoodTherapy.org Profile

There are differences in the way people approach personal standards, and some of these have to do with self-esteem.

People with high self-esteem tend to have high yet realistic expectations of themselves; they’re not afraid to aim for a star and put in the work to get there. On the other hand, those with injured (i.e., low) self-esteem have a tendency to live with either unrealistically high or unnecessarily low standards. They are often perfectionists or underachievers … or both!

Neither the high nor the low self-esteem folks consistently meet their own standards. After all, we’re talking about human beings, not robots. But what happens when standards are not met constitutes another difference between high and low self-esteem.

First, let’s look at how people with injured self-esteem relate to the concept of standards. Because low self-esteem acts like a fun-house mirror, distorting our perceptions, it’s often hard to know what level of standards is appropriate. Should we strive to be perfect in everything we do? Or should we not bother to try very hard, because nothing we do matters anyway? What would a happy medium between these two extremes even look like?

Because of this confusion, those with lower self-esteem frequently suffer under the weight of unrealistically high standards. For example, let’s say I have low self-esteem, but I’ve finally decided to do something about the clutter in my home. I might set an unnecessarily difficult goal of removing absolutely all the clutter in every area of my home, including the garage, in one day. When I fail to make it happen, I berate myself by saying, “I never follow through on anything.”

Setting goals that are almost impossible to achieve sabotages our efforts to feel good about ourselves, and is a sign that our standards may be too high in general. Commonly known as perfectionism, having too-high standards points to injured self-esteem.

The flip side of impossibly high standards is unnecessarily low expectations. Deciding to live with an uncomfortably disorganized home instead of a clean, tidy one might be an illustration of a low standard. Here are a couple of other examples (Keep in mind that sometimes one lowers one’s standards on purpose out of necessity. Pay attention, however, to your general pattern):

• Dating the first person who shows an interest in you;
• Interviewing for a job you have no interest in doing;
• Settling for poor service when you’ve paid for better;
• Saying, “It doesn’t matter,” when asked what you preference is.

There are many ways that too-high and too-low standards might manifest themselves. They could show up in our work, our relationships, our appearance, our children, our vacations, our dreams for the future, our thoughts about the past, or any other aspect of our experience. When self-esteem is low, distorted standards can perpetuate a vicious circle of trying too hard or not hard enough, resulting in chronically impaired self-esteem.

In healthy self-esteem, our standards for ourselves tend to be high yet achievable with sufficient effort. Unlike many people with lower self-esteem, those with good self-esteem are willing to work hard even with the risk of failure. They know that failing at something is not a sure sign that they’re incompetent, but simply an indication that they need to try harder, get more help, or alter their expectations. They’re willing to do all of these things because they can afford to; they don’t need to defend against persistent feelings of inadequacy.

However, those with high self-esteem do suffer when they fail to meet their own standards. They are certainly capable of feeling ashamed, disappointed and diminished. All human beings are capable of these emotions; they’re not self-esteem-dependent. The difference is in what happens next. In individuals who enjoy healthy self-esteem, these uncomfortable feelings motivate them to take positive action. But in those with injured self-esteem, these same feelings are a dead end.

In summary, while low self-esteem can make personal standards confusing and disappointing, high self-esteem enables us to set and achieve realistically high standards for ourselves, and to enjoy a feeling of competence. The vicious circle of low self-esteem and unrealistic standards becomes on the other side of the fence a “delicious circle” of high self-esteem and high satisfaction with self and life.

If you think your personal standards are off somehow – either too high, too low, or some combination of these – start paying attention to people you respect. What are their personal standards? How do they respond to challenges? Are they devastated when something they do isn’t perfect? Do they give up at the first sign of defeat? Having a role model gives you a picture of what you’re shooting for. You’ll find that adopting appropriate standards for yourself will increase the quality of your life more than you could have imagined.

