Category: Therapy

feature-1-470x260_0

Pregnant Women Struggle with Managing Psychiatric Medication

00Child Development, Featured news, Health, Stress, Therapy, Trauma, Unclassified December, 17

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

–Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

feature-_-af5-470x260-fe5510d0d275a89fd87a25acc8b8aee46014c652

Trauma Exposure Linked to PTSD in 911 Dispatchers

00Featured news, Health, Post-Traumatic Stress Disorder, Therapy, Trauma, Work September, 17

Source: Public Domain at flickr

In February 2016, Gail—a 911 dispatcher with Toronto Paramedic Services—found herself in tears at work. She had just received a call about Wallace Passos, a three-year-old boy from Toronto, who fell from a 17-story apartment building to his death.

At age 57, Gail has been working as an Emergency Medical Dispatcher for 15 years. Taking calls from around the city, she dispatches the closest ambulance. All dispatchers are expected to work 12-hour shifts, at times with only one colleague on duty.

This past year, Gail’s job became especially difficult for her when she was diagnosed with Post Traumatic Stress Disorder (PTSD). Gail recently spoke with the Trauma and Mental Health Report to discuss the experience that led to the diagnosis:

“I’m still haunted by the sounds of the family crying on the phone after the three-year-old fell off the building. I imagine the boy in pain, and it’s just awful.”

Gail is not the first emergency dispatcher to experience PTSD symptoms. A study conducted by researchers at Northern Illinois University described how 911 dispatchers are exposed to duty-related trauma, which is defined as an indirect exposure to someone else’s traumatic experience. Duty-related trauma puts dispatchers at risk for developing PTSD. Participants in the study reported experiencing fear, helplessness, and horror in reaction to various calls they received.

Along with the stress of being on the receiving end of difficult calls, emergency dispatchers also deal with the pressure and demand of following protocol, despite variability in situations.

Toronto Paramedic Services follows specific protocols set by The National Academy of Dispatch. The system was developed at Salt Lake City, Utah in 1988 and incorporates a set of 33 protocols for those answering 911 emergency phone calls. On a call, everyone is treated equally and is asked the same basic investigative questions. These questions are then used to give priority to life-threatening situations and provide guidance to first responders like firefighters, paramedics, and police officers on the scene.

While the protocols can be useful for guiding dispatchers through stressful situations, in other circumstances, they can cause pain and discomfort when a dispatcher can tell that a situation is hopeless. Dispatchers are not trained to deal with each unique case differently; they are expected to follow through with the routine questions regardless of circumstances.

In the case of Wallace Passos, Gail had to give instructions for CPR despite knowing that the child was already dead.

“It’s not just that the little boy died, but I feel that I traumatized the people that were trying to help him because I was required, in my position as a dispatcher, to tell them what to do to try and save him. And I knew from their description that he was dead. But we have to follow the procedure; we have to try.”

This predicament is further compounded by the blame placed on dispatchers for negative outcomes. Gail explains:

“People curse us and call us names just because we’re doing our jobs.”

Before her diagnosis, Gail often found herself crying at work without reason; she would take a call regarding a minor injury and become emotional. Her supervisor eventually gave her permission to take a leave of absence.

Over the past few months she has had disruptive sleep, nightmares, headaches, and unexplainable muscle spasms:

“I am hyper-vigilant, especially when I hear sirens. And it doesn’t have to be an ambulance; it could be a police car or fire truck. I hear the sirens and I start tensing up and looking all around me.”

Gail has been on a year-long search for proper psychological support for her PTSD. Unfortunately, there are few mental health benefits offered to dispatchers. Gail sought help from doctors, counselors, and social workers, most of whom referred her to other mental healthcare workers without providing much support.

But there is reason to be optimistic. The Ontario government passed legislation in February 2016 for better mental health support and benefits for first responders with PTSD, including 911 dispatchers.

“It made me sad that no one was stepping up and taking care of us. I want my peers to understand what it’s like to have PTSD after doing this job because I felt so alone when it happened to me. But this new legislation is huge. I think it’s very important because it’s raising awareness around this concern.”

