help4yourfamily

Create the family you want to have

Stopping the Parent Shame and Blame Game

Parenting

Parenting (Photo credit: Leonid Mamchenkov)

 

When parents come to me for help with their children, my job is not so much to change every single thing about the way they are parenting. My job is to help mom and/or dad to create the outcome they are looking for. Many parents come in to me worried that I will shake my finger at them while scolding them about all the things they are doing it wrong. The fear that this could happen is one that keeps people away longer, until the problem gets “bad enough” that they have to come in.

I wish I could wave a magic wand to make this fear go away. If parents brought kids in when the issues first started, they would save so much time and money. Instead, we end up weeding through the guilt and shame of whatever the perpetuated cycle has been for parent and child. Most often what I end up doing with parents goes more like this:

  • What are you doing right?
  • How can we increase the times when you feel as though you are handling issues in a way you feel good about?
  • How can we find ways to increase your effectiveness when you feel you are not meeting your own expectations?

A while back I heard someone (I wish I could remember who) saying that so often we focus on what we want to do, as in,

  • What am I going to do about this?
  • If you do this, I’m going to do that.

The speaker went on to point out that we are asking the wrong question. The real question is “Who do I want to be?” Answering this question, “Who do I want to be?” makes the question of what you want to do clear. If who you want to be is a loving parent, then what you want to do will incorporate love for your child (which can also include boundaries and discipline- just so we are clear). If who you want to be is a guide for your child then what you would do would incorporate modeling for your child the appropriate response to a particular situation. It guides us away from whether we are right or wrong to do what we do and into a new discussion about whether we are acting in a way that aligns with our values. When the answer is that we are not acting in such a way, and we cannot come up with a way to act that feels more in line with our value system as parents, it is time to seek help. Think about finding a therapist, parent coach, pastor, rabbi, parent support group or someone that you trust to take the courage to ask the questions about how to become more aligned with who you want to be.

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April 11, 2013 Posted by | affirmations, attachment, counseling, discipline, family, help for parents, kids, mental health, parent support/ self improvement, Parenting, psychology, thinking about therapy? | Leave a comment

Should I Stay or Should I Go?

English: Couple on the street with child, Cent...

English: Couple on the street with child, Centro Habana, Havana, Cuba. December 2006. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

I’m going to take a little trip away from talking about parent/child relationships to talking about the relationship between the parents.  Just like parenthood, it is impossible for anyone to predict before entering into a relationship just what will happen next.  No matter what the reason you had for building your family by birthing, fostering, or adopting children, it will, without question, change your relationship with your child’s other parent and may, at times, leave you scratching your head about whether to stay or go in this relationship.

I have personally found, and I believe it is also true for my clients, that during each stage of my own children’s development I re-live parts of my own childhood.  It starts in infancy.  It was when my children were infants that I looked at my daughters while rocking them and wondered, “Did my parents look at me this way?  Did they feel this awe?  This fierce protective feeling?  Did they love me this much?”  For me, for those questions, the answer was a yes, I don’t remember myself as an infant, but I know it in my soul.  I have other, unanswered questions about other stages…the vast majority of us do.  Our most intense questions seem to be the ones we have not resolved.  People with a history of trauma tend to ask whether their child feels protected.  We may compare the expectations of our parents for us to our expectations for our own children.  When we pause to think about it, the questions can bubble up seemingly out of nowhere.  All parents- even child therapists- wade through these swampy waters.

I can not think of a situation that raises intense questions more for any parent than when the relationship between parents is going through a major transition.  The start of parenthood is a major transition.  No longer do you have the option of pretending that you are not connected to each other for life.  The time for walking away from each other and having the ability to completely cut ties if things go wrong is past.  Even if someone seems to have walked away, rest assured, they may be gone, but they are not forgotten by anyone, nor have they forgotten.  Similarly, your decision about leaving a relationship also becomes infinitely more complex as you are no longer considering only how this change would impact you but, I assume if you are reading this post, you are also someone who would consider whether that change would impact your children as well.  I wish I had easy answers.  I don’t, but I have, throughout the years, come across some helpful questions and observations that I use when I have a client, or client’s parents trying to work through these issues.  With that in mind, here are a few thoughts to help you in your journey.

