Article #7
Happy Holidays
Many people experience emotional turmoil at some point during the winter holidays. The reasons vary, but there are common themes. It really isn't that you are too busy. Of course you are too busy. Everyone is too busy. I expect the only reason you are reading this article is you are stuck in a waiting room, waiting, and reading this is better than worrying about everything else you have to do. You really are too busy. However, you are always too busy, not just during the holidays. So what is it about this time of year that sets us up for emotional turmoil?
Let me suggest that our emotionality at this time of year has a lot to do with our expectations of this season. We remember past holidays, and those memories whether positive or negative create an expectation for the current holiday. We work to create the perfect holiday, or to avoid the recreation of a negative holiday. We recall family and friends who were with us in the past and are no longer available, we yearn for the emotional warmth that we "should" feel, the religious connection, the special moment.
Our emotionality also has to do with the expectations that others have of us; children who have lists for Santa that are longer than the parent's bankroll; in-laws or grown children who have an agenda for our time; friends and family for whom gifts seem obligatory; neighbors who decorate their property and assume we should do likewise. And tell us again why you aren't having that dinner party for 20 on December 21st?
Many of these expectations are created by the media, and they are at best a one sided view of life in a different time and place; at worst, they are a construction of pure fantasy that no one could or should try to live up to. Beware of sentimentality; you are likely to feel very emotional, without feeling emotionally fed. We have generally come to terms with the fact that Leave It to Beaver was not an accurate depiction of life in the 1950s; neither is the media's construction of a happy holiday.
How does a person stay grounded during the holiday season, and avoid feeling the "holiday blues"? First, when did these "blues" begin? If you started feeling depressed in October or early November, perhaps you are suffering from Seasonal Affective Disorder (SAD); consult your health care professional. If your current emotional upset began with the holiday ads on television or at the mall, try to understand what about it has caused the upset. Spend some time feeling your feelings, trying to figure out what they are about, and whether you might benefit from talking to someone about them. Perhaps you are still grieving the death of a loved one with whom you shared past holidays; try to find a way to celebrate that person's life through the celebrations you engage in. Perhaps you are grieving for your own lost innocence and belief in "happily ever after"; try to create new traditions that will help you look forward rather than backward, making new memories. Perhaps your upset has to do with a crisis in your own faith. The winter holidays are both secular and religious, and it is important to decide what you are celebrating. Those who are members of minority religions who find Christmas difficult should make an effort to become more connected with their own faith traditions and those who share it.
As you plan your holiday and involve yourself in holiday activities, be realistic. You are already too busy, and now the season comes piling on. Add the word "no" to your vocabulary, and use it liberally, to food, commitments, and spending. Are you celebrating because you "should"? What are you celebrating and why? Lower your expectations of the season and of yourself. Simplify your plans. Remember the little kids who spent more time playing with the packing box than with the objects that came in it? Sometimes basics really are better.
Article #6
Seasonal Affective Disorder
Autumn in Southern Maryland may be our most appealing season. Finally the days are clear and sunny; the nights are cool and crisp. The Canada geese are back, the leaves are turning, the children have settled back into school routines, and it feels good to be outside again. So why are you finding you can’t get up in the morning, feel tired all day, and feel depressed and overwhelmed by simple problems? ... Seasonal Affective Disorder.
Seasonal Affective Disorder (SAD) often gets lumped into "holiday blues" -- a real enough problem in its own right -- but is actually a kind of depression directly related to light. From the moment of the summer solstice, our days have been getting progressively shorter; at first it was only a minute or two per day, barely noticeable in July and August. However, by the beginning of October, the time difference relative to late June is distinct; we have “lost” a couple hours a day of daylight, and will lose a couple more before the winter solstice reverses the process. These beautiful fall days and the longer evenings that follow may provide images of cozy evenings in front of the fireplace. The reality for many people, however, is an increase in depression or other mood changes because of inadequate daylight.
There is some debate about how this process actually works, but in general, it seems that SAD is caused by insufficient light stimulation to the brain. It affects many people, and those of us living in more northern latitudes are affected at greater rates than those living close to the equator. People who have depression year round may find it worsens in the fall and gets better in the spring; some people who take antidepressant medication find they need to increase their dosage during the winter months to counteract the effect of the seasonal change. People who are never depressed at other times may find they have a very difficult time during the darker months; complaints of fatigue, being unable to wake up, being unproductive at home or at work, being short tempered, having no interest in activities, and feeling that life isn’t enjoyable are common.
