Category Archives: treatment

can I get a redo?

My experience with psychotherapy supports the findings that we can “rewire our brains.” In cognitive therapy, I learned to stop negative thoughts and suicidal ideation, rewrite those thoughts and replace them with more accurate ones. In therapy I’ve learned to reframe my life experiences as meaningful – as preparing me to be a better mother, wife, and daughter, […]

via Bipolar Disorder and Neurocounseling — Kitt O’Malley

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a new way to handle infant loss

So dang important. As a hospital social worker I faced this horrible situation way too often – the middle of the night, a groggy chaplain, teams of residents and nurses silently sobbing, the cries of a mother’s grief that don’t even sound human.

There’s no way to ease the pain they’re feeling, the ongoing grief they’ll feel…the going home to a finished nursery or the telling of friends or the baby gifts they won’t get to use. For some reason one of the most vivid images I have is of sitting in the room holding a mom and looking over to the table where this expensive camera sat, waiting to take pictures of a newborn…a toddler…the first day of kindergarten….it was awful.

We try to give the family as much time as they need with their child, with their little family that won’t ever leave this hospital. But this article is right: 2-4 hours often isn’t enough. In fact, the first couple of hours the mother may even refuse to see the child, saying she can’t do it. But most of the time she changes her mind, and we try to anticipate it – keeping the baby in another room until mom is ready. We take footprints even when mom says she doesn’t want to see them, create a memory box just in case. Sometimes family takes it and we hear later that mom/dad were so grateful later on when they had these keepsakes. I love this idea of slowing down, of letting the family have extra time to make decisions. We try to never tell the family there is a time limit, and honestly my families rarely use the whole time we’ve given them….but I think if the staff knew we had extra time we could aid in this slowing down process rather than feel the pressure of the clock and worry that we’d have to tell the family it’s time to physically let the child go.

I love these little suggestions, the colorful blanket or the recording family members. But this….this has changed the way I will handle infant loss forever:

It’s all about taking the time to say hello to their child before saying goodbye.

What a profound and incredible statement. Thank you, Megan, for the work you do and for taking time to share it with us.

Mandy Maneval faced infertility for years. Finally, three years ago, she became pregnant with twins. At a routine ultra sound, she was faced with the news that Aaron was lost at 20 weeks. Her little girl, Abigail (Abby), was healthy.

At 30 weeks, Mandy went into labor. She called her sister, Megan Shellenberger, a nurse at Penn State Milton S. Hershey Medical Center, located in Hershey, Pennsylvania. Megan spends most of her time working in labor and delivery, and she was quick to reassure Mandy that everything would be O.K.

Suspecting that baby Abigail had a heart defect, Mandy came to Penn State Milton S. Hershey Medical Center, the home of a leading neonatal cardiologist. The physicians were able to stop Mandy’s labor, but she would remain an inpatient until delivering Abby at 35 weeks.

Abby was born with two very complex heart defects. So rare, that her doctors described it…

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Aha! Moments

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

Okay, heads up: this entire post is a re-blog from PESIinc., a company that provides continuing education for a variety of professions. I kind of love them, even when they spam me four thousand times a day with courses I might like to take.

10 Ways to Help Stuck Clients Move Forward

posted Nov 24, 2015.

“I know it’s irrational, but I can’t stop the extreme anxiety I feel around people because I’m a 6’3” tall woman and fear they’ll think I’m a freak,” said Natalie, a 35-year old nurse. Though she was comfortable working with patients, was happily married, and had two very close friends, she couldn’t shake the anxiety she felt around colleagues and large groups of people.

“My last therapist taught me relaxation exercises, how to talk back to my negative thoughts, and encouraged me to get out socially with small groups,” Natalie added. “But none of that seems to work. The anxiety just hijacks my brain.”

She’s right. Sometimes, no matter how we try to outsmart it, our emotional brains are primed to override the rational mind with patterns that persist until we intervene with something this feeling brain can understand: a compelling emotional experience that completely changes how we feel, not just how we think.

Orchestrating such felt experiences with your clients is easier than you think. In this post, I’ll share 10 strategies from my book, “The Therapeutic ‘Aha!’” that you can use to engage the emotional brain and help stuck clients move forward.

Strategy #1: Align, Lift, and Lead

Most of us were taught to validate our client’s feelings. However, if you spend too long merely validating your client’s pain, it can amplify negative feelings in the emotional brain. To help your client access positive states of mind, you have to find a way to lift and lead them emotionally. To make this transition, I recommend a language pattern that I call “Align, Lift, and Lead.”