1.  This first question, I’m going to paraphrase from memory and it comes from author and coach, Cheryl Richardson (her most recent book is “You Can Create an Exceptional Life*” and her radio show is call “Coach on Call” on Hay House Radio).  It goes something like this: “If you decided to believe that from this moment on that your partner was never going to change a single thing about themselves, would you want to stay with them?”  Let me be more specific: if they never gained or lost a single pound, if they never took you out more, nagged less, spent more or less time with the children, at work or with friends, etc. would you still want to stay with them?  This is important because despite our longing to change people, we really can’t.  There is no magical combination of words that will create change for a person unless they are ready to change.  Take a moment to consider the possibility that your partner will never change, then think about if you still want to stay.

2.  If you decide that you would not want to stay with this person unless they make changes, what is it that you absolutely require from your partner in order to stay?  In other words, what are the nonnegotiables in order for you to want to be in a relationship?  A little warning for this step is that this is a question that tends to bring out our inner critic.  The inner critic tells us we should have known from the beginning that we needed that and that it is too late to ask for it now.  After all, you decided to have children with this person so, as the saying goes, “you made your bed and now you have to lie in it,” and so on and so on.  The critic can be relentless. Let me strongly encourage you to take a moment to tell your inner critic that you are not making the decision based on this question alone, only that this is a part of knowing what to do next.  That being said, what is your bottom line on staying in this relationship?  Requiring the absence of abuse, emotional manipulation, and dishonesty can seem like no-brainers to some of us, but, if those are things we grew up with, we can easily come to expect that they are part of life and are to be expected.  Let me assure you, they are not a part of every relationship and if it is your belief that they are, please contact a therapist to begin to work on loving yourself more.  I have met too many people who have said to me that they are staying with the person they are with because they don’t cheat and don’t hit.  I’m going to encourage you to go beyond this.  If you can’t think of the relationship you would want for yourself, think of the relationship you hope your children will have with a romantic partner one day.

3.  This next one is a helpful “re-frame.”  I got it from listening to Robert Holden (author of Shift Happens* and host of a radio show with the same title on Hay House Radio).  He makes an important point that even if you decide to “end” what you think of as your relationship with your child’s other parent, you are really only ending one part of your relationship.  In reality, what you are thinking of as an ending is actually a transition from one kind of relationship to another- from romantic, to co-parenting.  If you are anticipating this change, please remember that people can act differently in different situations.  I have seen parents where, if I’m being honest, I understand why the relationship ended with their partner, however, that same person can be a “good enough” parent.  Sure, they may not do things the way you do them.  But, just take a moment to think of every way you have ever seen someone fold clothes.  Does everyone fold them the same way?  Of course not!  Even if the clothes are folded differently are they still folded?  Yes.  Sure, you may have a preference for how things are done, but your life will be easier if you stay open to the possibility (as long as the other parent is not abusive) that your child’s other parent may have an alternative and acceptable way of parenting as well.  Having this attitude can improve your relationship whether or not it stays romantic or transitions to co-parenting.

4.  This might be the most important of my tips.  For the sake of your relationships with your child’s other parent, your child, and yourself, take really, really good care of yourself.  The only thing we can control is how we react to different situations.  We cannot change people with ultimatums, threats, and resentment.  What we can do is to really take care of ourselves.  Have you been telling yourself that as soon as your partner’s issues are taken care of you will____ (fill in the blank, lose weight, stop smoking, meditate)?  Guess what?  When you do that you are holding your partner up to a higher standard than you are holding yourself up to.  Take time to be the kind of person you want to be with.  Follow your interests, be loving, take care of your chores around the house, laugh often.  When we do these things there are a few possibilities.  One possibility is that you will find that you are happier and see how you may have been contributing to the unhappiness in the relationship.  Another is that you will find that you are strong enough to leave the relationship if it becomes apparent that it is not healthy for you.  Still another is that your partner may take notice of your positive changes and begin to make some as well by your example.  I know your children will do just that also.

