Category: Therapy News

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What Can A Lizard Tell Us About Mental Health?

00Therapy News September, 18

A new study on lizards has found that, when exposed to stress, their responses can be passed down genetically. Scientists now believe there may be more to the process of heritability than once thought. This process is called “Transgenerational Stress Inheritance.”

As recently as 2011, most research did not examine the possibility that parental stress could affect sperm or egg cells. Since genes are transferred to offspring through these cells, anything that modifies them can have an impact on genetic expression in children. The idea that parents’ experiences prior to pregnancy can change gene expression and, therefore, affect offspring behaviour, is novel.

In the lizard study, researchers from Pennsylvania State University exposed young lizards to fire ants (a natural stressor) and compared stress levels to unexposed lizards. Interestingly, contact with the stressor did not affect the lizards’ behaviour later in life. But, their offspring had stronger stress reactions than offspring of lizards who had not been subjected to the ants.

Lead researcher Gail McCormick told PsyPost:

“Our work reveals that the stress experienced by an individual’s parents or ancestors may overshadow the stress that an individual faces within its lifetime. In this study, offspring of lizards from high-stress sites were more responsive to stress as adults, regardless of exposure to stress during their own lifetime.”

These findings suggest that, although early life stress may not manifest later in adulthood, the effects may be passed down to offspring, even if offspring are not directly exposed to the stressor.

similar study involved researchers conditioning mice to associate the smell of cherries with a mild electric current. When the fragrance permeated the air, the mice were given a small electric shock. And so, the mice began to fear the scent even when the shock wasn’t administered. Even more fascinating was that offspring of these mice, as well as their offspring, experienced fear in the presence of the odor. The fear reaction occurred even though the later generations didn’t experience the conditioning process.

Of course, the question these studies pose is whether there is a similar effect in humans.

As recently reported in the Guardian newspaper, researchers from New York’s Mount Sinai School of Medicine compared the genes of direct descendants of Jews who were “interned in a Nazi concentration camp, witnessed or experienced torture or who had had to hide during the second world war” to the offspring of Jews living outside of Europe who were unharmed. The children of parents who experienced WWII trauma showed genetic changes and a greater risk of stress disorders. These were not present in the other children. The Guardian article stated:

“[The] new finding is [a] clear example in humans of the theory of epigenetic inheritance: the idea that environmental factors can affect the genes of your children.”

In other research, psychologist Margaret Keyes from the University of Minnesota and colleagues examined twins to determine if the behaviour of biological parents could affect offspring who were not raised by them. The study found that children of parents who smoked were more likely to be smokers, even if those children weren’t raised by the parents, and as such, did not have parental smoking behavior modeled to them. Scientists are still questioning, though, whether it’s parental behavior directly affecting these genes or a genetic predisposition to smoking being passed down for generations.

On the whole, these studies make the case that genetic changes can happen a lot faster than previously thought, within a few generations or even one generation. And, as reported in Science magazine, people can see evolution in real time:

“Now, thanks to the genomic revolution, researchers can actually track the population-level genetic shifts that mark evolution in action—and they’re doing this in humans. [Studies] show how our genomes have changed over centuries or decades…”

Research in this field is still new and is subject to several caveats. Perhaps the most important one is the complexity of human beings and their environments. Indeed, there may be too many variables that factor into the human experience for researchers to arrive at definitive conclusions.

But, these studies do suggest that individuals may be affected by the stress felt by ancestors in  before them. Further research is required to determine whether these findings are the result of transgenerational stress inheritance or an external factor that has yet to be considered.

– Andrei Nistor, Contributing Writer

Image Credits
Feature: Hayke Tjemmes at flickr, Creative Commons
First: Hartwig HKD at flickr, Creative Commons
Second: Blondinrikard Fröberg at flickr, Creative Commons

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Prison Executioners Face Job-Related Trauma

00Therapy News September, 18

When an order of execution is issued by the courts in the United States, the prison warden or superintendent is responsible for the sentence being carried out—often by Corrections Officers (CO) who are unaware they will be tasked with killing a prisoner.