You align with the client by reflecting your understanding of the problem, and then you lift the client by affirming her strengths, and lead her by suggesting her desired response to the situation. Here is how I used this language pattern with Natalie:

 “Natalie, I understand that you’ve had these experiences where you’ve not felt comfortable around large groups of people because you’ve not been sure how they would react to your height. Being a nurse, you’re obviously an empathic person and are probably pretty good at helping people feel at ease. I’m seeing you using these people skills in other social situations, too, realizing that a person’s reaction just tells you something about them, and you can sense how to put them at ease.”

Reframing her problem in this way helped Natalie feel more socially competent and encouraged.

Strategy #2: Visualize the Desired Response

Because the emotional brain learns better through metaphor and imagery than it does through words, another strategy you can use is to have your client visualize her desired response. I suggested Natalie visualize herself successfully navigating a social situation and imagine feeling curious, secure, and calm. Then, I asked her to imagine something in nature that could represent her mind working this way. Natalie smiled and said, “Muir Woods with the redwood trees.” Visualizing the peacefulness of the tall trees in this forest helped her feel calmer and gave her a sense of belonging.

Strategy #3: Identify Inspiring Goals

Instead of setting dry, lifeless goals like, “Client will practice relaxation skills and talk to two new people per week,” explore potential goals that have real value and meaning for your client.

When I explored inspiring goals with Natalie, she began talking about her desire to have lunch with a group of colleagues. They’d been inviting her to lunch for several weeks, and she liked the idea of connecting with fellow nurses. Targeting a small group of people she wanted to be around felt more intriguing and doable to her and less like a task.

Strategy #4: Locate the Root of an Emotional Conflict

Even though Natalie felt encouraged by this goal, she still felt a knot in her stomach at the thought of going out to lunch with these colleagues. I asked Natalie to follow the sensations in her stomach back to the first time she could remember having a similar feeling. Her eyes widened as she recalled being teased during lunchtime in middle school by a group of kids who called her names like “Amazon” and “Sasquatch.”

She had coped by avoiding the school cafeteria and doing her homework in the library during lunch. As a result, she avoided her bullying classmates and was praised by her teachers for being studious. Natalie gasped as she realized she was doing the same thing at her job­—skipping lunch with peers to avoid fears of being ridiculed and getting praised by her boss for being so dedicated.

Once Natalie made this connection, she understood her emotional brain had simply continued the pattern because it had been adaptive for her in the past.

Strategy #5: Reverse Traumatic Memories

Natalie was excited to have made this connection, but just having cognitive insight into the cause of her social anxiety didn’t change it. In fact, recent neuroscience discoveries have shown us that in order for the emotional brain to change a response that was once adaptive, we have to recall the old memory while eliciting a new experience that invalidates the beliefs that got attached to the disturbing memory.

Strategy #6: Change Beliefs With Imagery and Metaphor

To change Natalie’s negative self-concept, we revisited her imagery of the redwood tree­—tall, beautiful, and majestic. I suggested she imagine the smaller trees laughing at the redwoods for being so tall and see the absurdity of it. Imagining this scene made Natalie laugh and realize every tree had its natural place in the world, and so did she.

Strategy # 7: Conjure Up Compelling Stories

Another way you can reverse the meaning of a traumatic event is to have your client finish her story with a new ending. For instance, she can finish it with a later moment in her life when she was out of danger, in a better situation, or felt competent or empowered.

The first time Natalie told her story about being bullied at school, she ended the story with an incident where a boy asked her to dance, then brought out a chair to the dance floor and stood on it so he could be as tall as she was. Everyone laughed, which made Natalie cry.

When I prompted her to consider a new ending to this story, she said, “Well I’ve been happily married for 15 years, and my husband said he was attracted to me because I was tall. He thought I looked like a graceful dancer.” She smiled and realized that ending her story this way suddenly caused the experiences she had with the boys in her youth to seem trivial.

Strategy #8: Prime With Play and Humor

Using play and humor are also great ways to dissipate anxiety and trigger new perspectives on events. Natalie and I acted out a role-play in which I let her play a woman with a snobby attitude teasing her while I played Natalie. She began the role-play by wrinkling her nose and saying,

“Who invited you to lunch with us, Amazon lady?”

I answered by simply saying, “Linda invited me.”