–Afifa Mahboob, Contributing Writer

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

feature-_-lg5-470x260-516d550639c32440ae9dcba31855b8a080ac5967

Using Mindfulness with Opioid Addicted Chronic Pain Patients

00Addiction, Chronic Pain, Featured news, Health, Mindfulness, Therapy August, 17

Source: frankieleon at flickr, Creative Commons

In March 2016, legislative bodies in Maine put a bill forward to combat the state’s rising opioid addiction problem. New restrictions on opioids for chronic pain require doctors to limit prescriptions to just 15 days, and to encourage doctors to consider non-medicinal forms of treatment.

Treatment of chronic pain involves a delicate balance between managing pain relief and risk of drug addiction or abuse. Opiates have been used for centuries to treat acute and chronic pain. There is little debate over the short-term benefits of medication, but their use for chronic, non-malignant pain is controversial.

Chronic pain is a debilitating lifelong illness, affecting more than six million Canadians. The National Institute of Health defines chronic pain as lasting for at least six months, and creating both physical and mental strain on the victim’s quality of life. Patients may experience fear, depression, hopelessness, and anxiety in coping with their pain.

At the annual 2013 American Psychiatric Association meeting, pain specialists debated how to properly treat chronic pain and explored new forms of non-medicinal treatment.

Jennifer Potter from the Department of Psychiatry at the University of Texas advocates continued use of opioid prescriptions, but cautions doctors to examine potential risk factors for substance abuse.

“The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse to be denying access to all people in pain who can benefit from opioids.”

But a 2015 study by Kevin Vowles and colleagues from the University of New Mexico found that, on average, 25% of chronic pain patients experience opioid misuse and 10% have an opioid addiction. So, we also need non-medicinal treatment options to care for lifelong pain.

“Patients with substance abuse issues can be treated for pain in a variety of ways that don’t involve opioids,” says Sean Mackey, Chief of the Pain Management Division at Stanford University and Associate Professor of Anaesthesia and Pain Management.

One alternative way to approach chronic pain is through mindfulness, described as the process of paying active, open attention to the present moment. When a person is mindful, they observe their own thoughts and feelings from a distance, without judging them as good or bad.

Mindfulness is based on acceptance of one’s current state, and is becoming increasingly popular among patients as a way to help with pain symptoms.

Jon Kabat-Zinn, founding Executive Director of the Center for Mindfulness at the University of Massachusetts, advocates for mindfulness-based strategies to be incorporated into chronic pain treatment programs.

Kabat-Zinn created the popular Mindfulness Based Stress Reduction approach designed to treat chronically ill patients responding poorly to medication. The eight-week stress reduction program involves both mindfulness practice and yoga, and is effective in alleviating pain and in decreasing mood disturbance and stress.

A study by Natalia Morone and colleagues at the VA Pittsburgh Healthcare System showed the benefits of mindfulness in older adults with chronic low back pain by looking at diary entries of participants throughout an eight-week mindfulness treatment program. They found that treatment improved attention, sleep, pain coping, and pain reduction through meditation.

Some participants gained better awareness of their body throughout treatment:

“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.”

The authors also found that practicing mindfulness helped participants create vivid imagery to enhance their mood and decrease pain. One patient noted:

“I hear a sound in the distance and felt it was bearing my pain away, replacing it with a joyful ‘lifting’ of my spirits.”

While no miracle treatment exists, mindfulness can help improve patient quality of life.

–Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report. 

Copyright Robert T. Muller

This article was originally published on Psychology Today

an2-_-feature-470x260-7440f2380cd5636ae268bedf13e5554c14b2482b

Barriers Prevent Soldiers From Seeking Psychological Help

00Featured news, Health, Post-Traumatic Stress Disorder, Psychopathy, Therapy, Trauma August, 17

After two tours of duty in Iraq, Sergeant Eric James of the United States Army returned home to Colorado where he began experiencing symptoms of Post-Traumatic Stress Disorder (PTSD).

James sought out a military psychiatrist for his declining mental health. In over 20 hours of recorded audio, therapists and officers at Fort Carson in Colorado can be heard berating James for suggesting he may be suffering from serious mental illness and ignoring his repeated requests for help. James was told that he was not emotionally crippled because he was “not in a corner rocking back and forth and drooling.”

James’ experience in seeking mental-health treatment may be indicative of a wider, systemic issue within the military. As pleas for help go unanswered, soldiers have begun to actively avoid mental health treatment, fearing consequences like forced retirement or reduced pay.

