help4yourfamily

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Caught in the Loop: Why People Repeat the Same Bad Choices Over and Over

train circle

train circle (Photo credit: bitmapr)

written by, Kate Oliver, LCSW-C

When I met Aaron, he was 10 years old and living with his parents who had adopted him after three failed placements.  Aaron’s parents were at a loss about what to do with him.  They were committed, loving parents who wanted to help him make better decisions; however, after living with them for over a year, Aaron continued to have bizarre behaviors that they did not understand.  In addition to continuing to steal from his parents any time he had the opportunity, his parents had just figured out that he had also been urinating into the vents in his room.  Aaron’s parents were at a loss as to how to help him change this behavior and they were terrified that it would continue to get worse.

Children who have experienced trauma can seem to continually engage in activities that can be baffling to parents.  I have had many a parent come in to my practice and describe a foster or adopted child who seems to seek attention in negative ways and to actually work to recreate the circumstances that were traumatizing to them in the first place.  From rooms that seem to get instantly messy immediately after cleaning them, to repetitive behaviors that pluck even the calmest parent’s nerves, these children can seem intent on turning their parents into a recreation of the child’s biological parent or earliest caregiver.  There is a name for this phenomenon.  It is called “traumatic reenactment.”  The best way to explain traumatic reenactment is to first understand how trauma works, and the ways we store it in the brain.

Think of your brain as a computer.  The files in your computer are stored in different areas.  There is a short term memory file that stores what you had for breakfast today and yesterday.  There is a long term memory file that stores the stories from your childhood.  There is the work file, the running “to do” list file, and many, many more.  Days that go as planned are pretty easy to file away.

But what happens on a day when something traumatic happens?  An easy definition of trauma is anything that impacts you in such a way that it causes you to feel as though your life is in serious danger, with the possibility of death, or that changes who you perceive yourself to be in a negative way.  To show how people typically store traumatic memories, let’s take the example of a car accident.  You do not wake up in the morning thinking this is probably going to be the day you are in a car accident.  If you really believed that, you would probably never get into the car.  But, there you are, driving down the road and someone sideswipes the car you are in.  No one is hurt, but there are a few moments of panic and your car is seriously damaged.  What do you do?  Well, of course, as an adult you make sure everyone in both cars is okay, call 911 to make sure no one is hurt, and then the insurance.  But what is happening with your memory filing system?  How are you filing this memory?  It sure does not go in the breakfast file!

What happens with trauma is that, until we file it, it acts like a virus on our computers.  If you have ever had a virus on your computer, you know what happens.  You go to get on the internet and think you are checking your email, only to find all kinds of unwanted images popping up on your computer.  Then, if and when you are able to get to your email, you may find out you sent a bunch of messages to people that were not even from you!  You never sent that!  This is how trauma works.  Until you file that traumatic memory you just got from the car accident, your brain is going to be working overtime to file it.  You will go to get in the car and up will pop the memory of the accident and maybe another accident you had a while back.  You will start to remember those terrifying moments when you were out of control and you did not know if you were going to live or die.

Healthy adults file traumatic memories as they verbally process the trauma.  Remember how you called the police?  You had to tell them what happened so they knew who to send.  You were processing the memory.  Remember when you had to call the insurance?  Same thing.  Did you sit in your car for a moment and do some sort of self-soothing like deep breathing to calm yourself down?  Maybe you got a hug or reassurance from someone.  Perhaps you reminded yourself that you have been in cars thousands of times and the vast majority of those times nothing bad happened.

If you did any of those things, you were processing and filing your memory.  Another part of filing trauma is finding a way to understand the event.  This includes thinking about whether you could have done something differently, how you got through it, and how you can avoid the same thing happening again.  Therapists call that mastering the situation.

Now, think about the child you have or have had in your home who has experienced trauma but did not have anyone to process it with and did not have anyone to soothe them, nor did they know how to self soothe, after all, who would they have learned soothing from?  The clinical term for the way this “virus” manifests is “traumatic reenactment.”  It goes like this.  A trauma occurs.  It is not filed appropriately because there is either no, or not enough, processing or soothing for the child.  The child tries to gain mastery (understanding) of the trauma by subconsciously putting themselves back into the same situation over and over again in an attempt to understand or “master” it.

Remember Aaron?  When Aaron lived with his birth parents he was repeatedly locked in his room for days at a time when his parents went on drug binges.  When his adoptive parents brought him in to see me he was lying and stealing constantly, then, they had recently discovered that when they sent him to his room for punishment, he had been urinating into the vents of their home.  What became clear was that this child had found a way to experience a traumatic reenactment with his adoptive parents.  He lied and stole, then got sent to his room for punishment.  While in his room, he had the emotional experience of feeling trapped again, just as he was trapped when he was very young.  In his mind, being sent to his room meant he was not allowed to come out even to go to the bathroom.  When he had to go, he did what he had before, went in the vents, so he did not have to be around a wet spot in his room.  His loving parents had responded in every way they could think of to change these behaviors, but it was not until they understood where the behaviors were coming from that they were able to adapt their responses to more accurately fix the underlying problems.