Perhaps the overall question of staying or going is the wrong one after all.  More importantly, we want to ask, “Who do I want to be in this relationship?”  If we can ask and answer that question, then work to get to be that person, then we can find happiness either in or outside of any relationship.  It is when we stop looking to outside relationships to fix something inside that we find ourselves and when you find yourself to be a person you will always like, that you will always want to be with and around, that you will also find you are able to have relationships with others that meet your expectations as well.  I strongly encourage anyone considering separation or divorce from their child’s other parent to seek therapists knowledgable in helping parents to create a healthy co-parenting relationship.

*You can find the links to purchase any books mentioned in this post by clicking the Amazon widgets button at the top, right hand corner of this page.  See disclaimer page.

May 30, 2012 Posted by | parent support/ self improvement, Parenting, thinking about therapy? | , , , , , , , | Leave a comment

Who’s Who in the World of Mental Health

Mental Health Awareness Ribbon

Mental Health Awareness Ribbon (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

In the field of mental health, you will come across many titles for professionals.  It can be confusing to understand what the differences are.  Here is a quick primer to walk you through the different types of helping professionals in the mental health field.

Social Workers- We typically have a Master’s Degree followed by a few years of supervision with a mandatory test to obtain a license.  Each state has different standards for Social Workers and it is a good idea to check what a license means in your state.  In my state, Maryland, in order to have my clinical license I needed to complete my Master’s in Social Work, then have a minimum of two years and 1500 hours of supervised work time.  After that I needed to pass my licensure exam.  In my state there are also Social Workers that have other certifications that mean they do not have as much training or experience, and or that they declined to take or did not pass the licensing exam meaning they still must be supervised by someone trained to supervise Social Workers. The lens Clinical social workers use when working with clients is typically to look at a person in the context of their environment to see what environmental stressors a client has and to work with a client to see how we can help them better manage within the system they live in.  Social Workers do not prescribe medication

Psychologists have a doctoral degree.  They also are required to take an exam following their degree and need to be supervised during and after school for a period of time before practicing without being supervised.  Psychologists tend to look at patients (Social Workers call them clients, psychologists call them patients) through more of a medical model i.e.- in what ways is this person not functioning?  What are the symptoms…let’s treat the symptoms.  Psychologists do not prescribe medication.

Professional Counselors have varying ways to describe themselves, Licensed Family Counselors, or Licensed Marriage and Family Counselors.  Like Social Workers, Professional Counselors have Master’s Degrees with supervision and testing following their Graduate Degrees, however their Master’s is in Counseling rather than Social Work and they are more likely to be trained in methods akin to a Psychologist, and/or have specific training for their license such as specialization in Marriage and Family work rather than working with individuals.  They do not prescribe medication.

Pastoral Counselors have a Master’s or Doctoral degree in Pastoral Counseling.  They come to counseling with a spiritual perspective often related to a specific religion and will bring in religious and mental health elements into their work with a client.  They do not prescribe medication.

Psychiatrists are trained medical doctors.  Psychiatrists have been through a full medical training with all the tests involved with becoming a doctor but, just as a Pediatrician specializes in working with children, Psychiatrists specialized in mental health.  They most definitely tend to see patients through the medical model and do prescribe medication.  Psychiatrists often meet with patients for about 30 minutes and do medication monitoring.  I would highly recommend that anyone seeing a Psychiatrist also see a Psychologist or Social Worker as it is unlikely you will be getting any talk therapy with a Psychiatrist.

Mental health providers may be found in many different places, schools, hospitals, and in private practice.  They may provide individual, group, couples or family therapy, or a combienation of all of those.  No one group of practitioners has been found to be more successful in treatment than any other group.  However, there is one factor that increases the effectiveness of treatment across mental health provider types.  It will probably come as no big surprise that regardless of training background or methodology, the strength of the relationship between a client/patient and the provider  is the number one predictor for success in treatment.  So, if you see someone a few times, and the chemistry is just not there, it is probably time to switch to another provider.