An article in the The Globe and Mail addressed one of these issues directly:

“Because Canadian Forces members do not earn a pension until they have served 10 years, this encourages some to wait until they’ve reached that milestone before asking the military for mental health counseling and other aid.”

Mental-health programs become inaccessible as soldiers are caught between a desire to seek out support and a fear of losing financial security, potentially losing their livelihood or living with declining mental health.

Worse, a 2012 Harvard Gazette report on the US Military stated that:

“Estimates of PTSD are higher when surveys are anonymous than when they are not anonymous.”

There may be consequences for soldiers who speak up about their mental health issues, and these consequences act as a barrier to seeking help.

It’s also possible that James’ case may be an example of the old “patch ’em up and send ’em back” approach to treating members of the military, whereby doctors and therapists devise a quick fix for physical and mental problems in an effort to get soldiers back into active duty.

Donald (name changed for anonymity), a current member of the Canadian Armed Forces, told the Trauma and Mental Health Report in an interview that painkillers and antidepressants are often prescribed in place of a more comprehensive approach to health concerns. These treatments address symptoms, but not the underlying causes.

Using medications to help sufferers of PTSD manage symptoms is an important aspect of treatment. But if supportive psychotherapy is provided either on its own or alongside drug therapy, the need for medications can be significantly decreased.

A study published with the American Psychiatric Association noted that:

“While treating PTSD with drug therapy has accumulated some empirical support, the Institute of Medicine rates trauma-focused cognitive behavioral therapy as the only first-level treatment for PTSD.”

And while proper treatment for PTSD is necessary, it can be expensive. An article from the LA Times reported a military estimate of treating PTSD to be $1.5 million over a soldier’s lifetime.

For James, after an internal investigation, he was ultimately sent for treatment and received a medical retirement with benefits. Many of our military personnel receive no treatment at all, leaving them to struggle with PTSD on their own.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report.
–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller

This article was originally published on Psychology Today

lb3-_-feature-470x260-58e392185f3b82cd27e26cda1d8cbefffc2aa25d

A Hands-On Approach to Psychotherapy?

00Empathy, Featured news, Health, Therapy, Trauma July, 17

Source: stux at Pixabay, Creative Commons

A friend of mine, Sigourney (name changed), once told me she would never see a therapist who wouldn’t hug her. Adamant that non-sexual touch in therapy helped her feel connected, she characterized a therapist who wouldn’t touch her as rejecting, cold, and untrustworthy.

The subject of non-sexual touch in therapy is controversial, and seems to vary depending on the professional training of the clinician. A study of clinical psychologists by Cheryl Stenzel and Patricia Rupert of Loyola University shows that many practitioners worry touch can be misinterpreted as erotic, or can damage a vulnerable client. There is also the risk of ethical complaints, so most psychologists refrain from touching clients under any circumstances.

In contrast, a summary of research by James Phelan of the American Psychoanalytic Association shows that, in surveys of psychotherapists and social workers, more than 80% touch their clients in non-erotic ways. This touch might include a pat on the arm or back, a side hug, or a full-on embrace.

So, when is touch appropriate in a therapy session?

Little training or discussion exists on therapeutic touch. Students of psychotherapy are often left confused, unsure of how to proceed, and afraid to broach the topic with their supervisors. The ethics code of the American Psychological Association does not prohibit non-sexual touch, while sexual contact, of course, is forbidden. In an interview with the Trauma and Mental Health Report, social worker Cara Grosset, a 20-year practitioner of trauma counselling, says that touching a client depends on the context and the person.

“I work with children and adolescents who have experienced or witnessed severe traumas. They may have discovered a parent who died from suicide or seen their parent killed. If they are sobbing uncontrollably in a session when describing this experience, it seems almost inhuman to not reach out with a comforting and appropriate touch.”

Grosset sees many of her clients in group situations, such as summer camps for grieving youth. In this type of setting, a soothing side hug or pat on the back during a difficult discussion happens publicly, leaving little room for misinterpretation. She has found that these gestures help the healing process.

Another example of successful non-sexual touch happens when Grosset facilitates therapy with children and their parents. Some of her young clients run to her at the beginning of a session to hug her as their parents stand by. An affirming response from Grosset is important for the child to feel nurtured and valued.