In therapy, Aaron processed the trauma, learned how to soothe himself and to be soothed by his parents.  It really did not take long for the vents to become dry again so his parents could focus on new ways to address other issues related to his early abuse and neglect.  For traumatized children, I strongly recommend counseling, with a therapist that specializes in trauma, as a resource to help them process traumatic memories to improve behaviors and help parents find a way to adapt parenting styles in ways that are most beneficial to the child.

January 15, 2013 Posted by | attachment disorder, child development, discipline, help for parents | , , , , , , , , , , , , , , , , , , | 4 Comments

A Few Thoughts on Seasonal Affective Disorder

written by, Kate Oliver, MSW, LCSW-C

seasonal affective disorder

seasonal affective disorder (Photo credit: Evil Erin)

This is the time of year when, like many clinicians, I see a spike in the number of people calling for first time appointments. One of the reasons for this is Seasonal Affective Disorder (SAD). SAD can impact both adults and children.

At it’s core, SAD is a kind of depression that occurs at a certain time of year. If you have ever heard people talk about the “winter blues,” they are typically referring to SAD. Two issues I see which keep people from seeking treatment for SAD is that they worry about being put on medication, and that they have normalized feeling blue at this time of year. If this is you, please allow me to educate you about some of your easy, quick, medication-free options that you might want to try.

1. In the United States, there is an epidemic of people who have lower than optimal Vitamin D levels. Vitamin D is that essential nutrient we get from the sun that, among other benefits, helps us to regulate our moods. As people spend more time indoors, and get better about using sunblock and covering their skin in the sun, we also end up getting less Vitamin D in our system which impacts our mood. We are more prone to this in the winter months. Your Vitamin D level is a quick and easy thing to test. If you have a regular doctor, you can contact them and ask them to test you for your Vitamin D levels. If you do not have a doctor, there are in-home kits you can order off the internet.

2. Talk to your physician about a sun lamp. These are special lamps that produce light which mimics the sun and, for people impacted by a change in the seasons, they also help to even out your moods. You can even purchase them inexpensively online.

English: A 30 kHz bright light therapy lamp (I...

English: A 30 kHz bright light therapy lamp (Innosol Rondo) used to treat seasonal affective disorder. Provides 10,000 lux at a distance of 25 cm. Suomi: 30 kilohertsin kirkasvalolamppu (Innosol Rondo) kaamosmasennuksen hoitoon. Kirkkaus 25 senttimetrin päässä 10 000 luksia. (Photo credit: Wikipedia)

3. Take fish oil. Iceland, a nation where people experience shorter days and longer periods of darkness has one of the lowest levels of depression anywhere, why? The eat fish like it’s candy around there! Okay, maybe not like candy, but they do eat a lot of fish and fish oil specifically has been linked to reducing depression. Obviously, you want to check with your doctor before starting this, especially if you have any seafood allergies or if you have any blood related issues especially as fish oil can change the clotting of your blood.

4. Try therapy. You might not have SAD. Just because you experience depression around this time of year it does not necessarily mean you have SAD. I see many people who, around the anniversary of a specific trauma, experience some symptoms consistent with depression. If you have a loved one that passed away this time of year, you might be missing them more. Even if they didn’t pass away this time of year, if you have specific memories linked to this time of year (this happens a lot around holidays), you might be sad thinking about them. Death is not the only trigger, perhaps you experienced the loss of a job, a relationship, or something else around this time of year. If you have not resolved those losses to the point of acceptance, you may just be getting triggered to remember that particular feeling and your brain is giving you a chance to resolve the issue now. I find that seeing a good therapist is essential in this process and that some people who have told me they have SAD have actually, via therapy, addressed and resolved old issues that pop up around this time of year making it so that they did not experience SAD the following year.

For more about Seasonal Affective Disorder from the experts, please check out the link below from Everyday Health.

November 8, 2012 Posted by | counseling, mental health | , , , , , , , | 10 Comments

PLACE Parenting for Children with Attachment Disturbance

A mother holds up her child.

A mother holds up her child. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

When you have a child with any sort of attachment disturbance, you also have a child that is very good at making you feel like you don’t know what you are doing.  In one training I went to on attachment disturbance, the presenter, Art Becker-Weidman said one of the parents he worked with described it something like this:  ‘It’s like you as the parent are the control station for a radio station, then the kids come up and play with all the buttons until they find one that gets the response they are looking for.  When they find that button that gets them what they want, they just keep flipping the switch over and over again.’  I have used this description with the parents that come through my own practice and find it resonates deeply with them as well.  What to do when you have a child that is constantly pushing your buttons and finding creative ways to make you feel like you don’t have a clue what you are doing?