Complicating matters, human connections are frequently formed between guards and prisoners. According to Jerry Givens, who administered the death penalty in Virginia to 62 inmates over 25 years, COs may spend more time with death-row prisoners than with friends or family, and can develop empathy towards these inmates.

With potential bonds between death-row guards and prisoners in mind, a separate team of officers frequently conducts the actual execution. COs directly involved with the prisoners are often given smaller roles, such as walking the prisoners to the execution spot, or putting a hood over their head. This approach aims to reduce the emotionally damaging effects of executions on those in close contact with the inmates.

Authorities also try to disperse feelings of responsibility for the killing by having multiple guards involved in the execution process. With lethal injection, the method of execution used in most States, three COs are assigned to turn a key switch that releases the lethal drug into the prisoner. Only one “live” switch dispenses the fatal chemical. The CO initiating the procedure that ultimately kills the prisoner is not known.

Despite such measures, guards can feel mentally tortured by their participation in executions, both before and after.

As illustrated in Into the Abyss, a documentary detailing the death sentence of convicted killer Michael Perry, many execution guards experience post-traumatic stress disorder (PTSD). One guard explained his acute symptoms at the outset of his descent into PTSD. He began crying and shaking uncontrollably when “the eyes of all the inmates he had executed began flashing before him.” Another developed nightmares, cold sweats, and sleeplessness.

Other guards, like Givens, have reported depression, inability to sustain relationships, and changes in personality. According to Rachel MacNair, author of Perpetration-Induced Traumatic Stress: The Psychological Consequences of Killing:

“The inner lives of guards who execute become like those of battlefield veterans who suppress memories from themselves and others.”

In 2007, two South Carolina COs who developed obsessive compulsive behaviour, nightmares, and other emotional disturbances filed civil lawsuits, claiming that their conditions resulted from performing executions. The COs alleged that they were coerced into carrying out executions and were not given any debriefing or counselling to help them deal with the emotional effects.

For some guards who need psychological treatment, it is simply not available. Other times, guards do not use available psychological help for fear of being labelled ‘weak’ by their colleagues. Additionally, guards may not have the opportunity to talk about their involvement in executions with members of their families. Givens explained:

When I accepted the job, I never told my wife or kids or anybody. I didn’t want them to go through anything I had to go through. If I told someone, they would tell someone. It would have been like a snowball and gotten bigger and bigger and everyone would know exactly what I was doing.

This secrecy protects guards from having to explain or defend their actions. But it also prevents them from obtaining help to lessen the ill-effects of the associated trauma. Lack of disclosure precludes obtaining support.

The unacknowledged stress experienced by guards on execution teams risks dangerous mental-health consequences. As Givens, who now campaigns to end the death penalty, put it:

“It’s not an easy task to do. If I had known what I had to go through as an executioner, I wouldn’t have done it. You can’t tell me I can take the life of people and go home and be normal.”

– Veerpal Bambrah, Contributing Writer

Image Credits
Feature: Fumigraphik at flickr, Creative Commons
First: CACorrections at Wikimedia Commons, Public Domain
Second: Alexis Fracois at flickr, Creative Commons

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Man to Monster

00Therapy News May, 18

Anatomy of Violence, a film directed by Deepa Mehta, takes viewers on an emotional journey, illustrating how we create perpetrators of violence against women.

Mehta made the film after hearing about the gang rape of Jyoti Singh in Delhi, India. The BBC news reported that an off-duty driver took his bus for a joyride with five friends. When Jyoti boarded the bus, believing it was on-duty public transportation, the men raped her and beat her with iron bars. She died of the injuries.

According to the BBC, a rape victim cannot be publicly named under Indian law to protect the family from shame. In defiance, Jyoti’s mother Asha Singh stated in a public gathering after the attack:

“I say this in front of you all that her name was Jyoti Singh.”