©Copyright 2009 by Tina Gilbertson, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Tina and/or see her GoodTherapy.org Profile

Click here to contact Judith and/or see her GoodTherapy.org Profile

We live in a world that is frightened of the darkness. A world that doesn’t understand and therefore is frightened of the darkness. As a consequence of holding the fear at bay, that fear gets distorted into hatred of the darkness, denial of darkness, scapegoating of the darkness. And in scapegoating the darkness, we also scapegoat anything or anyone that triggers in us memory of the darkness – memory of a conscious or unconscious experience of the darkness within us that needs to be explored, healed, and transformed. We live in a time where we are all going through darkness in some way communally and individually. Just like anything else, this passage can be misused and abused, or it can be used well and for magnificent good!*

We live in a culture where darkness is not tolerated. It’s not tolerated physically: there are lights on twenty-four hours a day! It’s not tolerated emotionally: many people will do anything to get away from pain! It’s not tolerated mentally: so many use their minds to manage and control what are too often thought of as dark or negative emotions – the painful emotions people try to get away from and get rid of! And darkness is not tolerated spiritually: too many people use the spiritual – prayer, chanting, meditation, etc. – to get away from and transcend the pain we need to go through rather than escape. Responding in this way to the darkness, we perpetuate a duality that splits us apart, within and without, and keeps us from integrating, from becoming whole. Responding so to the darkness, we deprive ourselves of the riches it has to offer: among them wounds reaching to be healed, strengths calling to be discovered, gifts longing to be developed.

A long time ago, before I even wrote Power Abused, Power Healed, I sent out “snail mail” newsletters. In the very first issue, I shared a story. My version of the story was a re-creation of another, written by Richard Proescher. Recently, I have felt called repeatedly to offer the story as a help to people I work with, individually and in groups, as they move deeper and deeper in their journeys. It is time to share it again with you, as together we descend toward the darkness of the Winter Solstice, and as individually we descend, each of us into our own inner labyrinths of psyche and soul.**

• • •

A woman is prepared for her initiation by the crones*** in her community. She is lovingly and sacredly bathed, fed healthy foods to purify her body, prayed and chanted over. She is taken into a cave, told she will be left alone there for seven days, with ample foods to sustain her body. A boulder will be moved to cover the opening into the cave. Her task: to find her way through the dark cave out into the light.

They kiss her goodbye and bless her for her journey, leave, and cover the entrance. Excited and frightened, she sits where she has been left, with her back to the opening of the cave. She prays for help, and lets her eyes – inner and outer – adjust to the darkness. Soon she sees a tiny point of light in the ceiling of the cave, right above where she sits. “Hmmm!” she thinks. “That’s my way out.”

Looking around in the darkness, she sees to her left a huge pile of rocks. Pulling herself up, she heads toward the pile. One by one, with great effort, she moves rocks from their pile to the ground of the cave directly below the point of light. By the end of the first day, tired but well satisfied with herself, she has begun another pile that is now thigh-high. Giving thanks, she eats her dinner and goes to sleep.

The second day she rises, once again praying her thanks and asking for help. By nightfall she has built a pile waist-high. Filled with hope, she sups and retires, asking for the strength to continue and be guided as she works.

Day-by-day, our initiate’s work continues. By the night of the sixth day, she has used every rock in the pile. Her “ladder” to the light is very high, but not yet high enough to assure her of her success. Resting for awhile to gather strength and courage, she prays for help; she prays that she will be able to stretch herself to reach the light and find her way through.

Then carefully she climbs. At the top she stretches and reaches. She’s so close! But all of a sudden, she loses her balance and falls to the ground, where she lays hurt, still and unconscious until the crones return the following night.

They find her there, beside the pile she has spent her time so carefully building. Gently they check to make sure she’s okay, and then tenderly lift her into their loving arms. You would think they would carry her out through the entrance. But no! They hold her with their backs to the opening, and then carry her slowly, reverently leftward, moving past the point where the rocks had been piled. Moving deeper and deeper into the dark cave, the procession walks sure-footedly for almost one-quarter of a mile. At that point they round a bend and move from the darkness into a passageway that becomes lighter and lighter … until at last they leave the cave and come into the brilliant light of the full moon right at the shore of the ocean!

As they gently lay the initiate on the still-warm sand, the woman in the group who is truly the crone’s crone sweetly asks: “When will we learn? When will we learn that we cannot allow ourselves to be distracted or frightened out of the truth? When will we learn that we must go all the way into the darkness within us in order to find our way through and back out into the light?”

