In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.
What is missing for these patients? Medication management.
Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece.
When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit. Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case.
During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence.
Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management.
Originally published on http://utvalleywellness.com/
Though almost half of marriages in the US end in divorce, most people who divorce successfully transition to their new life within two years. However, about 15% of divorces experience continued litigation. These cases exhibit a high degree of hostility and distrust between the spouses, making it difficult for them to communicate about the care of their children without involving the court. Often in high conflict divorce, it only takes one high conflict person to keep the dispute from resolving. If one spouse is noncompliant with the parenting plan and unwarrantedly denies the other parent access to the children, it compels the blocked parent to fight to not only see their children, but often to defend themselves against false allegations of abuse. The accused parent has two choices: either engage in conflict, or be separated from their precious children.
If you are experiencing denied visitations and an unwarranted campaign of denigration, you are most likely going through parental alienation. Those who have experienced it say it is one of the hardest things they have ever gone through. It requires developing advanced skills in order to cope. Parents who have been successful in dealing with parental alienation have developed the following skills:
- They sought knowledge. They read about parental alienation in order to understand why it happens, and what they could do to make it less difficult for their children. “Intellectually understanding parental alienation provides an emotional anchor to help make good decisions for yourself and your children.”1
- Reframe the meaning of your child’s behavior. For example, based on your current situation you may constantly tell yourself, “My child doesn’t love me anymore and never wants to see me again.” Try altering that statement to, “My child still loves me and wants to see me, but he is painted into a corner and is doing what he thinks he has to do in order to survive an experience that is as painful for him as it is for me.”2
- Stay even-tempered and never retaliate. “A person who reacts in anger is proving the alienator’s point that he or she is unstable.”3 Avoid falling into this trap.
- Don’t live a victim’s life. Although you are experiencing victimization, don’t live asif you have no power or worth.Deliberately take care of yourself. Eat healthy foods, stay socially connected, do something spiritual daily, exercise and get out in nature. Do things that you enjoy and that rejuvenate you.
- Be proactive. Always show up to pick up your kids even if you know they won’t be there. Keep a journal, and document what happens.
- Take a parenting class. Learn how to understand your children developmentally and respond empathetically.Develop superior parenting skills.
- Reduce your children’s anxiety. Find ways to reduce their anxiety when they are with you by picking your battles and not engaging in conflict.
- Never talk bad about your ex to your children.This forces them to align with the other parent against you, and paints you in a bad light.
- Try to make what little time you have with them positive and fun. It is through having fun that you gain connection and preserve your attachment.
- Find an alienation-aware therapist, and get the appropriate support and treatment you need.
Each time you board a plane you are reminded that if the oxygen masks drop, you need to put the mask on yourself first, before helping others. The same is true of parental alienation. You must deliberately take good care of yourself first if you are going to survive emotionally.
Custody and parent-time decisions are usually made by using what is called “The Best Interest of the Child” standard. This standard is intended to guard children from conflict and abuse, and to promote stability, but because it is vague, and not based on empirical evidence, it is susceptible to influences of what Edward Kruk, a social work researcher, describes as “judicial biases and preferences, professional self-interest, gender politics, the desire of a parent to remove the other parent from the child’s life, and the wishes of a parent who is found to be a danger to the child.”1 He argues that “a more child-focused approach to child custody determination is needed to reduce harm to children in the divorce transition and ensure their well-being.”2
What does the research show about the well-being of children of divorce? That shared physical parenting is the best custody determination for children. (This excludes cases of abuse, neglect, and parents with no prior relationship.) So why isn’t this the norm in most cases? It is because of Woozles and Zombies. Woozles are myths and misrepresentations of research that are not supported by evidence, but because they keep being repeated, they are believed to be true.3 Linda Nielsen, psychologist, and expert on shared parenting, explains,
To summarize briefly, the words “woozling” and “woozles” come from the children’s story, “Winnie the Pooh.” In the story the little bear, Winnie, dupes himself and his friends into believing that they are being followed by a scary beast – a beast he calls a woozle. Although they never actually see the woozle, they convince themselves it exists because they see its footprints next to theirs as they walk in circles around a tree. The footprints are, of course, their own. But Pooh and his friends are confident that they are onto something really big. Their foolish behavior is based on faulty “data” – and a woozle is born.4
Nielsen continues, “Nobel Prize-winning economist and New York Times columnist Paul Krugman (2014) wrote about a similar concept that he called a ‘zombie,’—a belief that ‘everyone important knows must be true, because everyone they know says it’s true. It’s a prime example of a zombie idea—an idea that should have been killed by evidence, but refuses to die. And it does a lot of harm.’”5
Some common Woozles and Zombies of shared parenting, followed by what research actually shows, include:
- Children want to live with only one parent and to have one home. Shared parenting is not worth the hassle.