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May 25, 2012 Posted by | thinking about therapy? | , , , , , , , | 5 Comments

getting insurance to finance specialized therapy

No matter how you feel about the whole health insurance debate in the United States, I think most of us can agree that dealing with insurance companies can be confusing and frustrating.  It can almost seem like the insurance companies have their own special language and code words.  If you have a child in need of specialized therapy, or you are in need of therapy yourself, going through your insurance can seem really daunting and to add to the difficulty,  many specialists no longer deal with insurance.  My hope is that this post will help you navigate the way US insurance companies work so that you can get services paid for (even if they are out-of-network).

Do not let your insurance’s first response, where they say they are not funding an out of network provider, or they say they will but will only pay 20%, throw you off.  You still have options, they just aren’t going to tell you what they are.  Let’s start with a quick primer on insurance “lingo” you need to know:

in-network providers– are providers covered by your insurance company.  If you are going to an in-network provider your insurance company has an agreement with your provider so that they are likely to pay most of the bill except for your regular co-pay.

out-of-network providers– are providers your insurance company does not have an agreement with.  If you are calling your insurance company and they say the provider you are calling about is out-of-network, you will want to ask if you have out-of-network benefits on your plan.  If they say no- do not panic- you have options!

usual customary rate (UCR)- is the rate your insurance customarily agrees to pay for a given service.  When your insurance says they will pay 70% of the UCR that means they will pay 70% of what they normally agree to for that service- which is often different from what the specialist charges.  If your insurance says they cover a percentage of the UCR, ask them what the UCR is for the service you are getting.  If they say $80 and they cover 70% of the UCR, that means they will reimburse you or the therapist $56 and you would be responsible for the remainder of the UCR if you are seeing an in-network provider, or the remainder of the provider’s fee for out of network providers.

Now that you know these terms. give your insurance a call and see what they have to say about the provider you want to see.  Remember to also ask if you have a deductible and how much of your deductible has been covered.  Other insurances have a rate that changes, for example, they pay 20% for sessions 1-5, 40% for session 6-30 and 70% for sessions 31 and above.  Don’t worry, I’ll summarize at the end so you can get all the questions together.

So, what do you do if your insurance company tells you your chosen specialist is not covered? 

Gather the information that makes your provider special.  Do they have special skills and training to help your child that other providers do not have?  My clients that call would tell their insurance I have specialized training in trauma, attachment and adoption- if they are bringing their children for one or all of those reasons- pick only the issues that pertain to you and your child.  Ask your insurance if they have anyone in-network that provides that same level of expertise.  Your insurance is required to find someone with comparable skills within a reasonable distance of your home who has the specialized skills you require.  If they do not, they are required to offer to pay their UCR to your specialist.  If you have a willing specialist, with just a short conversation with your insurance, they can negotiate a rate for services.  I have done this several times now.

To summarize, the questions for your insurance are:

1.  Is (name of the provider) in-network for my plan?

2.  Do I need authorization?- asking the question starts the process if you need it.

3.  If my provider is out-of-network, do you have an in-network provider with the same skills and availability within reasonable distance from my house?

4.  If you do not have anyone in-network, could you offer the provider a single case agreement?

5.  What is my deductible?

6.  What is the reimbursement for this service?

7.  If they mention UCR, what is the UCR?

Remember, if they say they have an in-network provider with the same skills as your specialist, make sure to follow up and call that specialist to make sure they are taking clients because if they are not, you can call the insurance back to report and they need to find someone else or offer a single case agreement.

In case you understand better with a flow chart, I have included one of those below as well.  If you have further questions or would like clarification, please ask in a comment.  This stuff is confusing and someone else probably has the same question!

insurance questions flow chart

April 27, 2012 Posted by | health insurance, thinking about therapy? | , , , , , , , , | 1 Comment

Finding a therapist for a traumatized and/or attachment disordered child

Some elementary school counselors use books an...