But Grosset understands why some therapists are reluctant. Many clients don’t want to be touched, and it’s important to know each person’s boundaries. Touch must be for the client’s sake, not the therapist’s. And when touch helps build connection with the client, it can be a beneficial adjunct to talk therapy.

At the same time, touch can be difficult to navigate in private sessions due to ambiguous professional guidelines and taboos surrounding touch in this type of setting. Grosset’s viewpoints are substantiated by other therapists in qualitative research by Carmel Harrison and colleagues at Bangor University in Wales:

“The values of touch included the ideas that touch could offer clients support, acknowledgement and containment. Despite this, all therapists emphasised the rarity and cautious use of touch in their practice. They discussed touch as being outside the remit of clinicians, and considered how limited discussion and training perpetuated this belief.”

It’s easy to find opposing points of view. Some clients feel that a touch from their therapist increases their self-esteem and enables them to move past feelings of worthlessness. For example, a response to a blog on the website ‘Jung at Heart’ read:

“Twenty years ago, my therapy sessions were, after the first six months to a year, almost always punctuated at the end by a hug. Those hugs saved my young life.”

On the same website, others state that they would feel awkward and violated by a therapist’s touch:

“As a therapy client, I really don’t want my therapist touching me. Not a hug, or a pat of the shoulder, or even a handshake.”

In a 2015 New York Times blog, psychotherapist Hilary Jacobs Hendel explains how she spontaneously hugged a client, but still feels uncomfortable about integrating touch into her practice. Instead, she uses imaginary touch, asking her clients to visualize hugs: “Even when I think a physical hug would be therapeutic, I continue to rely on fantasy.” This unique workaround ties back to concerns of actually touching clients.

The benefit of non-sexual touch in therapy is still open to interpretation. Even thoughresearch shows that human touch is important to wellbeing, individual clients and therapists differ greatly in their beliefs on the subject, and risk-management leans toward using it sparingly if at all.

–Lysianne Buie, Contributing Writer, The Trauma and Mental Health Report.
–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

feature-470x260-43a74536f236a495ef7d7c28fca8bc2e9e661e81

Losing a Pregnancy Only to Lose One Again

00Fear, Featured news, Grief, Pregnancy, Resilience, Therapy, Trauma July, 17

Source: margimadness, Deviant Art

Anna R. was having an ultrasound, prepared to see her baby for the first time. When she asked the technician what the sex of the baby was, the tech quickly left the room. The physician then entered to tell Anna there was no heartbeat. This became the first of seven pregnancy losses that she would endure.

Recurrent pregnancy loss (RPL) is typically defined as three consecutive losses prior to 20 weeks from the last menstrual period.

Affecting 1-2% of women, the causes of RPL differ. Advancing maternal age is associated with elevated risks of miscarriages, particularly in women 45 or older. Paternal age can also be a variable, with environmental and genetic factors playing a role as well. The risk of miscarriages further increases with the number of previous miscarriages, reaching approximately 40% after three consecutive losses.

While these causes have been established within the medical community, doctors still struggle to predict what ultimately leads to a couple’s pregnancy loss. Even after numerous tests, Anna’s physicians never found anything wrong, making the loss that much harder to cope with.

After her eighth miscarriage, Tracey Beadle of County Durham, UK told The Northern Echo:

“I think I wanted for them to find something wrong, because that would mean something could either be fixed or give us a reason to stop trying for a baby. We did not know when to stop.”

Janet Jaffe, a clinical psychologist and co-author of the book “Reproductive Trauma: Psychotherapy with Infertility and Pregnancy Loss Clients”, told the American Psychological Association:

“A miscarriage is a traumatic loss, not only of the pregnancy, but of a woman’s sense of self and her hopes and dreams of the future. She has lost her ‘reproductive story’, and it needs to be grieved.”

This grief is unique, in that expectant mothers and fathers mourn a child that never came to be. As Kate Evans, a woman who had six miscarriages said in an article in the Independent:

“If there’s no body, how can I grieve? I feel as though I must be kidding myself, wallowing in a morass of grief over a person who never even lived. Every time my mind trips back to this death, this loss, it strikes on empty, because there’s nothing there to miss.”

While there is no physical body to grieve, the hopes and dreams for a future with the child are ultimately the elements missed the most.