Daniel Hughes and Art Becker-Weidman are working to popularize a parenting attitude that really can work wonders if parents are able to maintain it when they have an attachment disordered child (or any child for that matter).  It is called the PLACE mentality, it stands for: Playful, Loving, Accepting, Curious, Empathic.  I find that while the words are familiar it can be easy to misinterpret the meanings of those words in this particular context so let’s look at each word to see what we are talking about when it comes to parenting children using the PLACE mentality.

Playful–  The most common misinterpretation of this quality is that parents believe I want them to throw a parade in their child’s honor every time they do something desirable to the parent.  What I mean by playful is just finding an approach that has a less authoritarian tone.  Instead of telling kids where to go to find their glasses, encourage them to play a little game with you where they have to look at your face for them to give you a hint where the glasses are.  When they look into your face and lie, come up with a playful response “That’s a good one.  I’ve always known you were creative.  Tell me another!”  Often being playful can help everyone tone it down a notch.  If you have a child with a history of abuse or neglect, it can also keep them from getting triggered into believing that they are in huge trouble and helps prevent them from going into fight or flight mode so that you have some chance of them hearing some of the words you are saying.  A way to really get playful is to learn from a parent that really gets this stuff.  Christine Moers is a mom raising adopted children with attachment issues.  She posts vlogs on youtube to help other parents (and to keep herself sane).  Her video blog:  http://www.youtube.com/watch?v=HDAALaVG27k&feature=fvwrel is a wonderful example of how to discipline in a playful way.   I would recommend you look at her videos when you need help staying sane.

Loving– When I think of saying things in a loving way to children, what really helps me to stay in that place is remembering my purpose for saying the words in the first place. Yes, ultimately I may be asking my child to do a task because I want it done. But the bigger picture reason for asking children to do a task is to teach them so that they know how to do it, to give them a system for tackling problems, to get them into the routine of caring for themselves and planning how to fit everything into a schedule, or something else like that. In the end, our job as parents is to make it so that our children no longer need us in order to make it through the day. When we remember that we are asking our children to do something because we love them and want them to be happy, healthy adults, we can state requests in a more loving way. By remembering this, I believe the primary change is our tone of voice, which makes a world of difference to children with attachment disturbance.

Accepting– One trap I see so many parents walk into is the argument with their child(ren) about whether their child is having a reasonable feeling or not.  Both the child and parent find this is a way to feel crazy pretty quickly and I would like to present an alternative…acceptance.  Here is how it goes, maybe it sounds familiar:

Child comes down to breakfast dressed in a completely inappropriate outfit for school

Parent (being curious):  Wow, is there something going on at school today?  That’s an interesting outfit.

Child: I knew you wouldn’t let me wear it!  You never let me wear anything I want!  You’re such a witch!  You want me to be the ugliest girl in school!

Parent (accepting):  That made you mad.  I can see how you would be mad if you thought I wanted you to be the ugliest girl in school.

It’s that simple- do not engage in an argument about whether you want her to be the ugliest girl in school!  If that is her belief in that moment, accept that her feeling is appropriate for the interpretation.

Curious– In my office, I often frame this curiosity as being a “feelings detective.”  I tell kids I ask lots of questions because I am a very curious person and sometimes it takes me a while to understand things.  Get curious about your children.  In the above example, rather than arguing about who wants whom to look ugly, you might get curious about it.  “I wonder what made you think I wanted you to look ugly when I asked about your outfit.”  Another way to help with getting kids to understand you are curious (not judgmental) is to say something along the lines of, “I’m curious what got you so mad because I don’t want you to feel that way again. ”  When they tell you what got them mad, again make sure you avoid arguing about whether that is really what happened (accepting) and then …empathize.

Empathy– Empathy looks like this,” If I thought someone felt that way about me/ said that to me/said that about me I can see how you would feel mad/sad/ scared too.”  That’s all empathy is being able to see something from the viewpoint of another person.  Empathy does not involve any discussion about whether someone is right or wrong for feeling the way they are feeling.

So, why does this work?  It works because our children with attachment disturbance find the things we need to do most often, educate, speak with authority, and parenting, to name a few, to be triggers to them of things that remind them of times they were hurt or  neglected.  When kids do not learn the typical role of parents early on, they easily misinterpret the actions of parents.  Using the PLACE mentality is one way of reducing the number of triggers for your child, not to mention that it just makes parenting more fun.  I use it with my own securely attached children as well.  Of course, this is a very quick overview of the PLACE mentality.  It is important that if you feel you are in a position with your child(ren) where you need to utilize the PLACE attitude more and could use support in doing so, that you see a therapist that has an attachment informed practice.

October 18, 2012 Posted by | attachment, attachment disorder, help for parents, parent support/ self improvement | , , , , , , , , , , , , | 12 Comments

Suicide Prevention: Determining if Someone is Suicidal

Written by, Kate Oliver, MSW, LCSW-C

Man thinking on a train journey.