Treatments for SAD vary by individual need and history. A person who has thoughts of hurting himself should seek treatment immediately. Anyone already in treatment who notices a seasonal pattern should make a point to discuss this with their treating professional. Individuals with severe SAD may need exposure to a special light that mimics sunlight every day. These lights are now commercially available and affordable. Increased exposure to florescent lighting is generally helpful, though not ideal. Having a light in the bedroom on a timer that comes on twenty to thirty minutes before the alarm goes off may help with waking, as will keeping the same sleep/wake schedule on the weekend as during the weekday. Finally, everyone should make an effort to get outside whenever possible and enjoy the fresh air and sunshine. The bonus is a nice dose of vitamin D!
Article #5
Panic Disorder
Everyone has experienced a sudden flush of anxiety that leaves the heart pounding, palms sweating, and stomach lurching. Whether from a narrowly averted collision, an unexpected flash of police lights behind you, or an unexpected encounter with a menacing dog, the resulting rush of adrenalin is a reminder of one of our basic survival mechanisms. The “fight or flight response” is the brain’s preparation of the body to deal with danger by either using force (fight) or escaping (flight).
Some degree of anxiety can be helpful in performance situations. This mild anxiety can keep an individual focused, alert, motivated to prepare thoroughly, and in high performance mode. However, when anxiety is too high, it interferes with performance rather than enhancing it. It has stopped being functional and may require treatment.
There are several different anxiety disorders, many of which have been well described in the popular media in the past several years. Although the details vary, each has the common characteristics of emotional feelings of worry, dread, or fear, and physical symptoms including racing heart, breathlessness, sweating, nausea, or dizziness. Generally, a person with anxiety is very uncomfortable both physically and emotionally, and requires a great deal of support from family, friends, and professionals. Panic disorder can become very disabling. It is as though the “fight or flight” response has gone into “stuck” mode, as there is often no cause of the sudden panic. It is not uncommon for panic disorder to occur with agoraphobia (literally, fear of the market place), which is defined as an anxiety about being in places or situations from which escape is either difficult or embarrassing. Panic disorder with agoraphobia results in the individual limiting activities. For example, she might say to herself, “I can’t go to the store because I might have a panic attack while in the check out line, and people might be behind me, and I wouldn’t be able to get out, and everyone will stare at me and think I’m crazy, and I’ll fall apart”. This same argument prevents trips to the hairdresser, the bank, the movies, and most other public places. Some people with agoraphobia are unable to leave their homes at all; others can leave only with a “safe” person to accompany them. These are extreme examples of panic disorder with agoraphobia, but they illustrate how painful and disabling the disorder can be.
Treatment for panic disorder generally consists of cognitive behavioral therapy and medication. The medication prescribed will be determined after a careful assessment, including history, duration and intensity of the panic, and whether or not depression is also a part of the presentation. Talk therapy will help the individual develop a better understanding of the nature of anxiety, and develop coping strategies to manage stress more effectively. The client and therapist will develop behavioral goals, and then systematically implement a plan to achieve them. Learning to use relaxation techniques when in anxiety provoking situations proceeds in a step-by-step format until the individual is able to perform activities with less anxiety. For the individual who is experiencing symptoms of anxiety, it is important to remember that there is help available.
Article #4
ADHD in Children .... And Adults!
ADHD, which stands for Attention Deficit/Hyperactivity Disorder, is a commonly diagnosed problem for school aged children. In addition, we are frequently seeing the disorder diagnosed in adults. This article will briefly review the symptoms of ADHD, and discuss the common treatment options.
First, there are three basic subsets of ADHD, the “inattentive type”, the “hyperactive type”, and the “combined type”. As the names suggest, the inattentive type is characterized by problems attending, sustaining attention, organizing, and following through with tasks. The hyperactive type is characterized by fidgeting, moving about inappropriately, and always being “on the go”. The combined type is characterized by behaviors of both inattention and hyperactivity.
It is important to know that a child does not “develop” ADHD after years of being able to attend and sit still; in fact, the symptoms must be present before the age of 7, and are usually demonstrated by the toddler years. If a child has done well in school and suddenly (or gradually) shows symptoms that suggest ADHD, a more careful diagnosis is warranted. A very intelligent child with the inattentive type of ADHD may have done well in the lower grades in spite of the ADHD; then, when the school expectations become more challenging, the child has a greater difficulty coping so demonstrates problems. On the other hand, symptoms of other disorders can look like ADHD in children. For example, an anxious child may be inattentive and daydreaming; and a depressed child may be irritable and having outbursts. For this reason, school failure, inattention, and acting out should be evaluated by a mental health professional to find out what is the cause of the behavior so appropriate treatment can be given.