This grief is further complicated by feelings of isolation. When a loved one dies, there is often comfort in collective mourning with other grief-stricken individuals. But grieving the loss of a pregnancy can be an isolating experience for parents, as others haven’t formed the same connection with the unborn child and may struggle to understand why the experience is so painful.

Outsiders may also lack empathy for the mother’s experiences and fault her for the outcome of the pregnancy. Anna explained that people unintentionally implied that she was to blame for her miscarriage through comments like, “Do the doctors know what’s wrong with you?” or “Maybe you weren’t taking good care of yourself.”

RPL has been shown to severely disrupt the parents’ mental health. According to astudy by psychiatrist Michael Craig and colleagues at the Institute of Psychiatry, King’s College London, of 81 women with recurrent miscarriages, 33% were classified as depressed, with 7.4% suffering from severe depression. And 21% of the women also had clinically significant anxiety, while some experienced heightened anger and guilt.

Research documenting fathers’ grieving processes showed that, unlike women, many men do not react with increased depressive symptoms, crying, or feeling the need to talk. But similar to women, a major source of grieving arises from relinquishing their hopes and expectations for their unborn child.

While physical treatments for RPL include surgeries, medications, genetic screening, and lifestyle changes, the emotional and psychological toll must also be addressed.

A report by the Practice Committee of the American Society for Reproductive Medicine indicates that psychological support in early pregnancy results in significant improvement of pregnancy outcomes. Psychotherapy can also help work out anxieties and fears from previous miscarriages.

According to Anna, therapy was what helped her through seven painful miscarriages:

“My therapist became my saving grace. I could comfortably tell her anything and everything—especially things I didn’t want to discuss with my husband, like thoughts of suicide. She was the voice of reason in my confused and isolated world.”

Individuals can find additional help through in-person support groups at local organizations, or through online sites, such as the Baby Center, which offer web-based clubs and blogs. Connecting with these groups allows individuals to interact with others experiencing the same grief, which may reduce feelings of isolation.

In the midst of hopelessness, people may feel safer bracing themselves for more heartache. But it is important to remember that, even after four consecutive losses, a patient has a greater than 60% to 65% chance of carrying the next pregnancy to term. In the meantime, seeking psychological support to work through the anxiety and grief may be beneficial.

–Eleenor Abraham, Contributing Writer, The Trauma and Mental Health Report.

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report.

Copyright Robert T. Muller.

This article was originally published on Psychology Today

michael-at-flickr-470x260-bd7bff8112620d5050e8288b933cde7d365585ff

Conversation Cards Help Therapists Dig Deeper

00Child Development, Education, Featured news, Parenting, Therapy, Trauma June, 17

Source: Michael on flickr, Creative Commons

As a counselor, social worker, or therapist, how do you begin conversations with your clients? What are the best ways to break the ice and generate meaningful discussions? These are questions that Jane Evans, trauma, parenting and behaviour expert, found to be common among her colleagues in the field.

Evans is a therapist and member of NEYTCO, the National Early Years Trainers and Consultants Organization, located in the UK. She has spent over 20 years working with parents and children who experience difficulty in relationships.

In an interview with the Trauma and Mental Health Report, Evans explains:

“I find that many practitioners don’t entirely understand childhood trauma and they struggle to talk to parents about it.”

To facilitate more open dialogue, Evans created Fink Cards—a conversation tool that provides structure to therapy sessions and helps therapists and clients engage in meaningful discussions. The Cards list questions to help parents who have trouble communicating and forming a good relationship with their children. And the Cards help parents and families who have encountered trauma in the past.

Since Evans sees trauma as a major factor in difficult parent-child relationships, she directly addresses this issue with the Fink Cards. They ask questions like “what does the word trauma make you think about?” to open the door to therapy work. The Cards support the counselor in facilitating discussion, and assist clients.

Evans found, while working with families, that parents are not always aware of how their own actions, as well as their interactions with the child, may in fact perpetuate problem behaviours. She says:

“Most parents see the child as the problem; they’re always aiming to fix the child. However, these cards invite them on a different journey. Parents consider what has happened early in their own lives or in their child’s early years and how that impacts their child’s behaviour now.”