The significance of her actions cannot be overstated. Jyoti’s mother said she had no shame in being known as the mother of a rape victim—it was the perpetrators who should feel shame.

Jyoti’s death sparked outrage across India, and brought public attention to the false belief that women are to blame when assaulted. Although media coverage focused on the victim, filmmaker Mehta decided to analyse what led the men to do what they did.

In an interview with The Reel, Mehta explains:

“I was in Delhi when this horrific incident [the rape of Jyoti] took place, and since then, I have been curious about what made or turned these men into brutal animals.”

Film Director Deepa Mehta

Mehta thinks the rapists were not born monsters, but became that way. In the film, she explores factors contributing to their violent behaviour. She also humanizes the men by portraying their day-to-day lives, similar to the lives of other Indian men. They worked, they cooked, they had families.

This approach was highlighted when she spoke to the CBC about the film:

“I really wanted to humanize [the rapists]. [It] doesn’t excuse what they did, but it helps start a conversation about why these things happen.”

Early in the film, Vikas, one of the perpetrators, is shown hiding under the bed when his uncle enters his room and sexually assaults him. By age eight, Vikas is homeless.

Another character Dinesh grew up in a family where women were treated badly. He always received what he wanted, while his sisters were forced to take care of him and do household chores. In one scene, Dinesh’s sister is reading a book. Dinesh yells that he wants the book. His sister is then threatened by their father with violence if she denies her brother’s request.

Researchers at Georgia State University found similar themes in the backgrounds of men who were self-confessed rapists. The researchers analysed an “ask a rapist” thread on Reddit that posed the question: Reddit’s had a few threads about sexual assault victims, but are there any redditors from the other side of the story? What were your motivations? Do you regret it?”

Someone responded with:

“I was an extremely isolated youth who came from a broken home, and my escape was the Internet… Most of the material [internet pornography] was very sexually aggressive towards women.”

Much like the characters in the film, this individual sees his environment as contributing to his violent behavior.

The responses to the Reddit thread also showed themes of: blaming the victim or their biology, expressing hostility toward women, and objectifying women. More than one motivation was typically found to underlie a single rapist’s actions.

Similar themes are apparent in Anatomy of Violence, with some dramatic examples of victim blaming. The defense lawyer stated explicitly:

“The girl is to blame as much as the guys. Why was she roaming outside? If my daughter did this, I would burn her alive.”

Not only was Mehta’s focus on the rapists unconventional, so was her decision to film the documentary in an amateurish style. In a conversation with the Trauma and Mental Health Report, the film’s cinematographer Maithili Venkataraman said that the low-budget feel of the film was deliberate. They did not want to distract from the deeper social issues the film was emphasizing.

When speaking with Refinery 29, Mehta emphasizes:

“I wanted it to look very raw. I felt it doesn’t need distractions… it just needed to hit you in the gut.”

-Anika Rak, Contributing Writer

Image Credits
Feature: intographics at pixabay, Creative Commons
First: Donostia Kultura at flickr, Creative Commons
Second: Hamilton-Mehta Productions, Movie Poster

Robert T Muller - Toronto Psychologist

For Those With Schizophrenia, Writing Can Help

80Therapy News February, 18

A myth in popular culture: Mental illness leads to creativity. The idea is bolstered by successful movies like Total Recall, Minority Report, and Blade Runner, based on the work of author Philip K. Dick, who struggled with schizophrenia. Other notable artists, like singer-songwriter Brian Wilson from The Beach Boys, also showed schizophrenic symptoms.

These links have led scientists to question the relationship between schizophrenia and creative expression. While a connection appears to exist, the assumption that schizophrenia can cause creativity (or vice versa) doesn’t hold up, not in any simple or direct way. Often, these assumptions overlook other risk factors, such as family history, that contribute to the disorder.