Some elementary school counselors use books and other media to help their counseling (Photo credit: Wikipedia)

As therapist who specializes in both trauma and attachment disorders, I can tell you it is important if you are searching for a therapist for one or both of these issues, that you find the right therapist for your child.  Doing so will save you a lot of money and aggravation and is more likely to speed the healing time for your child.  To start, look at my post on  finding the right therapist for you or your child (you can find the link at the bottom of this post).  With these particular children, and probably people with other specialized issues as well, there are further steps you would want to take to ensure that you have the right person.  I see the steps for this particular issue as follows:

1.  Figure out if your child has “only” trauma, or has trauma with attachment related issues.  Here is the distinction, a child with trauma without attachment disturbance usually experienced a one time occurence, or something that happened over a relatively short period of time and was quickly identified.  Trauma with attachment related issues is trauma that also impacts a child’s ability to bond with their caregivers in a healthy way, for example abuse or neglect by a primary caregiver or ongoing abuse or neglect that a child did not disclose.  If you feel as though your child’s trust in adults to provide care for them has been altered significantly, you will want to see someone with knowledge of attachment related issues.  To clarify this distinction, a teenager carrying on a short-term, secret relationship with a much older adult that they thought was younger or who was tricked into a situation where they kept a secret because they were breaking the rules when they were traumatized does not fall into this category of attachment disturbance.  It is within reason to anticipate that teenagers will try to stretch or break the rules and it does not signify a break in a child’s core ability to trust that their parents will care for them.  A teenager whose step sibling was abusing them for an extended period of time whenever their sibling came to stay at the home does fall under the category of possible attachment disturbance.  The difference is the primary caregivers were around at the time of the trauma and did not know to stop it, while in the first example, the teen was doing an activity it would be reasonable to assume is developmentally expected but someone took advantage of them inappropriately.  When in doubt, I would see someone who specializes in both trauma and attachment.   If you find that there is an attachment related issue for your child’s situation, I would always make sure to take the child to a therapist that understands attachment because in order to work on attachment disorders or disturbance, you must know about trauma since the two go hand in hand.

2.  Once you have determined whether you are looking for a therapist with trauma training or whether you need someone with an attachment and trauma focus, follow the steps from my first post on finding a therapist and ask these additional questions.

  • What is your training in attachment and trauma?
  • What recent trainings have you attended or conducted that relate to attachment and/or trauma?
  • How do you conduct your sessions?

The answers to these questions, if you are talking to the correct therapist, should indicate that the person stays actively engaged in seeking training for attachment and trauma related issues.  Additionally, an attachment specialist will indicate to you that you will be in the room for most, if not all, of the time that your child is in therapy with them.  Attachment oriented therapy is significantly different in that a therapist focuses much more on your relationship with your child rather than their relationship with your child.  In traditional therapy including therapy for singular trauma, you would take your child to see the therapist, you might check in with the therapist at the beginning or the end, then your child would see the therapist alone for the majority of the session.

While traditional therapy is effective with many children, for children with attachment disturbance, it can actually damage a child’s relationship with their parent.  I have seen this happen, since a child with attachment disturbance has a tendency to reject caregivers, and, while they are alone with a therapist they may talk to their therapist about how terrible and difficult their parents are.  The therapist and child will bond over this and the therapist shakes their head in disbelief, meanwhile they may be overlooking a parent who is really trying their hardest to meet the child’s needs while reinforcing for the child that the caregivers in their lives are, in fact, inadequate.  Remember, children with attachment disturbance see adults as unsafe on some level and tend to fit them into these categories.  A skilled attachment therapist will spot when a child is doing this and help them to retrain their system of trust by teaching them how to find trustworthy adults and by training the adults in their lives to be trustworthy in the way the child needs them to be.  To learn more about attachment disturbance you can see my post linked below “What is attachment disorder?”

**A note to providers- I understand that you have seen parents who are, in fact, inadequate.  For this post, I am assuming that a parent who cares enough to read this post is adequate because they are involved and caring enough to research this issue.

Stay tuned for my post on getting specialized treatment for your child- the things insurance companies won’t tell you that can help you get your child’s treatment paid for.