May this article be helpful to you in going through what’s in and around you rather than trying to escape it or defend against it. May the riches on the other side be plentiful!

*Examples of the darkness we are going through are all around and in us: suicide bombings, wars, sexual wounds and wounding, distortions in our relationships with money, abuse in the home and in the workplace . . . They are coming out into the open and can show us — both the outer manifestation and our inner and outer reactions — what is emerging from the darkness to be healed.

**The story is written about a woman with wise women. It could just as easily be written about a man with wise men. If you are a man reading this story, please let yourself do what you need to in order to be open to the wisdom it offers.

*** Often when we think of the word “crone” we have a negative connotation, as when calling a woman an “old crone.” Originally, however, the term “crone” meant simply a wise woman. It is in this spirit and with this meaning that I use the term here.

©Copyright 2009 by Judith Barr, MA, LMHC. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Judith and/or see her GoodTherapy.org Profile

In the mental health fields, there is often reference made to the concept of a client’s well-being. While professionals can easily agree that the fostering and support of such well-being is an important and central goal in their work, they run the danger of excessive use of this and other “buzz words,” eventually losing touch with the meaning behind these words. To combat this phenomenon, the Mind Conferences UK will be held over the twenty fifth and twenty sixth of November. The conference hopes to help professionals gain a better understanding of how they conceptualize their client relationships and goals.

Click here to contact Deborah and/or see her GoodTherapy.org Profile

Two primary components of a disordered relationship with food that drive disordered eating are food deprivation: restriction of and compensation for food intake, and emotional and psychological issues: painful feelings with which one lacks adequate means of coping, and wounds experienced in the past that propel one to deal with emotional pain via abusing food. The latter speaks to a disordered relationship with one’s self. Although eating problems affect males as well as females, for simplicity’s sake, I will be using “her” and “she” throughout this article.

An eating disordered individual equates fat with worthlessness and “unloveability.” Someone who suffers from anorexia nervosa typically restricts her food intake because she has developed an intense fear of becoming fat, and by extension, a fear of eating an adequate amount of food. A bulimic individual is caught in a cycle of deprivation/restriction and bingeing/purging, which fuel one another and are driven also by a fear of weight gain and belief that “getting rid” of food taken in during a binge is necessary to ensure that she does not become obese. This is true also of individuals who do not binge, but induce vomiting after eating nonetheless. Binge eaters and compulsive eaters who overeat in ways other than bingeing share the same aversion to fat. They usually struggle constantly with dieting or restricting food intake, thus perpetuating the cycle of under-eating and overeating. Overweight binge eaters, and overweight eaters of other disordered stripes, assign the same negative significance to fat that those with anorexia and bulimia do, believing themselves gluttonous and of little worth. Most all disordered eaters value the restricting/depriving aspects of their relationship with food, seeing this as positive, while cravings for foods and desires to eat are viewed negatively. Ceasing to engage in the restrictive aspects of disordered eating does not automatically solve overeating, but it is a necessary step towards that end.

A disordered relationship with food cannot be fully resolved unless and until each of these components is addressed thoroughly. Therapists can’t get to underlying issues if a client is too malnourished to think clearly, or is insistent that some foods remain forbidden, or focused mainly on weight loss or avoiding weight gain. Neither can clients simply “legalize” foods and eliminate the idea of off-limits-foods, or focus solely on re-feeding and weight restoration. Recovery requires willingness not to abuse food no matter how painful it might feel, nor how tantalizing, appealing, relieving, etc. the thought of abusing food might be, while doing the often painful work of digging deeper. These two aspects of disordered eating necessitate three foundational components of recovery:

• Food and body: “Legalizing” all foods. Letting go of adherence to an externally-prescribed way of eating that is based on the belief that one will eat like a maniac without rules, whether the belief is that the reason for this is that one is a fat pig, or that one is an addict and can’t control oneself. Taking the focus away from weight and body, and learning to eat and exercise for the purpose of self-nourishment, not weight control. Re-connecting with hunger and satiety signals, and learning to trust one’s body as the guide to what, when and how much to eat. Using one’s mind to put information about nutrition and exercise to good use. Understanding that disordered eating thoughts and behaviors an attempt at self-care, yet emotionally as well as physically harmful. Practicing non-judgment of food-related behaviors.