And a report on brain illness and creativity by Alice Flaherty, associate professor of neurobiology at Harvard Medical School, paints a more complicated picture. While schizophrenia is not necessarily associated with creativity, one specific trait—openness to unusual ideas—relates to creativity and is prevalent among schizophrenic patients. This trait is common in many writers, as their work is a product of their imagination.

Mental health professionals have observed the therapeutic effects of writing on patients with schizophrenia—finding that the creative process assists these individuals with managing their symptoms.

Laurie Arney, who has schizophrenia, is a case in point. Arney’s therapist Christopher Austin from the Calgary Health Region in Alberta applied an approach called Narrative Therapy to help her cope with the illness. As part of the approach, Arney wrote about her thoughts, feelings, and hallucinations in an open journal to Austin, who would then write back, asking questions about her experiences and helping her process them. He found:

“Writing helped the client to express her experience of living with a mental illness, to describe her years of mental health treatment, and to find her own path toward wellness.”

As an adjunct to other therapies, the approach was helpful for Arney. She explained:

“When I am writing, I do not censor myself the same way as when I am talking. When something stressful happens to me, I can just go to my computer. As I write to Chris about the incident, I am already starting to go through the process of dealing with it. I do not have to save up all my concerns until my next [therapy] appointment.”

Writing therapy is also supported by research from Simon Mcardle at the University of Greenwich in the United Kingdom and colleagues. Certain creative or expressive writing exercises, such as poetry and story-writing, help schizophrenic patients express themselves, and control their thoughts and hallucinations.

According to Noel Shafi, a poet and neuroscience researcher, poetry can be used as a communicative tool for schizophrenic patients to share their emotions and disturbed thoughts. Shafi explains:

“The client externalized his negative beliefs in the form of a Haiku, using poetic expression for personal awareness and growth. The client had lost his sense of self-worth through his experience with psychosis and was now using poetry to validate his existence.”

But there are some risks associated with writing therapy, as these narrative exercises can elicit negative or disturbing expressions. According to Shaun Gallagher of the University of Memphis and colleagues, when using self-narratives, such as journal accounts or stories, patients can get confused between the story and real life. One patient’s narrative account reads:

“I get all mixed up so that I don’t know myself. I feel like more than one person when this happens. I’m falling apart into bits.”

Without regular monitoring, there may be difficulties, especially if patients struggle to distinguish between their thoughts and reality. Still, as a tool in the therapist’s kit, therapeutic writing does offer some help to a number of high-risk patients with serious mental-health problems.

– Afifa Mahboob, Contributing Writer

Image Credits
Feature: Joe Skinner Photography at flickr, Creative Commons
First: Calum MacAuley at unsplash, Creative Commons
Second: Wellcome Library at Wikimedia, Creative Commons

Robert T Muller - Toronto Psychologist

Inadequate Training Leaves Workers Vulnerable to Compassion Fatigue

60Therapy News, Unclassified January, 18

Every afternoon, personal support worker Susan (name changed) struggled with administering medication to a particular elderly patient in the dementia ward where she worked. On one such occasion, fed up with the patient’s behaviour, Susan became so frustrated that she mumbled a profanity, reached over, and pinched the patient’s arm. With a sharp cry of pain, the patient quickly accepted the medication and Susan was able to move on.

Stories of malpractice or poor patient care like this are not as uncommon as one might imagine. Evident from media reports of negligence in hospital settings, such cases can ignite an outcry in the community and prompt questions about individuals’ suitability for caretaking roles. How could someone with a career revolving around caring for others lack empathy?

Grace, an Ontario care worker who witnessed Susan’s behavior firsthand, believes the demanding nature of the job took a physical and mental toll on her co-worker. Having worked for eight years at a residential center for dementia patients, Grace knows from experience just how mentally exhausting the work can be. In an interview with the Trauma and Mental Health Report, Grace explained:

“There’s so much to take care of with these particular patients. When it’s dinnertime, you have to make sure to clean the patient, take them to the dining room, prepare the area for them, feed them, etc. But the next thing you know, they may have soiled themselves or vomited and you have yet another thing to clean when you already have so much to do… There are times when you need to take dirty clothing or dishes from them and they refuse to give them to you or just start yelling at you.”