When adult children of divorce were asked, they said having a relationship with both parents was worth any hassle they experienced in moving between homes.6
- Young children have one primary attachment figure, the mother, with whom they bond more strongly. Given this, it is hurtful for infants to spend any overnights with the other parent in the first year of life.7
The truth is that infants form different, but strong attachments to both parents and that “there is no evidence to support postponing the introduction of regular and frequent involvement, including overnights, of both parents with their babies and toddlers.”8
- Where there is high conflict between the parents, children do better with sole custody. Shared parenting only increases the conflict and puts the children in the middle.9
Conflict remains higher in sole- than in shared-custody families. Most children are not exposed to more conflict in shared-parenting families. Maintaining strong relationships with both parents helps diminish the negative impact of the parents’ conflict.10
- Shared parenting only works with those who agree to it, and is only successful for a small, cooperative group of parents who have little conflict.
The research shows that even if shared parenting was originally mandated, it leads to better adjustment for the children and less long-term conflict between the parents.11
Sadly, Woozles and Zombies can distort the facts about best practices for custody arrangements, but the research evidence is clear and irrefutable that a shared parenting model is truly optimal for families and “traditional visiting patterns . . . are . . . outdated, unnecessarily rigid, and restrictive, and fail in both the short and long term to address [the child’s] best interests (Kelly 2007).”12
1,2,12 Kruk, E. (2012). Arguments for an Equal Parental Responsibility Presumption in Contested Child Custody. The American Journal of Family Therapy, 40(1), 33-55. DOI:10.1080/01926187.2011.575344
5 Nielsen, L. (2015). Pop Goes the Woozle: Being Misled by Research on Child Custody and Parenting Plans, Journal of Divorce & Remarriage, 56:8, 595-633, DOI: 10.1080/10502556.2015.1092349
3, 4,8,10 Nielsen, L. (2015). Shared Physical Custody: Does It Benefit Most Children? Journal of the American Academy of Matrimonial Lawyers, 28, 79-138.
6,7,9,11 Nielsen, L. (2013, Jan. & feb.). Parenting Time & Shared Residential Custody: Ten Common Myths. https://issuu.com/nebraskabar/docs/janfeb_2013/1
WRITTEN BY MICHELLE JONES, LCSW
Michelle is the director of Concordia Families – a treatment center offering services for reunification, court involved therapy, parent education classes, treatment needs assessments and professional education seminars and classes.
Originally published in Utah Valley Wellness Magazine
Each branch of the mental health profession, including psychologists, marriage and family therapists, and social workers, has a code of ethics which outlines the values and standards which should guide the treatment they offer. For example, according to the Social Work Code of Ethics, “social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people (Code of Ethics, 2017).”1 Further, most exceptions to confidentiality are also based on the values of protecting the vulnerable in the population, meaning children and the elderly.
Within the arena of high-conflict divorce, there are children who are truly being subject to physical, sexual, and emotional/psychological abuse, and at the same time, there are also parents who make false allegations of child abuse in order to gain an advantage in court. When a professional becomes involved with these families, they need to explore multiple possibilities, and see the bigger picture of protecting the children against all forms of abuse. Reflexively denying contact between a parent and child in order to err on the “safe” side is not always the “safe” thing to do. Unnecessarily disrupting a healthy parent-child relationship actually enables psychological abuse.
First of all, therapists should take all claims of abuse seriously. Their obligation is to report it to the Division of Child and Family Services (DCFS). This agency will determine whether an investigation will be made, based on an assessment of risk factors. DCFS should be able to determine if the claim should be substantiated, whether it is a chronic problem or a one-time incident, or whether there is no evidence for the claim at all.