April 16, 2012 Posted by | attachment, attachment disorder, health insurance, help for parents, thinking about therapy? | , , , , , , | 8 Comments

Finding the right counselor/therapist for you and your family

So..you decided that you want to find a therapist for you or your child.  How in the world are you supposed to know how to do that?  What an intimidating thing to do, and, like any other doctor you see, who you pick can have a strong influence on your outcomes.  While your first instinct might be to go through your insurance to find a provider, this is actually not the path I would suggest for the majority of people (even if money is an issue).

My first suggestion is that you identify the reason you are seeking a therapist.  Is it for marital issues?  Are you looking for a social skills group for your child who has a diagnosis of ADHD?  Have you had a history of trauma and are you seeking to heal from it?  If you know anyone who has had similar experiences and you are close enough to them to ask, check with them if they have found a good mental health provider.  Even if you do not want to see their provider because that might feel weird, if their person is good, you can call them and ask for referrals. Similarly, do not be afraid to ask a mental health provider that you know personally about referrals as long as you trust their opinion.  While someone you know personally can not see you for ethical reasons, they may know of a referral for your specific issue.  If you do not have a resource like this, look up local groups in your area that specialize in the issue for which you are seeking treatment. They may have some providers they commonly refer to.   School counselors also typically have referral resources.  If you are attending a college or university, you may also be able to see a therapist on campus.

On a side note, if you are not clear on the specifics of who you are looking for, think of mental health professionals being like other health providers.  There are specialists and general practitioners.  If you are unsure, go to a general practitioner.  If you work for a large company, there may be an Employee Assistance Program (EAP) provider who will see you for a few sessions and steer you in the right direction (with the understanding that then your work has a record you saw someone), or there are many good, general mental health practitioners out there that you can find using your personal network.  If you find a good one and they identify that you need a specialist, they may refer you out for more specialized treatment.

Now that you have identified possibilities, it’s time to make some calls.  I would encourage you not to be put off by someone if you can not find them on-line, you may find that in my profession, there are not as many technologically savvy people out there so there are tons of wonderful professionals who may not have a website- or even email!  Call the professional directly.  Try to speak with them on the phone to get an idea of availability and whether they specialize in the area for which you are seeking help.  Ask about what insurance they take, if any.  Those lists you find on line from your insurance company can be hopelessly out of date so always ask.

Pay attention to how you feel when you are speaking to the provider on the phone.  Do you feel they listened to you?  Do they have availability to see you at times that work for you?  If you are uncertain, do not be afraid to say that.

Now is the time to check with your insurance.  If the provider you want is in-network for your insurance, great- skip this paragraph!  If not, call your insurance and see what your out-of-network benefits are.  For instructions on how to do this, you can look under the insurance button on my practice website: www.ahealingplaceincolumbia.com.  Do not give up if you do not have out-of-network benefits and your selected provider does not take your insurance.  Call your insurance, ask them to find someone in-network who works with the specialty you are looking for.  If they can not locate someone in-network with the specialty you need and who has openings to see you- they must offer you an option to reimburse the person of your choice.  There is a law that says insurance companies cannot deny you coverage simply because they do not have an in-network provider that provides that specialty.

If all else fails, ask your chosen provider if they are willing to give you a sliding scale for payment up front- you would be surprised how many providers are willing to negotiate.  Finding someone that you work well with and trust, while it may cost more up front, you will also probably get better quicker so you do the math- say you go to see someone 10 times for $75/ week sliding scale vs. seeing someone who takes your insurance with a $40 copay but since they don’t specialize, let’s estimate it takes twice as many sessions- 20 for you to feel better.  That’s a total of $750 for the first treatment and $800 for the second (plus the extra time in your life you spent in treatment).  When you look at it that way, it’s a no-brain-er.  And, don’t forget, if you have a health spending account through your work, mental health care is covered and reimburseable.

Next it’s time to go ahead and meet with the person you feel comfortable with on the phone and remember- you are a consumer!  As a consumer, you have the right to decide where and from whom you are going to get treatment.  If you go in and see someone and they just are not it- try someone else.  Not all therapists are a good fit for every person.  However, if you find you have gone to meet five different people in search of the right person, you might want to think about whether your expectations are realistic and give the one you found the most helpful another try.