When faced with the same situation on a daily basis, Grace explains that it’s hard not to become exasperated:

“It can get annoying and even angering at times. It’s hard to control… I didn’t hear much from Susan when I first started working here, but then she began yelling at the patients. I do believe it’s because the stress finally got to her.”

Mental health professionals support Grace’s theory. Overworked employees who are plagued by such feelings of frustration are showing signs of Compassion Fatigue (CF).

Francoise Mathieu, CF specialist and founder of Compassion Fatigue Solutions in Kingston, Ontario, describes the condition on her organization’s website as a gradual emotional and physical exhaustion of helping professionals. While CF is sometimes used interchangeably with Vicarious Trauma (VT), there is a difference between the two. VT is a secondary form of post-traumatic stress disorder, where a worker becomes preoccupied with a specific event or patient problem. On the other hand, CF is an overall decline in the ability to empathize with others.

The American Institute of Stress also differentiates CF from ‘burnout’. With CF, the constant pressure to show compassion toward patients may wear on mental energy stores, leading workers to become emotionally blunted to people and events. Burnout is less dependent on this loss of compassion.

CF is not limited to mental health professionals. It has been shown to affect teachers, social workers, police officers, prison guards, and even lawyers who work with trauma victims. In Grace’s words:

“At first, the stories you hear and the things you see involving the patients really do follow you home. They used to make me feel depressed. Over time, that sensitivity does lessen. After being exposed to this type of thing day after day, you start to lose those feelings.”

According to CF expert Francois Mathieu, once workers begin to experience this emotional exhaustion, they may be prone to moodiness, irritability, difficulty concentrating, intrusive thoughts, feelings of hopelessness, and apathy in both workplace and personal relationships. Fran McHolm, Director of Continuing Education at the Nurses Christian Fellowship has written about how CF can lead to a decrease in general employee happiness, workplace satisfaction, and quality of patient care.

CF is not a rare condition. Results from a 2012 dissertation study by Shannon Abraham-Cook at Seton Hall University show that, out of 111 urban public school teachers in Newark, New Jersey, 90% were at high-risk for CF. In 2010, Crystal Hooper and colleagues from the AnMed Health Medical Center in South Carolina also found that 86% of emergency department nurses exhibited moderate to high levels of CF.

While CF is common in many workplaces, help for employees who are experiencing symptoms, is not readily available. In an interview with the Trauma and Mental Health Report, Isabella, an assistant teacher working with special needs children at a Toronto daycare, describes her experience:

“When we began training, the instructors only talked about how to care for the children and how to work with the different age groups. Management didn’t provide us with anything else. The only thing we can do when feeling overly stressed is go for a break.”

Grace adds that her center for dementia patients fails to directly address employee needs:

“Recently, they added cameras everywhere to prevent poor patient care, but it’s made things worse. Now we are forced to seem especially compassionate and the littlest mistake can lead to a suspension. The management doesn’t try to understand the worker’s view of things at all.”

Dan Swayze, vice president of the Center for Emergency Medicine of Western Pennsylvania, discusses several ways management can address employees’ personal needs pertaining to compassion fatigue. In an article in the Journal of Emergency Medical Services, Swayze writes about the importance of implementing policies and developing programs that can help ease the onset of CF. Teaching employees how to set professional boundaries with patients, conducting meetings to solve individual client issues as a team, and offering counselling services to stressed employees are just a few options administration can take.

And a 2015 study by researcher Patricia Potter and colleagues in the Journal of Continuing Education in Nursing argues for resilience training, a program designed to educate personnel about CF and its risk factors. Workers are taught how to employ relaxation techniques and build social support networks to cope with symptoms that arise from working with difficult populations. Staff members from a US medical center who participated in the training self-reported an increase in their empathy and overall emotional health.