With more and more children diagnosed with ADHD, their parents began to think back to their own school difficulties and wonder if they, too, may have had ADHD. The mental health community is now recognizing that adults as well as children have problems with maintaining attention and concentration, and keeping behavior focused appropriately. Like children, symptoms of ADHD overlap with the symptoms of other disorders, so it is important to be evaluated by a mental health professional. Also like children, an adult doesn’t suddenly develop it; it has been there all along. However, some situations or work tasks put more strain on an individual’s coping resources, pushing symptoms into greater awareness.
Treatments for ADHD include medication and psychotherapy. There are several medications that are used, nearly all of them in a class of drugs known as stimulant medications. Some parents wonder why someone would prescribe a stimulant to a hyperactive kid. The reason is that the ADHD individual is struggling because the area of the brain that is supposed to screen out distractions is underperforming; the stimulant medication stimulates that area of the brain so it starts doing its screening job. Hence, the person isn’t constantly “pulled” by extraneous stuff. Therapy is useful for the families of young children to help them manage behaviors in consistent and age appropriate ways. Older children and adults benefit from therapy to help with organizational skills, general coping strategies, and issues of self-esteem. Often older children and adults have secondary problems which may be related to difficulties created by the ADHD. For example, it is not unusual for an individual with ADHD to have difficulties with social relationships. The sooner intervention is started, the sooner such secondary problems can be nipped in the bud.
Although ADHD can be a frustrating problem, treatment works. Find a mental health professional so you can get the proper diagnosis and treatment.
Article #3
What to Expect in Psychotherapy
If you are new to psychotherapy, you may wonder what to expect. What are the rules? How do treatment decisions get made? What are your obligations to the treatment process? This article will discuss some of these topics, so you can get the most benefit from therapy in the least amount of time.
First, let us assume you have chosen a therapist you are comfortable with, and that you feel safe and respected. In the first session, you and your therapist should have reviewed confidentiality and boundaries. You should have been informed that your therapist will only disclose information you have shared if you give specific permission to do so, unless there are certain emergencies or mandated reports which the therapist should describe in advance. For example, if you report child abuse, your therapist is mandated by law to report the abuse to the authorities. Likewise, if you reveal that you are currently a danger to yourself or others, your therapist has to take steps to protect you from the harm.
Your therapist should also have talked with you about the length of therapy sessions (usually 50 minutes), the price and insurance billing criteria, and the cost of missed appointments. These are conversations that should occur in the first meeting, but if they did not, or if you have forgotten, you should bring up the topic in your next session and clarify them with your therapist.
Early in treatment, your therapist will formulate a diagnosis for you. The diagnosis has several functions. The most practical function is to allow you or your therapist to bill your insurance company for your treatment; insurance companies pay for illness, and illness has to be named, hence, the diagnosis. Another function of the diagnosis is to allow professionals to talk with one another and with clients using a common language. “Major Depressive Disorder” or “Panic Disorder” are both labels for a constellation of symptoms which must be present for the diagnosis to be given. Although there are symptoms that are shared by several different diagnoses, the constellation of symptoms is required for the unique diagnostic label. A third function of the diagnosis can be to give focus to the treatment by providing a basis for goals and objectives to be achieved in the therapy.
Goals for therapy should be set by you and your therapist together. If you don’t know what your goals should be, ask yourself how you will know when you are ready to stop therapy. Will you have more self-confidence? Have a more positive mood? Be back to your “old self”? Have a better relationship? Be out of a bad relationship? Generally, the symptoms that brought you to therapy are the things you want to have resolved by the end of therapy, and you and your therapist should have a realistic plan for how to reach that goal. Goals should be set early in therapy and reviewed periodically to evaluate progress and determine whether or not to revise either the goals or the therapy.
It is important that you stay open to change, and be willing to try out new behaviors, attitudes, and ways of thinking about your problems. By talking with you, your therapist will be able to suggest different strategies you might try when confronted with problems, and by airing your problems, you might have new insights that will lead to fresh perspectives and new ideas for approaching situations. Over time, you should find you are developing new ways to deal with old problems, and that difficulties don’t bog you down as they did previously. With the support of a therapist, you may feel more confident in making changes that will allow you to meet your goals.