Man thinking on a train journey. (Photo credit: Wikipedia)

Over the years, I have talked to many, many parents, partners, and spouses about what to do if you think someone you love might be suicidal. There are really two parts to figuring out about suicide, 1. determining whether someone is indeed suicidal, and 2. if the person is suicidal, figuring out the level of risk and making sure they are safe. I am going to tackle one section a week so stay tuned for next weeks post. I want to state at the beginning of this post that, of course, my advice here is general and should not be substituted for individualized mental health advice. If you absolutely know someone is suicidal, please take them to the nearest emergency room or contact your local mental health hotline. And, if you are reading this post because you have someone you are concerned about, even if they are not suicidal, please do your best to encourage and support them in seeking therapy as soon as possible. There are mental health services available to many in the United States even if you are under-insured or are not able to afford counseling.

Determining whether someone is suicidal

There are times when you absolutely know someone is suicidal, either you found a note, they told you they were, you find them in the process of attempting, etc. But other times it can be more difficult. Sometimes parents tell me they think their adolescent is saying they want to die in order to get attention. If this is happening, please stop for a moment to think how desperate you have to feel about getting attention in order to say this. I want to make sure that you know that, even with young children, any indication that someone is suicidal needs to be taken seriously. Even if you think they are trying to get attention, don’t you think it would be a good idea to give them some if things have gotten this extreme? I’ve actually come to know of quite a few people via the work that I do who have tried to “get attention” by attempting suicide in the hopes that someone would notice them. I wonder how many suicides are just that, someone thinking they are doing something to get attention but they actually end up dying. Pay attention! Here is what I recommend to all parents who tell me that their child is saying they are going to kill themselves for attention. Tell them you need to take any statement like that seriously and ask if they are serious. If they say that they are, take them to the hospital. Here’s the thing, I know you might say to yourself, “I don’t want to waste the time of the hospital personnel” or, “This kid is trying to waste my time.” Take them to the hospital. Tell them you love them and that you have to take this threat seriously. Sit with them for the hours it takes to be seen. If they are not suicidal, they will be so bored and so over it that by the time you have finished with it, they will never want to have to do that again. You will have nipped a nasty reaction in the bud. The alternative when you take them to the hospital is finding out that they were, in fact, serious and you took them right where they needed to be anyway.

Here’s the thing about the hospital. They are busy. They don’t want to take your child, your friend, spouse, etc. unless they think they need to. Just like they are not looking to keep people for any extra time after surgery, they are not looking to take in people who do not actually need to be there, so please do not worry, the person you take will not be admitted unless they need to be, in which case, you did the right thing.

Warning signs

Other times, you may have someone who you care about who you fear may be suicidal and not telling. Maybe they have had a series of unfortunate circumstances or are having a mental health issue, like a depressive episode. Here are some warning signs that a person is more likely to consider suicide as an option:

  • They have had recent loss such as a death in the family, ending of a significant relationship or loss of a job.
  • They have a history of depression. Depression is characterized in adolescents differently than it is in adults. Adults tend to have a loss of interest in their usual activities, difficulty attending to tasks, a sense of hopelessness. In children and adolescents, depression more often manifests as irritability and anger.
  • They have friends or family members who have committed suicide.
  • They have mentioned, even just in passing, that they should just kill themselves, or that they wish they could die. Sometimes they may talk about everyone being better off without them.
  • They suddenly begin giving away important items you would not expect them to give away and seem to be suddenly peaceful after a period of difficulty.
  • They begin to isolate themselves from friends and family members.
  • They have increased alcohol or drug use and/or impulsive or reckless behaviors.
  • They have previously attempted suicide in the past.

If you notice any of these symptoms, please take these next steps to ensure that your loved one is safe. Better safe than sorry, as they say. It is especially true in this case.

Stay tuned, next week I will write about what to do to support someone if you fear they are suicidal. In the meantime, here are a few resources.

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

American Foundation for Suicide Prevention

How to Know When You or Your Child Need a Therapist (help4yourfamily.com)

October 4, 2012 Posted by | keeping children safe, Suicide | , , , , , , , | 9 Comments

The Spectrum of Attachment

This picture by Sovanna Ly -csc- can be used f...

This picture by Sovanna Ly -csc- can be used for any purpose, provided that his name is credited. (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

When we look at children’s attachment styles, they typically fall into one of three categories, secure, insecure and disorganized. I explained some about these categories in my post, “What is Attachment Disorder?” This post will go more into attachment disturbance and how to tell the difference between an attachment “issue” and an attachment “disorder” and some of the symptoms you might see from a child (or adult) with attachment issues. If you are interested in learning about attachment disorders, you can find the diagnostic criteria here. I personally do not find it helpful to diagnose a disorder vs. disturbance of attachment unless I need to as a means for getting insurance reimbursement because if you look at attachment across the spectrum, you would find that we all have attachment issues.