Questions like “who was in charge of discipline when you were a child?” and “who notices when you are worried or anxious?” help parents reflect on how their early experiences and current support systems shape their parenting practices, as well as any negative impact these may be having on the child. As parents consider how these events impact their parenting choices, the therapist is able to work with them to implement more effective methods of communication and alternative coping strategies.

Research has shown that conversation cards can help patients become more open about their feelings. In a study conducted by researchers at Stratheden Hospital in the UK, 6D cards were used to facilitate holistic, patient-led communication. 6D cards are a type of conversation card developed to help physicians and nurses ensure a meaningful consultation with female patients in a gynecology clinic. They contain six categories, or dimensions, of health, including healthcare, emotions, lifestyle, interpersonal relationships, symptoms, and life events. The purpose of these cards is to allow the patients to lead the conversation.

Another study, conducted by the Design Council of the UK and the Bolton Primary Care Trust, focused on creating stronger methods of communication and management for diabetic patients with the use of Agent Cards, which are similar to both the 6D and Fink Cards. Agent Card statements encourage patient-led conversations with practitioners. Results of the study showed that using the cards helped facilitate more open discussion.

With Evans’ Fink Cards, clients have the freedom to choose questions from four categories during sessions: the parent’s early childhood and upbringing; the parent’s relationship with his or her child; the parent and child’s worries and anxieties; and how early trauma may have affected the child.

“These cards are a way of having difficult conversations, but it’s not just me putting the questions to the patient and saying ‘you have a problem,’” Evans explains.

While the effectiveness of Fink Cards does require more research, they have already made their way into the marketplace, and look to be a promising resource in clinical settings. Sometimes building rapport or discussing sensitive topics with a client can be difficult, but Fink Cards may go a long way in helping therapists and clients ease into healthy conversations in an educational and comfortable way.

–Afifa Mahboob, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller.

This article was originally published on Psychology Today

1234_3-ea5a4d96e3cadee8dc854a007780e5666b80ba0b

Male Rape Victims Face Difficulty Finding Support

00Depression, Featured news, Post-Traumatic Stress Disorder, Suicide, Therapy, Trauma April, 17

Source: Fabrizio Lonzini on flickr, Creative Commons

In October 2015, Sweden opened the world’s first male rape center. It is the only known center that provides emergency medical care for men and boys who are victims of rape or sexual abuse. Although most rape centers don’t turn male victims away, there are no others that cater specifically to the physical and emotional needs of men who undergo such trauma.

The issue of male-on-male, and especially female-on-male rape and sexual abuse is largely unacknowledged in part because these forms of trauma are much less common than those involving a female victim. Statistics Canada reports that approximately 8% of sexual assaults involve a male victim.

In the 1980s, the word “rape” was removed from the Criminal Code of Canada and replaced by three different levels of sexual assault, specified by whether or not force or threats were involved and to what degree they were present. The problem with this approach is that “sexual assault” sounds like a lesser issue; it doesn’t carry the same weight as “rape”.

In October 2013, Kirk Makin wrote in an article for The Globe and Mail:

“Instead of the loaded word rape—with all its moral and social baggage—three levels of sexual assault were written into law, each level escalating in gravity. But getting rid of the legal term ‘rape’ didn’t stop it. In fact, many argue that it profoundly defanged the justice system and has resulted in lighter—not tougher—sentencing.”

Terminology may partly account for a lack of male rape centers, but so might the negative cultural view of a man being raped, particularly by a woman.

Popular culture and the media typically portray rape as involving penetration, which assumes only a male can perpetrate it. So, the common view is that men cannot be raped by women. For example, if a victim tells a friend he’s experienced unwanted sexual activity, the friend’s reaction is likely to be as congratulatory as horrified. And the victim is less likely to report the crime. An article on rape from Stanford University’s Encyclopedia of Philosophy even states in its premise the assumption that perpetrators are male and that victims are female, disregarding the issue of male rape altogether.

There is a common sentiment that men are always open to sexual advances and, therefore, automatically consent. This misconception can lead to situations where, if a man is intoxicated or otherwise unable to provide consent, he may subsequently be sexually assaulted. Contrary to stereotypes, the common view of “no means no” applies to both genders, and a lack of consent is just as significant as an expression of non-consent.

Another problem focuses on the male-on-male rape that occurs in prisons. Jokes about not “dropping the soap” are rampant in the media, giving the impression that, since these individuals are criminals, they should expect—indeed deserve—sexual assault.