Volunteer crisis hotline operator, Anabel, explains the benefits of these resources in her line of work:

“The staff at the distress center are really considerate of their volunteers. In the training they prepare you for compassion fatigue, encourage volunteers to take care of themselves, and to not take the calls home with you. They also make sure to be available to the volunteers 24/7 in case they need to debrief a call with someone. It really helps to know they’re there to talk to—often after a distressing call.”

Training and intervention programs can help safeguard against the development of compassion fatigue in care workers. But many people working in the field, like Grace and Isabella, have been thrown into care-taking roles with no consideration for the risks to their mental wellbeing. Both women have identified various ways of coping as a stopgap until they receive the assistance and support they need.

Isabella suggests taking full advantage of breaks every few hours:

“Whenever you feel overwhelmed, go for a break right away—even if it’s just to the washroom or for a coffee… When you leave and come back, you feel refreshed. I’m lucky that I live so close to my workplace that I can go home during lunch.”

Grace recommends taking a deep breath and focusing on any positive aspect of the job:

“I learn so much from the patients. Hearing their stories, you can end up getting really close to some of them. I try to listen to them when I can and when I see the positive effect that has on them, I feel very fulfilled.”

These coping mechanisms do not work for everyone, which is why early intervention is so important. While camera implementation has prevented some inappropriate conduct like Susan’s from continuing, it doesn’t address the root problem.

“There are times where I get angry,” Grace admits. “I can’t always entertain patients or be friendly. I try… but it’s so hard… I know a lot of people, like myself, are really sensitive, which is why we are so emotionally affected by this job. There’s no stress management or counselling here, but… these training programs could really help.”

For many helping professionals, compassion fatigue may be inevitable. Cases like Susan’s show that the wellbeing of individuals in caretaking roles directly influences the quality of care that patients will receive. Support in the form of training programs and other preventative measures can make a difference in the lives of these workers, and, improve patient care.

– Anjali Wisnarama, Contributing Writer

Image Credit
Feature: Pennsylvania National Guard at flickr, Creative Commons

Robert T Muller - Toronto Psychologist

Police Lack Training to Deal with Mentally Ill People

100Therapy News January, 18

On March 4, 2016, Devon LaFleur, a 30-year-old struggling with bipolar disorder, went missing. His father contacted law enforcement to notify police of his son’s mental illness and tendency towards violence. After learning that LaFleur had allegedly robbed a bank and was on the run, Toronto police tracked down and fatally shot the young man during a confrontation.

In many instances where mental illness is concerned, police officers respond too quickly with force, sometimes without probable cause. In an analysis conducted by the Washington Post, American officers shot 124 people who showed some sign of mental or emotional distress in 2015.

The Post explains that, for the majority of these crimes, the police were not called for reports of criminal activity. As in LaFleur’s case, police were contacted by relatives, neighbors or other bystanders worried that a mentally fragile person was behaving erratically.”

An article by psychiatry professor Richard Lamb and colleagues at the University of Southern California reports that police officers are authorized to transport individuals with mental illness for psychiatric evaluation when there is reason to believe that they pose a danger or threat. But the researchers also state that this responsibility turns officers into ‘street-corner psychiatrists’ without giving them the training they need to make on-the-spot decisions about mentally ill people.

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An article published in Criminal Justice Review by Teresa LaGrange shows that “higher educated police officers recognize a broader range of disorders”, and they are more likely to “view the situation as requiring a professional intervention”.

However, LaGrange also recognizes that, instead of teaching practical skills like learning how to identify individuals with mental-health conditions, many educational workshops only consist of general descriptions about psychological terms and concepts.

Police officers need to know how to handle individuals who display different types of mental illnesses. The Washington Post analysis states that the most extreme cases of mentally ill people causing a disturbance were schizophrenic individuals, and those who displayed suicidal tendencies, or had some form of post-traumatic stress disorder (PTSD).