“Well I hope you don’t think I can be seen walking next to you, Sasquatch,” Natalie continued. And you should really consider doing something different with your hair.”

I smiled and replied, “Oh, what a shame. I fixed my hair this way just for you.”

Natalie laughed and we continued the role-play for a few more minutes. Letting Natalie play the character she feared reduced her anxiety because she realized how insecure a person would have to be to make such insensitive comments.

Strategy #9: Rouse With Rhythm and Music

Music can influence mood and neurochemistry, and it can entrain the brain to calmer states. One activity many clients enjoy is creating a playlist of tunes that evoke desired responses. Natalie started her playlist with “Creep” by Radiohead, which reflected her fears of being a social reject. Then we added “Everyday People,” by Sly and the Family Stone, which was more upbeat and affirmed that humans come in different colors, shapes, and sizes. Natalie ended her playlist with “Can’t Keep a Good Woman Down,” by Mary J. Blige, which helped her feel empowered.

Strategy #10: Integrate Mindful Movement

Movement can also engender desired states of mind. Dancing to her playlist helped Natalie shake off anticipatory anxiety, but I also suggested she could place her hand on her abdomen to calm her stomach and invoke a sense of self-compassion. She practiced this gesture while she slowed her breathing and imagined the beautiful redwood trees. Over the next several weeks, Natalie reported that her anxiety completely dissipated and she was able to comfortably enjoy lunch with her co-workers and other social situations.

Closing Thoughts

Neuroscience is now suggesting that in order to change recurring emotional and behavioral patterns, we can’t just talk about change at the cognitive level, we have to evoke an emotional experience that changes patterns in the emotional regions of the brain. Creating these emotional experiences not only triggers profound transformation, but it can also be fun and uplifting for both you and your clients.

I hope this post has given you ideas for new techniques you can use, and that it leads to many “Aha!” moments for you and your clients.

Courtney Armstrong, LPC, MHSP, is a licensed professional counselor in Chattanooga, Tenn., and the author of “The Therapeutic ‘Aha!’: 10 Strategies for Getting Your Clients Unstuck.” She also offers training and free resources for therapists at her website: www.courtneyarmstrong.net.

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phantom ghosts

Here’s a very interesting approach to grief and grief counseling based on “mirror therapy” in adults with phantom limb pain. What a cool connection this blogger has made between the two – I’m excited for both the development of the therapy for amputees as well as the implications the idea has for mental health practice!  (The article has more than a few typos, sorry)!

“I find myself thinking: is this so much different from phantom limb pain? There is a loss of connection between the afferent circuitry in the brain and the efferent circuitry emanating from the limb. When this disruption in the previously existing give and take is recognized, there is a painful experience as a consequence, when the limb is felt to still be present, even if it is an illusion, the pain miraculously subsides. Can we learn from research and innovation in phantom pain to help ease the suffering of those who have tragically lost loved ones? Can we apply this type of understanding to practical tools to help people with grief pain?”  Read more at Beyond Estate.

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a new take on addiction and treatment.

“Addiction is an adaptation. It’s not you. It’s your cage.”

The above quote and the below passages are from The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think by Johann Hari, author of ‘Chasing The Scream: The First and Last Days of the War on Drugs.’ Read the whole article, it’s worth it.

“This gives us an insight that goes much deeper than the need to understand addicts. Professor Peter Cohen argues that human beings have a deep need to bond and form connections. It’s how we get our satisfaction. If we can’t connect with each other, we will connect with anything we can find – the whirr of a roulette wheel or the prick of a syringe. He says we should stop talking about ‘addiction’ altogether, and instead call it ‘bonding’. A heroin addict has bonded with heroin because she couldn’t bond as fully with anything else…

…But still – surely, I asked, there is some role for the chemicals? It turns out there is an experiment which gives us the answer to this in quite precise terms, which I learned about in Richard DeGrandpre’s book ‘The Cult of Pharmacology.’

Everyone agrees cigarette smoking is one of the most addictive processes around. The chemical hooks in tobacco come a drug inside it called nicotine. So when nicotine patches were developed in the early 1990s, there was a huge surge of optimism – cigarette smokers could get all of their chemical hooks, without the other filthy (and deadly) effects of cigarette smoking. They would be freed.