In my world, where I see many actions through the lens of attachment, I think of it like this: picture the security of a person’s attachment on a scale from 1-10. A person with a 1 would be a person who feels worthless and unlovable in all situations across the board. They do not believe they have the power to make any positive changes in the world, nor do they believe that anyone cares about or wants to help them to make positive changes. This person would constantly live in the moment, since they do not feel as though planning helps anything and would constantly look to meet his or her own needs (without distinguishing between wants and needs) by whatever means necessary. A person operating at a  “one” steals and lies constantly, manipulates with as much sophistication as possible for their developmental level, does not seem capable of forming any lasting relationships, etc. A” 10” would be a person who never worries about rejection or abandonment from the people they love, knows they are loving and loveable at all times, and understands that all problems can be solved, etc.

The way I see it, most of us fall between a 4 and an 8. From 1-4, I would say you have a disorder: an attachment style that presents major problems in your day to day life that requires specialized therapeutic treatment. A 5-8 is what I would call a good, healthy neurotic: while therapy is an option for difficult times, the gaps and insecurities in attachment are manageable most of the time as long as life is relatively stable for you. Yes, you worry about people leaving you sometimes and might avoid conflict when it might be healthier for you to confront an issue, or make a confrontation out of something that really could have been a constructive conversation, but, overall, life feels manageable and you have areas you do well in even if there are parts where you feel you struggle.

All of our internal feelings and perceptions about ourselves can be seen through behaviors. To figure out if someone has serious attachment issues, we need to look at what the symptoms are of an attachment disturbance. Here are some of the things practitioners who see people with attachment disturbance look for:

Difficulty maintaining eye contact with primary caregivers (especially when someone is saying something loving)

  • Constant lying
  • Manipulating situations
  • Lack of language to express feelings
  • Lower developmental age than chronological age
  • History of multiple primary caregivers (foster care, adoption at an older age, frequent changes in child care providers)
  • Stealing
  • Identification with the villain in movies
  • Playing with fire
  • Bullying and/or blindly following others who are a bad influence
  • Abusing animals
  • Seeming lack of remorse or conscience
  • Difficulty empathizing with others
  • Lack of understanding of cause and effect
  • No trust in authorities
  • A constant seeking for control of every situation

Now, before you start worrying that you and your child will be featured on the next segment of “Kids who Kill” on 20/20, let me point out that it is a combination of all of these features that would point toward a diagnosis of attachment disorder. Even though headaches are associated with brain tumors, you would not automatically assume you have a tumor every time you have a headache. Also, it is not only the presence, but the severity and consistency of the symptoms that informs the diagnosis. For example, we have all probably lied a few times this week. We said we were fine, or even great when asked “how’s it going?” rather than saying, “Well, everything’s going well except for my job.” Or maybe a telemarketer called and asked you for a few minutes of your time but you said you were busy when really you were not.

Just like with attachment being on a spectrum, so are the symptoms. If you stole $20 out of your mother’s wallet once when you were 13 and felt awful about it, that is very different than being 13 and stealing from your mother, your brother, and the teacher’s desk at school whenever you get the chance, and your stealing includes anything from candy and treats to money, toys, and clothes. Also, when you were 13 and stole that time, maybe you had a specific purchase in mind or something you were going to do with the money. That too is different from stealing whenever the chance presents itself as if you needed to fill a perceived lack with any and every chance that comes along.

I have mentioned before Daniel Hughes book, “Building the Bonds of Attachment.” This, to me, really is the best book with the most readable format* that explains what happens with a child with attachment disorder, while simultaneously showing how secure attachments are made.  You can easily link to find his book, and other books about attachment that I recommend on Amazon by clicking on the “Amazon widgets” link at the top right corner of my webpage.**

Something that can make an attachment related diagnosis difficult to make, is differentiating it from other diagnosies, such as post-traumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), or even early bipolar disorder or schitzophrenia. That is why, this post should never substitute for seeing a mental health practitioner. It is possible for children and adults to have any or all of those issues and each needs to be carefully treated. If you are concerned that your child needs therapy for attachment disorder, please find a mental health practitioner. I give tips on how to do this here. I give tips on how to get insurance to reimburse specialiazed therapy here.

What are your questions about attachment? Do you have a question about something that your child does and whether it is attachment related? Please feel free to ask here or comment. Or you can contact me directly, helpforyourfamily@gmail.com.

*If you are not a practitioner, I would suggest that you skip or skim the first 50 pages of the book.  Even as a practitioner, I found them difficult but I am glad I kept reading after that.

**see disclaimer page

June 8, 2012 Posted by | attachment, attachment disorder, help for parents | , , , , , , | 15 Comments

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.