But when a parent makes false claims of abuse and unwarrantedly induces symptoms of anxiety or hatred in the child in order to destroy the child’s relationship with the ex-spouse, this is also an abuse known as parental alienation. It has been recognized as a form of psychological abuse, and is severely damaging to the child. A research article published in 2014, called, “Unseen Wounds: The Contribution of Psychological Maltreatment to Child and Adolescent Mental Health and Risk Outcomes,”2 examined the effects of psychological abuse. The lead author, Joseph Spinazzola, Ph.D., of The Trauma Center at Justice Resource Institute, Brookline, Massachusetts stated,
“Given the prevalence of childhood psychological abuse and the severity of harm to young victims, it should be at the forefront of mental health and social service training,” (APA, 2014).3
The American Professional Society on the Abuse of Children (APSAC)4 defines psychological abuse as five parental behaviors, as measured by the PMM and CAPM-CV scales:
- Spurning(In parental alienation, a parent withdraws love from the child to punish them when they connect to the other parent.)
- Terrorizing(In parental alienation, one parent induces fear of the other parent in the child.)
- Isolating(In parental alienation the child is cut off from the other parent and most likely the whole side of the family.)
- Corrupting/Exploiting(In parental alienation the child is encouraged to engage in behaviors that are cruel, disrespectful, and immoral in order to benefit the “favored” parent.)
- Denying Emotional Responsiveness(In parental alienation, the child is punished for accepting love from the other parent.)
In the latest version of the Diagnostic and Statistical manual, psychological abuse is defined as:
“…non-accidental verbal or symbolic acts by a child’s parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child.” (DSM 5, pg 719)5
If our fundamental value is to truly protect children, who are the most vulnerable in the population, then we need to raise the level of therapeutic competency through education and training, and do assessments which consider all forms of abuse, including parental alienation. Children should never be weaponized, and intervening systems should never enable it.
2 Spinazzola, J., Hodgdon, H., Liang, L., Ford, J. D., Layne, C. M., Pynoos, R., . . . Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy,6(Suppl 1), S18-S28. doi:10.1037/a0037766
3 Childhood Psychological Abuse as Harmful as Sexual or Physical Abuse. (n.d.). Retrieved March 25, 2018, from http://www.apa.org/news/press/releases/2014/10/psychological-abuse.aspx
4American Professional Society Abuse Children | APSAC. (n.d.). Retrieved March 25, 2018, from https://www.apsac.org/
5Diagnostic and statistical manual of mental disorders DSM-5. (2013). Washington: American Psychiatric Publ.
Originally published in Utah Valley Wellness Magazine
Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.
If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.
Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.”
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed.
Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.
What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember that at times symptoms of depression need to be treated just like any other medical condition.
Originally published on http://utvalleywellness.com/
Divorce is hard. It is emotionally and physically draining for all people involved, including children. When a divorce becomes high conflict, children are caught in the crossfire and are treated as “prizes” to be won. Parents start pressuring their children knowingly and/or unknowingly to choose sides. These behaviors can escalate to “alienation”. Alienation is defined as a parent teaching their children to reject the other parent using fear (Templer, 2). Due to limited research, professionals often mistake alienation for estrangement. This misdiagnosis can have devastating effects on a family.
One misconception about alienation is that the alienated parent is responsible for being rejected by their child, whereas the alienating parent is considered to have little to no part in why their child is rejecting the alienated parent. Discerning whether a parent has been alienated or estranged requires specialized skills and knowledge. Unfortunately, many professionals who are assigned to such cases often have little to no training in this area.
Misconceptions about alienation prevent families from getting the help they need and can even have legal ramifications. Here are some examples of harmful misconceptions:
- It is generally believed that if a child does not want to be with their parent it means they have done something to deserve it. However, the reason could be that the alienating parent programmed the child.
- It is generally believed that the child would not align with the abusive alienating parent. However, children are vulnerable to manipulation. The targeted parent often tries to enforce appropriate discipline and fill the hole left by the alienating parent. In so doing, the targeted parent is looked at harshly and viewed as not respecting their child’s wishes and feelings.