But the Office of the Surgeon General has found that just 17.7 percent of cigarette smokers are able to stop using nicotine patches. That’s not nothing. If the chemicals drive 17.7 percent of addiction, as this shows, that’s still millions of life ruined globally. But what it reveals again is that the story we have been taught about The Cause of Addiction lying with chemical hooks is, in fact, real, but only a minor part of a much bigger picture.

This has huge implications for the one hundred year old war on drugs. This massive war – which, as I saw, kills people from the malls of Mexico to the streets of Liverpool – is based on the claim that we need to physically eradicate a whole array of chemicals because they hijack people’s brains and cause addiction. But if drugs aren’t the driver of addiction – if, in fact, it is disconnection that drives addiction – then this makes no sense.”

You can buy the book here.

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Back to Borderline.

“The urge was addictive, and I couldn’t think of anything else but ending my life. The ability to see how my death would hurt others was lost to me, and I still don’t quite know why I went back home after two hours. I stopped being angry, I think.

I have never considered suicide when depressed; even thinking about it would be too much effort in that situation. However, anger and panic are what drive me to think such thoughts, to harm myself, to chain-smoke and take more pills than I should. Any type of fear sends me into a blind panic; I just don’t know how to deal with the emotions. Or any emotion, really.”

From Halfway Between the Gutter.

While my therapist/psychiatrist and I established that I do not, clinically, have Borderline Personality Disorder (a constant nagging fear of which haunts me with surprising regularity), I definitely DO exhibit some serious BPD traits.  The above quote from HBG was like a lightbulb for me: it’s not depression that makes me think life is worthless, it’s anger and fear!  I’ve discussed my inability to name my emotions before, and with this new insight I feel like I have one more glimpse into the dysregulated organ that is my brain. Now to determine if I’m actually angry in these situations, or if it’s all a manifestation of fear. Specifically, the fear of being betrayed. Well, of being betrayed and not knowing about it. But still.

New goal: let’s separate the three emotions and figure out a better way to respond.  Like, now.  Actually like, two weeks ago would be nice. But you can’t undo the past, right? Dang it. #dbt.

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research.

Researchers at the University of Michigan School of Public Health and Medical School have teamed with the University of Southern California and the Broad Institute of Harvard and MIT for a four-year, $16 million study to better understanding bipolar disorder and schizophrenia.

It is the largest study of its kind funded to date, and the National Institute of Mental Health will provide the funding.

U-M will work with the partnering institutions to study the genetic material of 10,000 people of European, Hispanic and African-American descent. Researchers will study whole genome sequencing, where they will read all 3 billion pairs of DNA in each subject.

“We hope to gain a better understanding of these diseases that directly affect 1 percent of the population, but impact countless friends and relatives,” Michael Boehnke, principal investigator and director of the Center for Statistical Genetics, said in a statement.

“From what we learn, we hope we can identify better targets for drug development or better targets for the drugs we now have. We also could imagine improving our ability to predict who might get these diseases.”

Boehnke said the collaboration builds on previous research by these same investigators. They worked together on a smaller genome sequencing project, and each has a specific role in the work that begins this month.

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes mood shifts, and dramatic ups and downs in energy and activity level.

Schizophrenia is also a brain disorder that can cause people to have irrational fears, and other reports suggest that people who suffer from this disease have the feeling that people are reading their minds, controlling their thoughts or plotting against them.

There is clinical and genetic evidence of overlap of these illnesses, researchers say, which is cause for emphasizing the importance of a combined genetic analysis.

Symptoms of these disorders impact personal, social and vocational capabilities due to ongoing and fluctuating symptoms. Researchers say that suicide occurs in as many as 20 percent of cases.

Both conditions can be genetic and are thought to result from interactions between biological and environmental factors.”

Original article published on mLive.

Read a similar news release from USC’s Keck School of Medicine here.

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How can I help myself if I have borderline personality disorder?

“Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.”

To help yourself:

  • Talk to your doctor about treatment options and stick with treatment
  • Try to maintain a stable schedule of meals and sleep times
  • Engage in mild activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can, as you can
  • Try to spend time with other people and confide in a trusted friend or family member
  • Tell others about events or situations that may trigger symptoms
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people
  • Continue to educate yourself about this disorder.”

From the NIMH.

Looks like I have some work to do! Even if I’m not full-blown BPD, I have enough borderline traits that, as a good friend said today, something needs to happen.  Something has to change, because without getting myself together I’m changing my whole life for the worse.  By doing nothing I’m doing everything.  Time to take an active role in getting my life back to where I love it.

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