Related articles:

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

When your inner critic hurts your relationship with your children

Written by Kate Oliver, LCSW-C

We all have an inner critic.  Some of us have several.  You know, that voice in your head that just feels like it is part of you?  It’s the one that tells you that you did it wrong again, you are not working hard enough to fix your child’s problem, and reminds you of all the times you tried and failed to get items knocked off your “to do” list.  If you are not fully familiar with your inner critic, the next time you are upset about something, take a moment to listen to your thought process.  What are the thoughts floating through your head at that moment?  Our inner critic can be harsh…and sneaky.  We don’t even know it’s there, it feels so much a part of us.

I’ve heard our inner critic (or critics) referred to as “the committee.”

Committee

Committee (Photo credit: Editor B)

I love this because it is so true.  Think about the act of going to the grocery store and passing through the cookie aisle.  The committee gets activated!  You hear one part of your committee saying, “Get the cookies you like, you deserve it!”  Another part of your committee chimes in, “Yeah, your butt loves those cookies so much it will hold onto them all the way through summer.”  Then the internal negotiator pipes up, “Maybe there is a new, healthy cookie out that you could try.  Or, if you get the individual packs, you won’t eat the whole thing in two days and you can enjoy your cookies over the next few days, a little at a time.”  Of course then the critic chimes in, “Fat chance…get it?  Fat chance?  Haha.”  And so on.  Even after making a temporary decision to leave the aisle, or put the cookies into the cart, your mind wanders back as you continue through the store, either feeling like you should take the cookies out of the cart, or wondering if you will pass by other cookies and if you will be able to pass them over too.  Is it just me?  I don’t think so, maybe for you it’s not cookies, maybe it’s picking the right birthday card for a friend, or what job to take, the email you are sending to a friend, etc.

When the committee gets involved, we can all empathize with the wish someone stated to me once when he said he wanted to put them on a bus and send them away for the weekend.  Since that is not possible, what is the alternative?  I have one that may surprise you.  Think about loving them.  That’s right, envelop each part of your committee with love and thank it for working so hard on your behalf.  Right now I imagine there are quite a few people reading this who will argue that there is a part of them that is just plain wrong, that it is a part they would like to eliminate completely and that the focus should be on eliminating the “bad” parts.  If you are saying that, here is my question to you…how is that working for you?  I’m guessing that has not been so successful or you would not still be reading this post.   I might suggest that telling them to go away hasn’t been working so well so far.

If you want to try something new, take a moment to reflect on what it is each member of your committee is trying to say to you.  Try to listen to one at a time.  Are they trying to convey important information about your health, safety, or emotional well-being?  Is your committee chiming in about ways to keep yourself or your family safe?  Is it reminding you of something you need to know right now?  I promise you that even the most seemingly destructive parts of you are trying to help you in some way.   When you figure out the message, imagine yourself giving that part of you a hug and thanking it for it’s input, like you would a friend that just told you something that was really hard to say.  Make sure it knows you got the message and that you will take it into consideration.  Often times these parts of us, our committee, can be like any other team meeting where, if people feel like their important message is not being heard they just repeat it over and over again, saying it louder and louder, until people finally take notice.  Your committee may be doing this now.

Remember, listening to your committee does not mean that you will do exactly what they say, but, just like your children, if you take time to really listen to them, and they feel heard, they are more likely to listen when you tell them no, feel good when you agree, and feel less and less like they need to yell to be heard.

If it is confusing when I say to listen to your committee then listen to yourself, since your committee is part of you, that is understandable.  What I mean is, your committee members are all aspects of who you are.  At your core is you.  The you who knows what you really need, the you who is connected to all the love you feel for yourself and others, the you that does not need to judge anyone else, and is the same you that is connected to a higher, spiritual purpose.  Some people call it their higher self.  We all have this, it is the part that tells us we can do this, forgives us our imperfections, and that finds creative ways to solve any issues.  Take a few moments each day to connect with your committee, then to connect with your core, or higher self.  If you worry about fitting this into your daily routine, remember, thinking is free and can be done anywhere.  Even people with young children can take a few minutes a day to sit when the kids are in bed or are eerily quiet in the next room to check in with their inner dialogue.  The process of getting to know yourself and find peace within does not happen in one day, rather, it happens in increments over time.  It takes a lifetime, which is okay, because you have that long to do it.

A word of caution, your committee may try to tell you that doing this is too difficult and to stop or you won’t like what happens next!  Should you hear that warning from your committee, I would urge you to find a therapist to help you navigate the murky waters of your inner workings.  Over time you will find that the process of getting to know yourself can be like finding a long, lost friend that you have been missing desperately for a long time.

Doing this exercise is especially important for parents because, I hate to tell you, our inner dialogue shows to our children whether we like it or not and becomes their inner dialogue.  The best thing we can do for them is to clean up our inner space and be infinitely loving to ourselves so that our children may follow our example.

There are guides for this type of work as well. Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy, 2nd Edition by Jay Earley (Jan 27, 2012) is one such book.  It is available on Amazon and if you click on the Amazon widget link at the top right of this screen you can find out more about it.  Please read my disclaimer page.