- Enmeshment (blurred boundaries between two individuals) can be confused with healthy bonding. When children feel that they are not recipients of unconditional love they can be manipulated into doing what the alienating parents desires.
Professionals who have these or other misconceptions may come to the conclusion that the alienating parent is stable, whereas the targeted parent is not; this instability, real or perceived, is often the result of depression, anxiety, and anger that’s developed from the trauma of being alienated. Another example is if the targeted parent is falsely accused of abusing their child; the parent may exhibit unstable due to the fear being jailed, losing their children, or financial pressure. The unfortunate reality is that even strong, emotionally stable individuals may become anxious, depressed, and angry when under the pressures of alienation.
Mental health professionals play a critical role in high conflict divorce cases and have the power to make things much worse or better. Given the high stakes, families are encouraged to carefully select a professional with the proper skills and training.
Written by Carol Kim, MS, LMFT. Carol is a therapist at Concordia Families, a clinic specializing in reunification therapy, court involved treatment and is parental alienation aware.
Reference: Kase-Gottlieb L. (2014, April 22). Missing the Alienation. Retrived from https://www.nationalparentsorganization.org/blog/16…/21679-missing-the-alienation
Counseling, if done right, is husband friendly! Find the right therapist and you’ll understand. The problem is that many husbands worry that the therapist is going to take their wife’s side and gang up on him, or that therapy will be uncomfortable. While the latter may be true, the former isn’t. A good therapist doesn’t take sides or act as a referee. I have had many couples want to hash out an argument in front of me in counseling so that I can tell them who is right. I stop them, and explain that even if one of them ended up right, that they would be so wrong in their rightness – their marriage would suffer because they insisted on being right instead of compassionate and forgiving. A good therapist, rather, is able to foster healthy interactions between spouses so that they both feel safe and are able to be vulnerable and genuine with each other. When husbands understand that what they feel and think is important, then they are more willing to make this uncomfortable leap with their spouse. Women are more likely than men to initiate therapy, but without buy-in from the man, it is difficult to be successful in therapy. My suggestion to women who want to initiate counseling, but have a reluctant spouse is to recognize that this is scary for your spouse. They may feel as if they will be attacked, or worse yet, that they will lose you. Help them understand that your desire for counseling is because you love him and because you want this to work – but aren’t sure how to make fix it. Ask him to give therapy at least 3 sessions – after that, if he still feels reluctant there might be another counselor or approach that you could try. Most men feel better about therapy after at least 3 sessions if you have the right therapist for you.
Originally published on www.tristonmorgan.com
Secrets fuel addiction. As I’ve mentioned before in previous posts, addictions, such as pornography addictions, are a shame-based experience. This means that when someone uses pornography they feel as if they are a bad person, rather than feeling that they are a good person despite making a mistake. When someone feels shame, they often compartmentalize what they have done – they hid it and separate it from who they think they really are, or, think that that mistake totally defines who they really are.
This is where secrets come into play. Over time, a man (or woman – I’ve worked with both in therapy for pornography issues) who has been using pornography and feeling shame because of it will gather many secrets. He won’t want to tell anyone what he is doing, or won’t want to tell them all that he is doing. He might only present the best parts of himself or just tell enough about his mistakes to others to appease them or to feel like he is being open. But, in fact, he is keeping secrets. These secrets start to bury him and make him feel more shame. They take an effort to maintain and keep hidden. They cause him stress and to feel disconnected from others. All of these things can lead to more addictive acting out.
Being transparent is key. This, in part, is why in the 12-step model of recovery (for alcohol, sexual addiction or substance addiction) addicts are asked to write a fearless moral inventory and to share it. Being open with others can feel uncomfortable and embarrassing. Many would say, “It’s in the past – let it stay there” or, “I don’t want to hurt her, so I’m not going to tell her about it”. These mindsets only make things worse for someone using pornography and their spouse/family. Telling others and being transparent is on the path towards recovery.
Pornography counseling offers a venue to be transparent and honest with yourself and with your loved ones. A good therapist will help you through this process in a way that might be painful, but certainly not shameful.
Originally published on www.tristonmorgan.com
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