In some U.S. states, crisis intervention team training (CIT) is being implemented to help officers identify mental illness and determine the best course of action.

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CIT consists of a 40-hour training program for police forces that educates officers on mental-health issues and medications, and teaches about mental-health services in the local community. CIT also teaches methods that help de-escalate heated situations by encouraging officers to allow vulnerable individuals to vent their frustrations—methods that could have been useful in LaFleur’s case to reduce the risk of violence from both the police and offender.

So far, this program has been considered effective by the police departments using it.

Major Sam Cochran of the Memphis police department, a retired officer and a coordinator of the CIT program, emphasizes that law enforcement should partner with local mental-health agencies:

“If communities give attention only to law enforcement, you will fail as a training program. You cannot separate the two.”

Although the task of identifying mentally ill individuals can be daunting, these training programs are a step toward preventing injustices for individuals like LaFleur. Providing officers with appropriate training not only improves the ability to handle job stress, but may also provide the mentally ill with a chance to receive treatment.

– Afifa Mahboob, Contributing Writer

Image Credits
Feature: Free Images at Pixabay
First: Yannick Gingras at flickr, Creative Commons
Second: Alex Proimos at flickr, Creative Commons

Robert T Muller - Toronto Psychologist

A Hands-On Approach to Psychotherapy?

70Therapy News January, 18

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.

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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.”

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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 though research 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

Image Credits
Feature: stux at Pixabay, Creative Commons
First: Matthew G at flickr, Creative Commons
Second: Amy Wharton at flickr, Creative Commons

Robert T Muller - Toronto Psychologist

Let’s Eliminate Physical Restraints in Group Homes

20Therapy News January, 18

In April 2015, Justin Sangiuliano, a seventeen-year-old diagnosed with Autism, was physically restrained at his group home in Oshawa, Canada. To control an aggressive outburst, two staff members grabbed his arms and placed him on the floor as he kicked and screamed. Staff released him once he stopped struggling, but Justin never got up. He was rushed to the hospital without a heartbeat and died five days later.

Justin’s death, and the deaths of other children in Ontario group homes, raises questions about the provincial child protection system and the efficacy of using force to restrain vulnerable populations.

The Canadian Institute for Health Information defines physical restraint as when “a person is physically held to restrict his or her movement for a brief period of time in order to restore calm to the individual.”

Ontario regulations state that physical restraints can be used to prevent group home residents from injuring themselves, injuring others, or causing significant property damage. Restraints should only be used after less intrusive methods have been applied and deemed ineffective.

But a Toronto Star investigation found that physical intervention is being used as a frequent form of discipline in these homes. The report documented that, between 2010 and 2015, some 45,000 restraints were used in Ontario residential programs to discipline vulnerable children and youth. Restraints were used in more than one third of the 1,200 serious occurrence reports filed in 2013 by group homes in Toronto.

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While there may be some benefits to using physical restraint in controlling violent children, inappropriate use of these practices suggests a power and control issue among some group home staff.

The Toronto Star investigation reported an instance of a child begging to be released: “I’m going to pee myself.” The staff members refused to let go of the child until he urinated on himself.

In another study by social work professors Laura Steckley and Andrew Kendrick at the University of Strathclyde in Glasgow, Scotland, children spoke to the injuries they incurred as a result of forcible restraint:

Half the time when residential staff restrain you they just purely hurt you. I get hurt most of the time. I had a mark from a carpet burn, hurting on my shoulder, and marks on my chest.”

Additionally, preventable deaths and high rates of physical intervention on children with developmental disabilities demonstrate inadequate training of residential staff.

In an interview with the Toronto Star, Kim Snow, an associate professor at Ryerson University’s School of Child and Youth Care, speaks to the dangers of restraining children with developmental disabilities without safe and adequate staff training:

“Although the provincial government lists six approved training programs in the use of physical restraints, no one has looked at which techniques are best. Is one safer than the other? Should one be used in certain situations and not others? Sometimes staff can’t contain kids using a restraint. So what happens when those situations occur? Until we can answer those questions, the risk of harm as a result of restraints is quite high for both staff and kids.”