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May 9, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , , | 6 Comments

Talking with Robert Holden

Robert Holden Ph.D

Robert Holden Ph.D (Photo credit: Wikipedia)

Written by, Kate Oliver, LCSW-C

On Thursday of this week I decided to try calling into one of my favorite radio shows, Robert Holden’s Shift Happens.  It comes on at 1pm EST.  Every Thursday is the day I stay home from the office and try to get enough done around my house so that my family and I can have a weekend free from running errands and picking up the house.  I always listen to Hay House Radio using my phone app as I clean.  If you don’t know about Hay House Radio, it is a station dedicated completely to positive radio programming.  I love listening to Dr. Holden because he is always gentle and kind to everyone he speaks to and has a wonderful way of helping people to look at things in a different way.

I’ve had an unusual amount of anxiety lately, really since I started this blog.  While I have taught other mental health professionals and parents in educational seminars, I’ve never publicly shared my writing until now and I have been feeling, well…vulnerable.  So, I called into the show, anticipating a busy signal.  How surprised was I when the phone rang and someone asked me what my reason was for calling before putting me back on hold?  Umm, pretty surprised.  I am so grateful for the time I had on hold so that I could gather my thoughts.  Then, just after the commercial break, I heard Dr. Holden announcing…me!  What a wonderful, effortless surprise :).

I know most people hate public speaking.  I actually love it.  I know I have good, worthwhile information to share and I love being with people as we all gain knowledge together.  When I am in front of an audience, I can see people responding and adjust accordingly.  But with this blogging thing, it’s like I’m putting my baby out into the world and it’s difficult for me to see how people are responding.   When speaking in front of an in-person audience, I also know who is there (no one I know personally) and it is easy for me, in a professional setting, to shrug off criticism.  I know what I am saying some people will respond to and some will not.  Remember, I work with children with difficulties with attachment.  I probably hear a few times a week that I am wearing the wrong clothes, have a weird look on my face, don’t have the right games in my office, and that I am just plain wrong.  I usually find it pretty amusing since I know that criticism is more reflective of where my client is and if we stick with it, we will get to the other side to figure out where the defensiveness is coming from.

While speaking to Dr. Holden, I realized it was not so much the people I don’t know reading my blog, but more the people I do know.  It’s funny the things we worry about.  Mostly I was worried about people I know personally changing their opinions of me, or my blog causing conflict with people I love.  Everyone else, if you like it, wonderful!  If you don’t, I sincerely wish you luck in finding a site that better suits your needs.

The most surprising part of the call for me was toward the end when Dr. Holden suggested that if I am worried about critique from people I know and am most connected to, the concern I focused on in my call (no perfectionist tendencies here), that I must begin to be the most loving, least critical person I can be.  I had a little inner battle about that one.  “No, wait!” my insides wanted to cry, “I’m not critical of others!  In fact, I am one of the least critical people I know!  I pride myself on being non-judgemental!”  But then, after the call it clicked.  I am loving and non-judgemental to many, many people with one major exception.  You know the exception, right?  Yup, it’s me.  I have a tendency to save my major criticisms for me.  Don’t we all?  I mean, when we are yelling at our children, isn’t part of it that we are berating ourselves for our perceived lack?  Our inability to get them to eat what we want them to eat, the anger over the clutter or mess in our homes taking over that we can’t seem to keep under control, or feeling like we do not know how to address an undesireable behavior?  It is on the days when we are harshest to ourselves that we are the most harsh with our children.  I realized from that call, (thank you Dr. Holden) that I need to be less critical to everyone.

Let this be a reminder to us that we all, even the experts, need reminders to be gentle, kind and loving to ourselves.  Thank you to all of the people who have contacted me since hearing me on the call.  It has warmed my heart and I welcome building continuing relationships with you.  I hope that I can also take part in helping to you be kinder and gentler to yourselves as you continue your own journey as parents, no matter the age of your children.

You can listen to the show here: http://www.hayhouseradio.com/listenagain.php?latest=true&archive_link_type=link_mp3&archive_id=9401&show_id=180&episode_id=8697

This archive is available for only the next few days for free then it will go into the permanent archives and will cost money.

If I remember correctly, my call was the second after the break at the half way mark.  You can buy Dr. Holden’s book Shift Happens, on Amazon by clicking on the Amazon widget on the top right of this page.  I do not receive any financial compensation for this post or for any referrals to Hay House, or Dr. Holden however I do receive a nominal fee for purchases from Amazon if you click on the link on this page.  I only recommend products I believe in strongly.

May 5, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , , , | 3 Comments

Ten Free Ways for Parents to Break Free of a Bad Mood (I’ll bet there are a few you’ve never thought of)

How do they get any work done?