And rape committed in prisons is not even included in national statistics, an omission that has the effect of failing to prevent abuse, as well as diminishing the issue. As a result, there is an insufficient allocation of resources for victims within the prison system. Victims require both emergency medical services, as well as counselling, to address the physical and emotional damage of sexual violence.

The opening of a male rape center in Sweden is a positive step, suggesting some progress toward support for male rape victims. But on a broader scale, the problem goes unacknowledged. Attitudes cannot change without a more systemic shift in how male rape is viewed and addressed.

–Andrei Nistor, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Feature-1-470x260-9045ce9cc813e47d7e994deb1ab39405fbfbed21

Remote Northwest Territories Lacking Mental Health Care

00Environment, Featured news, Health, Self-Harm, Suicide, Therapy, Trauma November, 16

Source: Gloria Williams on Flickr, Creative Commons

On April 26, 2015, 19-year-old Timothy Henderson, a resident of the North West Territories in Canada, was taken off life support after sustaining self-harm injuries, the culmination of a long battle with depression and other mental health issues.

Beginning in adolescence, Timothy struggled with symptoms of ADHD and Asperger’s syndrome (Autism spectrum). When he felt overwhelmed by his condition, he reached out for support, but felt dismissed, and began to lose hope that the help he needed would be available.

Shortly before his death, Timothy admitted himself to Stanton Territorial Hospital for the fifth time in a year, where he again disclosed details about a tendency to self-harm. He was released two days later, without adequate follow-up or a long-term care plan. Later that month, he sustained self-inflicted injuries that led to his death.

Timothy’s case is not uncommon in the Northwest Territories, a remote region of northern Canada. The NWT Mental Health Act states that a medical practitioner can only detain an individual for psychiatric assessment for a maximum of 48 hours. This time limitation often results in rushed and insufficient care—a result of a system that is understaffed and overworked.

The territory’s current Mental Health Act, introduced in June 1988, has been cited as a main cause of inadequate services for individuals suffering from mental illness. The act is out-of-date and has not been modernized with strategies to address the current mental health climate of the NWT.

In a report by the Alternative North Health Coalition, the mental wellbeing of residents in the NWT is shown to be much lower than that of the average Canadian, with a national rate of suicide three times greater than those living in the more populous south. Lack of access to staff, resources, and community-based treatments are all relevant aspects of the act that impede adequate treatment and prevention strategies.

Timothy’s mother, Connie Boraski, believes Timothy’s mental health began to worsen when he turned 17, and no longer qualified for the pediatric healthcare program. This transition resulted in lengthier waits for treatment and drastic changes in privacy laws that prevented Timothy’s parents from having access to information about their son’s treatment. Mental health legislation regarding the legal rights of family members and other caregivers is an aspect of the Mental Health Act that restricts parents, like Timothy’s, from intervening to support their children.

After being repeatedly dismissed, Timothy eventually stopped asking for help. Boraski explains:

“Timothy never wanted to be a burden to anyone. That was a real challenge for him, to ask for help.”

Deficiencies in the quality and quantity of staff and resources reflect the isolation and socioeconomic climate of the NWT. Due to the small and relatively isolated nature of the region, accessing facilities within the community can be difficult. Timothy had to travel between hospitals in the NWT and Alberta to obtain psychiatric help, which resulted in seeing a different doctor on each occasion. This kind of disjointed doctor-patient relationship makes it difficult to stay connected.

The public outrage following Timothy’s death eventually drove NWT Health Minister, Glen Abernethy, to open a review into Timothy’s case and bring changes to mental health legislation. In addition to other important components, the new act will include information on services such as Assertive Community Treatment (ACT), which will allow patients to have access to specialized treatment and supervision within remote communities of the NWT.

The revised act, if passed, is expected to come into effect sometime in 2016. Though implementation of a new mental health act is too late for Timothy Henderson, the hope is that a new mandate will provide the Northwest Territories with better preventative measures and resources for residents suffering with mental illness.

– Nonna Khakpour, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Feature-1-470x260-6dfc53843e200946225a7a3504ce754e821dc011

Illustrating Mental Health with Cartoons

00Charisma, Creativity, Depression, Featured news, Health, Humor, Therapy November, 16

Source: Allie Brosh

From the darkness of despair, Gemma Correll and Allie Brosh have created deeply personal cartoons to illustrate their experiences with mental illness. Maintaining popular online blogs, they have recently published cartoon books revealing their innermost struggles and fears.