I will be the last person to tell you that all therapists are good, or even the same.  Look for my future post on different kinds of therapists to learn about just how different we can be.  No matter who you see, what is found consistantly in studies about mental health is that it is the relationship between the therapist and the client that is more important than the choice of intervention when we look at whether therapy has been successful.  You have a right to getting what you want from treatment.

Look for future blogs to address red flags when looking for a therapist and when it might be time to move on.  Since I specialize in attachment disorders, I will also be posting about finding an attachment focused therapist.

March 30, 2012 Posted by | thinking about therapy? | , , , , , , , , , | 7 Comments

Does my child need medication?

This is probably one of the most frequently asked questions that I get the first time I meet a parent who is planning to bring in their child for therapy.  I am a Social Worker and have a private psychotherapy practice which means I am not licensed to prescribe medication, however, many children I see have taken or are taking medication and I do refer out to psychiatrists, who do prescribe medication, if I believe a child is in need.

The short answer that I give to parents who ask this question is to do what I would do with my own children if I felt they needed medication: try everything else first!  This is just my opinion and it is not shared by everyone in my profession, however, while there was a decade or so that many parents were turning to pills to solve the problems for their children, this is not true today.  I do not mean in any way to offend any parent who has a child on medication, nor do I intend to say that all medications are bad.  I just think it is important to try everything else first.  Now, obviously, if your child is psychotic, they need medication.  More often, I have parents who bring in children who have experienced trauma and are feeling anxious or depressed.  There are many therapeutic techniques that can help with these issues outside of medication.  Before starting medication, I have a few recommendations:

  1. Get a full physical with a doctor that is familiar with depression and anxiety.  Even mania can be attributed to physical ailments such as a thyroid issue, as are depression and anxiety.  Depression is closely linked to vitamin D deficiency and research also supports the use of fish oil to increase Omega-3.  In fact, in a recent talk training I went to, physician Andrew Weil taught us that fish oil and vitamin D, combined with regular, moderate exercise are more effective than medication for depression.  Now don’t go out and do these things because I said so please consult your or your child’s doctor before changing anything.
  2. Start exercising.  In research with a control group who changed nothing, one group that used only medication and another group that introduced moderate exercise 3x’s/week for 20 minutes or more the group that exercised had the best results in treating mood disorders.  For kids I especially love exercise that gets them focused on controlling their bodies, dance, martial arts, qui gong, and yoga are all wonderful.
  3. Look at the food you and your child eat.  I have seen more and more children developing food sensitivities.  The main culprits seem to be food dyes, sugar (you knew that), caffeine, and gluten.  I used to see a kid where you could tell if he got into the pretzels just by looking at him when he walked in the door because his sensitivity to wheat caused him all kinds of trouble.  This is the easiest (and the hardest) one to do because all you have to do (feel free to laugh here if your child is a picky eater like mine) is eliminate each category of food for about a week to see if you see a behavioral change.
  4. Learn to meditate.  Meditation is good for just about everyone.  Even kids can meditate.  Just start small and work your way up to 10-20 minutes at least 3 x’s/ week.
  5. Check out other alternatives.  Acupuncture and reiki- even with children- have both been helpful to my clients.  Don’t ask me what it does I just know it works for many people.
  6. Let’s not forget talk therapy, art therapy, and play therapy are all helpful.
  7. Learn EFT (Emotional Freedom Technique).  I use this tapping technique with most children and adults I work with at some point.  It is easy to learn and you can find out how by contacting a therapist who knows it.  They should be able to teach you in one or two sessions.