How do they get any work done? (Photo credit: Wikipedia)

Picture yourself, it’s Sunday around 3:00 pm.  You have already watched the children slowly dismantle any progress you made in getting the house into order over the week while they were in school.  They have gone through the playdates, video games, television and 1/2 the board games- as evidenced by the living room floor.  As you think about whether you are up for making dinner and wondering if you even have anything to make, you start to get grumpy.  Okay, you were already grumpy.  Maybe you have already yelled at them a few times and now, in addition to feeling overwhelmed about the mess in your home, you are also feeling bad about the words you have said- not that you are going to stop saying them mind you, because you are stuck in a loop of grumpy, nasty behavior…the same kind you get angry with your kids for having.  Below are a few techniques to help break free from the grumpy nasties and I’m quite sure there are a few you have not tried yet.  Why not print out the full list at the bottom of the post and stick it on your fridge to try out when the grumpies strike again?

1.  Put the kids in the tub or shower or take a bath or shower yourself.  Something about being in the water helps to set the reset button for kids and sometimes adults.  If you are taking a bath or shower, visualize all the angry, grumpy feelings getting washed off of you and watch them go down the drain.

2.  Set up a behavioral chart for yourself (if you get through something without yelling, you get a point and x number of points gets you something like a night out, a new cd you’ve had your eye on, etc.  I cover this one in my post “Ditch Your Behavior Charts!”).

3.  Tap on the inside of your pinky finger and say three times “I forgive myself, I did the best I could do.”  Then, continue tapping and repeat three times “I forgive myself, I’m doing the best I can.”  Don’t ask how it works, it’s an accupressure technique, just try it!  You know a big part of what you are doing has to do with the way you are talking to yourself about what is happening right now.  Think about ways you can forgive yourself- this is one of them.

4.  Imagine you are speaking to someone who loves you, your best friend who always knows what to say, your grandmother, whoever, and pretend they are with you right now guiding you.

5.  Learn EFT.  EFT (Emotional Freedom Technique) is a quick, easy tapping technique that can help in all kinds of different areas of your life.  It addresses anxiety, depression, traumatic memories and much more.  Here is a link to someone teaching EFT.  I would recommend just doing the shortcut he teaches in the first 6 minutes.  It’s all I ever really teach and it seems to be enough.  http://www.youtube.com/watch?v=NPZ-xmj6KTI&feature=related.  If you really want to learn more, check out this site: http://eftuniverse.com/index.php?option=com_content&view=article&id=18&Itemid=21

6.  Do a quick 5 minute spurt of exercise even though it is the last thing you feel like doing right now.  Partly this is just going to break the pattern by doing something different from what you were originally going to do next.  Add to that a quick, natural endorphin rush, and a feeling like you just took care of your body for a moment and it can really do the trick.  A great exercise that we do sometimes in our home that really gets us moving and laughing is playing “Just Dance” on the Wii.  We crack up as we watch each other try to get the moves right.  Just make sure no one gets hit with the remote.  Remind yourself that you don’t have to be at the gym and doing a full workout to get a little benefit from exercise.  See how long it takes you to go up and down the stairs of your home or apartment building 10 times, jog in place, race the kids a few times in the yard.

7.  Cry.  You read that right.  Think of the energy we spend holding back tears when really tears can be quite healing and good.  Even better than crying is crying in a hot shower.  That really gives your body a release.  Your tears actually carry stress hormones, that are otherwise trapped in your body, out of your body.  So, when I say it’s a release, I mean it, you are letting go of stress hormones when you cry.  Also, people worry about crying in front of children.  Unless this is a recurring issue- in which case I think you need to read my post on finding a therapist, crying in front of  your kids a few times a year is okay and actually can teach them about allowing themselves to show feelings and get comfort.

8.  Change locations.  When the kids were little I called them, “I need a witness days.”  I didn’t need a witness for them.  I needed a witness for me.  I needed to go out of the house so that I would be more mindful of how I was acting with my children.  Also, just getting out and going to the park gets you away from some of the compounding factors that may be contributing to your mood.

9.  Accept help.  Remember how you did something wonderful for your friend or neighbor and they were so thankful and told you if you ever needed anything to call?  Call.  Ask for help.  Accept imperfect help from your spouse, partner or friend while you go out to take a walk or clean up so you can feel sane again.  Sure, they may not do things the way you want them to, but are you doing things the way you want to right now?  Right.  Ask for and accept the help.

10. Picture yourself tomorrow, thinking back on today.  What do you want to say you did today when you were feeling this way?  Do you want to say, “yesterday I was in a foul mood and I couldn’t pull myself out of it?”  or do you want to say, “Yesterday I was in a foul mood, then I remembered this list of things to do to get me out of it.  I looked on there and found something and I’m pretty proud of myself because I gathered the children and pulled myself together and we all went for a walk.  The rest of the day went pretty good.”  Once you have pictured what you want to say.  Break it down into three smaller steps, what you need to do to get to feeling that way.

Good luck!  Let me know what works for you, or, even better, add to the list…

May 3, 2012 Posted by | help for parents | , , , , | 10 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

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