Through simple drawings, Correll and Brosh make it easy for audiences to grasp the intricate aspects of psychological disorders. The unique illustrations are designed to be informative, yet dark and humorous.

In her 2015 book, The Worrier’s Guide to Life, Correll portrays her experience with anxiety, including unwanted intrusions from unexpected guests and unwelcome phone calls that one would prefer to avoid. She labels them “Real Life Horror Movies.”

Another example of Correll’s sharp humour comes in the form of a red poster, shouting: “I can’t keep calm and carry on because I have an anxiety disorder.”

Though the images are vital to the message, the corresponding narratives are equally important. Correll explains her images only make sense in combination with the words. One poignant cartoon called “Visit Depression Land! It’s the crappiest place on earth,”depicts a “non” amusement park with commentary on all of the “non” amusing things you can do while visiting.

The comics are both painful and funny. One of Correll’s fans sums up the experience on Twitter: “I’m laughing but I’m also crying. But I’m also laughing.”

A common thread in the struggle with mental illness is the accompanying isolation; in these comics, readers see themselves and their situations, and perhaps realize that they are not alone in the experience. In an interview with NPR, Correll explains, “I think people are really glad to find somebody who’s had the same kind of experience. Anxiety and depression can make you feel quite isolated.”

This sentiment was echoed by Brosh in an online Reddit question and answer session:

“Depression is such an isolating experience, but there’s always a tiny amount of comfort from knowing that someone else has been out there too. I mean, I never thought that writing about my depression would circle back around and make me feel less isolated, but in a strange way, it has.”

Although depression can be difficult to explain, Brosh chronicles it with startling clarity in her blog Hyperbole and a Half:

“I spent months shut in my house. I couldn’t feel anything through the self-hatred. Trying to use willpower to overcome the apathetic sort of sadness that accompanies depression is like a person with no arms trying to punch themselves until their hands grow back.”

In another blog entry with an accompanying cartoon, Brosh captures how depression feels:

“You’re stuck in the boring, lonely, meaningless void without anything to distract you from how boring, lonely, and meaningless it is.”

Brosh painstakingly works to get the facial expressions and body stances of her characters just right, to depict the emotions she wants to convey. Visual cues give meaning where words fail.

Depression is often misunderstood by those who don’t suffer from it. Many think that giving advice and imposing optimism are the answers. Brosh illustrates this disconnect.

Psychologists and professors are taking note—sharing the blogs widely and using them as teaching tools.

Psychologist Jonathan Rottenberg of the University of South Florida devoted a post on Psychology Today to Brosh:

“I know of no better depiction of the guts of what it’s like to be severely depressed. If you’ve been severely depressed, or if you know someone who is and you want to know more about what they are experiencing, please read ‘Hyperbole and a Half.’ “

Psychotherapist, psychology student, and Reddit user ‘busterbrother’ also explains on Reddit how the cartoons made a difference in her practice and at school. One of her suicidal clients struggling with depression felt that no one understood. Using Brosh’s blog, the therapist could offer an account of someone facing similar difficulties. ‘Busterbrother’ also used the blog in a presentation to illustrate depression to others in her cohort, after which her professor began incorporating it into his own classes:

“The professor said that this blog is the best way that he has ever seen someone talk about depression to someone who has never experienced it.”

This idea is supported by research. In the International Journal of Humor Research, Yan Piaw Chua, a professor at the University of Malaya in Malaysia, demonstrated how this type of humour can enhance student comprehension and motivation to learn. And studies show that humour can improve wellbeing and reduce depression.

Researchers Shelley Crawford and Nerina Caltabiano at James Cook University in Australia developed a humour skills program that included a booklet with jokes and funny stories. They found that participants achieved heightened wellbeing, as well as decreased depression and anxiety, in comparison to groups that received treatment without humour or no treatment at all. Other studies have shown similar results.

As one reader put it: “…these comic strips make my day whenever I am feeling a little glum and need an instant pick-me-up.”

Being able to communicate feelings of depression and anxiety without being judged, and doing so creatively… what better way to combat demons?

–Lysianne Buie, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today