Article #2
How to choose a therapist, part 2
You have decided that it is time to find a mental health therapist; you are having feelings that trouble you, and people around you are saying that you “should see someone to talk to”. Last month I outlined the different kinds of mental health professionals in practice. With this array of potential therapists, how do you begin to choose the therapist for you? This article will address some of the considerations that should go into the selection process.
Some people want a therapist whose office is near their home or workplace; others prefer to have a referral from another trusted professional, or will talk to a friend or relative who has had experience seeking therapy. Many people “let their fingers do the walking” and choose a name out of the phone book. However you find a person, it is important that you have a first session with that therapist before you make a final decision to enter treatment.
When you call to make an appointment, you should find out how much the session will cost, and how payment is expected. More and more mental health professionals request the full fee from the patient, and provide the needed information for the patient to submit to their insurance company. The reasons for this include overhead cost in the billing process, lengthy reimbursement time, and the fact that insurance companies are more willing to pay their client (you) in a timely manner than the treating professional. You should also find out the policy and potential cost of cancellation on short notice.
In the introductory session, there are several things to keep in mind as you evaluate your ability to be successful with this therapist. First, research informs us that a critical factor in the success of a psychotherapy treatment is the quality of the relationship between the therapist and the client. After all, your therapist is a person with whom you will be sharing your deepest feelings; you must feel comfortable in the relationship, including having a sense of being respected, feeling safe, and being understood. Next, what is your therapist’s professional training and background? It is acceptable and desirable for you to ask where and when the therapist was trained, what licenses are held, and if there is a specialization. Third, therapy should have a focus. After the initial interview, the therapist should be able to discuss with you a potential course of treatment, goals you may want to work on, and suggestions for achieving those goals. Do you feel that this therapist “got it”? Do these goals and suggestions accurately reflect where you want to go in your life? Do you feel comfortable asking questions, disagreeing with opinions, or making alternative suggestions?
In the ideal world, you might want to interview two or three therapists before making a final decision. However, since you will be paying for each of these meetings, cost may dictate a more pragmatic approach. Make your initial appointment with the professional whose training seems to reflect your needs as you currently understand them. If at the end of the initial session, you are comfortable that all your questions are asked, you feel you are contracting with a knowledgeable, safe, and trust worthy professional, and you approve of the direction for treatment that was outlined for you, then you have very likely found a therapist that will be right for you.
Article #1
How to Choose a Therapist, part 1
Have you ever wondered if you could benefit from mental health therapy? Maybe you have been sad or “down” more than usual, and have been unable to enjoy your life as you used to. Perhaps you have been worried more than usual, even when there have been no events that would make you anxious. Are you snapping at your spouse or children, or arguing with coworkers? Are you having trouble sleeping? Perhaps you were in a car accident and can’t stop having nightmares about it. Perhaps you are going through a divorce, or have lost a loved one, or have developed a serious medical condition. Whatever the problem, when you feel that your life has changed for the worse, when you are miserable with or without a reason, or when others in your life suggest you need help, the time has come to find a mental health therapist.
Finding the right therapist for you is a serious undertaking. This article will attempt to present an overview of the different kinds of mental health professionals, and the differences in their training. Future articles will elaborate on the selection process.
Psychiatrist: A psychiatrist is a medical doctor (MD) who has specialized training in the disorders of the mind. A psychiatrist can provide psychological therapy, and is the only mental health professional who can also prescribe medication.
Psychologist: A psychologist is not a medical doctor, but is a doctor of philosophy (Ph.D.) or a doctor of psychology (Psy.D). The training is advanced graduate training in thinking, learning, and disorders of the mind, usually lasting 5 years or more, followed by a minimum of two years of supervised experience. Licensed psychologists can provide psychological therapy, and can also conduct psychological testing to assess for learning problems or disability.
Professional Counselor/Clinical Social Worker: These mental health professionals have at a minimum a master’s degree in counseling or social work with a mental health focus. Their advanced training is usually about two years in length with an additional two years of supervised work experience. Licensed Clinical Professional Counselors (LCPC) and Licensed Certified Social Workers – Clinical (LCSW-C) are licensed to provide mental health counseling.
Marriage and Family therapists and pastoral counselors are also specialties that are licensed in their own way, and are available to provide marriage counseling, or counseling with a spiritual emphasis.
Navigating the mental health system can be an intimidating experience for many people. Vance Mental Health Services is trying to reduce the confusion for those new to therapy by providing a range of services, including both psychology and psychiatry, in one location. My next article will talk about how to interview your prospective therapist and important considerations in your selection.
If you have any questions or comments, just E-mail me!
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