• Psychological and emotional: Becoming emotionally literate, identifying the feelings that one is misusing food to aviod or numb. Doing inner work to identify and heal wounds that caused disordered-eater parts of self to develop, and making peace with those parts. Learning and implementing healthy coping skills to use instead of misusing food. Developing a set of tools to use for emotional self-care. Practicing non-judgment of one’s self. Cultivating radical acceptance. This involves psychotherapy and self-help resources.

• Attitude and action: Committing not to misuse food. The urge to misuse food won’t just disappear because one is doing #s 1 and 2. The willingness to feel uncomfortable and not misuse food when every nerve ending is screaming to do so is essential. This is too much to do by one’s self, so support is crucial. Learning to reach out to others for help when wanting to engage in disordered eating behaviors, as well as when engulfed in disordered thinking (e.g., preoccupation with weight/body, self-judgment) is crucial. Ultimately, #2 can’t be fully practiced while one is still abusing food, but #2 must be begun while one is still misusing food.

The process of recovery from disordered eating is complex and involves a team of treatment professionals (often a primary care physician, a dietician, a psychiatrist and a group therapist in addition to an individual psychotherapist), as well as good self-help resources (books, workbooks, recovery web sites, support from others in recovery via support groups, 12-Step programs, online list serves and chats. In future articles, I’ll be discussing each of these components.

©Copyright 2009 by Deborah Klinger, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Deborah and/or see her GoodTherapy.org Profile

The topic of mental health among returning veterans of the Iraq and Afghanistan wars has been hotly contested of late, especially in the wake of reports of growing suicide and post-traumatic stress disorder or PTSD rates in military personnel. Adding weight to the argument for more extensive, accessible, and meaningful mental health measures, the recent attack at the Ft. Hood army base has re-sparked discussions about a lack of thorough screening and understanding within the military community. After attending the memorial service for victims of the Ft. Hood shootings on Tuesday,the head of the Department of Veterans Affairs, four-star general Eric Shinseki, appeared on “The Early Show” Wednesday to talk about the incident and the Department’s plans for mental health going forward.

Though mental health advocates and medical professionals, as well as caregivers and family members of returning veterans may have been anticipating a clear description of plans for future improvements, Shinseki’s statements were relatively general. The VA Director noted that over nineteen thousand mental health professionals were employed in the service of the Department, and that work was being “diligently” carried out in order to provide an increased level of care to service members in need. Expressing grave concern and regret over the Ft. Hood incident, Shinseki was reported to convey deep concern over the role of mental health in overall personnel well-being, but beyond the implementation of a post-September 11th G.I. bill, there was little to indicate any specific plans for the future.

In the coming weeks and months, the inadequacy of military mental health services for both active-duty personnel and veterans alike may help the VA and other offices find greater motivation for taking definite, effective measures to better serve their staff.

Schizophrenia is a mental health concern that impacts the lives of people in various walks of life, and which is also responsible for creating turmoil within families. Though many advances have been made in the treatment of schizophrenia, the issue is greatly in need of more research and development, and society as a whole could stand to learn much more about this debilitating yet manageable difficulty. To meet these ends, the Annual Pittsburgh Schizophrenia Conference will be held on the thirteenth of November this year. The conference will showcase the latest academic and clinical work in this critical mental health field, and will be attended by professionals and clients alike.

An often overlooked age group, the 85 and up set face many challenges that are typically reserved for old age. Memory issues, difficulty finding energy, and the rapid or prolonged loss of friends and loved ones can all contribute to symptoms of depression, which is experienced at a high rate among those in this age group. Efforts to develop targeted therapy programs and other forms of treatment for such clients are on-going, with a recent development having been made through research at the University of Michigan and Kyungpook National University. The research found that involving the very old in family affairs and keeping them informed of events can greatly help to ward off symptoms of depression. A simple strategy, including the elderly in decisions and discussions may go a long way towards relieving some of the psychological burden often carried during old age.