Like I said before, medication is not all bad.  I have seen quite a few children who have been helped by it, however, more and more, I and others in my field are looking to try alternatives first and with good reason.  Dr. Weil also pointed out more recent research that points to our bodies adjusting to medication in ways we did not expect.  For example, the study he cited found that people who took SSRI’s to increase serotonin production to treat depression also had the effect that once a patient stopped taking the SSRI, their brain had adjusted to making less serotonin as it became adjusted to allowing the medication to stimulate production.  He also used the example that acid reflux medication, when given to a group of young adults who did not have issues with acid reflux, actually ended up causing acid reflux issues in a significant number of participants after they stopped taking the medication.  Why?  Because their bodies adjusted to producing more acid to counteract the medicine to try to reach “normal” for their body.  My point is, there is still a lot we don’t know about medication, especially for children and that the long-term studies on psychotropic meds for kids just isn’t there yet.  Before putting our children on these medications, please, let’s consider less extreme alternatives.

March 28, 2012 Posted by | help for parents, thinking about therapy? | , , , , , , , , | 3 Comments

How to know when you or your child need a therapist

“I’ve thought about coming in for a long time but it just didn’t seem that bad.”  How many times have I heard these words?  They are usually soon followed by the wish that the individual or family I am seeing had come in sooner.  Many people delay going to therapy because things just don’t seem bad enough.  I would encourage families to start thinking of therapists not only as people you go to as a last resort, but also as a kind of preventative help, kind of like going to your primary care physician when you have a cold.  How often have you delayed taking yourself or your child to your physician only to find out that had you gone sooner you would have been better off- that cold was actually strep, or that cough was really asthma?  Many people delay for understandable reasons, we are all busy, but by going when the problem starts, you can often (just like in medicine) reduce the amount of time it takes to recover from whatever the issue is.  Take depression for example, a person who is in the early stages of depression takes way less time in therapy to get better than a person who has been depressed for years.

Many people worry that once you start therapy, you end up going for years.  While this is true for some people, there are many people who go only a few times and find relief.  In fact, I have had an increasing number of parents calling my practice who just want to come in for a check in and guidance in helping their child adjust to a major change such as a move, or the death or illness of a relative.  Sometimes I never actually see the child, but the parents want someone to help them tailor their response to a distressing issue for their child since, especially if you have more than one child you know every child is different and has different needs.  Once you establish a relationship with a therapist, even if it is short-term, then you can continue to refer back to that person if any issues come up in the future.

Some signs that a person needs to be seen for therapy can be subtle but if they come in groups, you would want to have yourself or your child seen.  They include:

  • a sudden change in mood or behavior that does not seem to be going away.
  • lower grades than usual on a report card.
  • comments about feeling different from other people and not fitting in.
  • excessive worrying or depression.
  • an increase in challenging behaviors and/or bad moods.
  • increasingly disrespectful attitude or tone with parents.
  • sudden interest in death and dying.

If you see two or more indicators from the above list, I would recommend you contact a therapist.

Some indicators in and of themselves that indicate therapy is warranted include:

  • a statement from someone (including young children) that they want to die.
  • any previously untreated significant childhood sexual or physical abuse or neglect.
  • anyone in a family where the parents are separated or divorcing.
  • anyone who is self-harming (self-inflicted cuts, bruises, burns, etc.).
  • anyone who intentionally starves themselves or makes themselves vomit.
  • anyone who has become increasingly agitated and starts to make less and less sense (this could indicate a manic episode and needs to be treated)
  • anyone in an abusive relationship (if you do not know if your relationship is abusive, I would recommend therapy).

When in doubt, just call a therapist in your area.  We all know it is part of our job to speak to people who are just not sure if therapy is right for them or their child.  I have had plenty of people who have called where I have told them they did not need to bring their child in (like the parents who called to ask if a young child playing doctor with another young child needed to be in therapy).  Other times, people have called who have been on the fence and I end up saying if X, Y and Z happen, call back but lets see if some of this self corrects.  For example, sadness over the passing of a grandparent is normal, however if the sadness interferes with daily activities after a few weeks then I would want to see that child.

If you are thinking your next step is to find a therapist, please stay tuned for future posts about finding the right therapist for you and your child and on therapy myths- debunked!

For more information on my practice, please feel free to look at my practice website: www.ahealingplaceincolumbia.com

March 28, 2012 Posted by | help for parents, thinking about therapy? | , , , , , , , , | 13 Comments

   

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