As an advocate for child safety within the Ontario residential system for over three decades, Snow wants the province to track the use of restraints more closely.

“It takes highly skilled staff to work with children with histories of trauma and accompanying rage to be able to contain them without physically intervening. When people lack those skills they become frightened and they intervene much too quickly. When that happens, the child or youth’s physical and psychological safety is at risk.”

Research by the Residential Child Care Project at Cornell University addresses the physical and psychological harm that can result from restraint use on a vulnerable population. The 2008 study found restraints to be “a considerable risk to vulnerable youth, are intrusive, have a negative effect on the treatment environment, and have a profound effect on those youth who have experienced trauma in their lives.”

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And a 2013 report by Youth Leaving Care, a working group created by the Ontario government to investigate the quality of care vulnerable youth receive in group homes, identified high frequency of restraint use to be a major problem, and recommended the government “works with group home providers to clarify and reinforce policies and best practices to make sure they are followed.”

So, what is being done to improve the care of children with disabilities in Ontario residential homes?

Irwin Elman, the Provincial Advocate for Children and Youth, leads a group called Youth Leaving Care that caters to young people who grew up in Ontario’s group homes.

While certain advocates of children and youth in residential homes call for improved training to properly implement restraints, Elman believes these homes should eliminate restraint altogether to limit preventable deaths.

“These are children who often come with experiences of violence or serious mental health challenges. How in hell do we expect them to achieve to their full potential, to heal, to find supportive relationships in those kinds of environments?”

– Lauren Goldberg, Contributing Writer

Image Credits
Feature: Valentine Svensson at flickr, Creative Commons
First: William Gantz at flickr, Creative Commons
Second: Paul Townsend at flickr, Creative Commons

Robert T Muller - Toronto Psychologist

Brain Stimulation Device Powers Healing

20Therapy News January, 18

Promising new treatments for neurological disorders are looking to transform disease management through neuroplasticity—the brain’s ability to alter its structure and function to adapt to changes in the environment. Leading-edge research is investigating how technological solutions can enhance neuroplasticity, boosting recovery from neurological damage.

In September 2016, Helius Medical Technologies announced positive results for its pilot study using a brain stimulation device to treat pediatric Cerebral Palsy (CP). CP affects muscle control due to injury or malformation of the brain. For the study, some participants received standard physiotherapy, while others received standard physiotherapy along with 20 minutes of brain stimulation with Helius’s experimental device.

Those who received brain stimulation showed improvements in muscle spasms and gross lower limb motor function, over those who did not. And, there were improvements in quality of life, social status, and cognitive function. One explanation is that the brain stimulation device heightens the brain’s natural ability to heal, producing enhanced benefits from physiotherapy.

This new method of brain stimulation is termed cranial nerve non-invasive neuromodulation (CN-NINM). A successful feasibility study was done for the treatment of Multiple Sclerosis (MS), and studies are underway for Parkinson’s disease, brain injury, and stroke. Participants are reporting improvements in mental health and wellbeing, such as greater mental clarity and increased energy. And benefits may extend to other neurological conditions as well.

The brain stimulation device used in these studies comes from decades of work by researchers at the University of Wisconsin-Madison, in the Tactile Communication and Neurorehabilitation Laboratory (TCN Lab). The team named the device the Portable Neuromodulation Stimulator (PoNS). The PoNS consists of a small array of electrodes that transfer an electrical current to the patient’s tongue, activating areas of the brainstem and cerebellum. Researchers theorize that this activation induces a sequence of activity that spreads through the brain.

In his book, The Brain’s Way of Healing, researcher and psychiatrist Norman Doidgeexplains how brain stimulation enhances neuroplastic healing. Doidge says an underlying cause of symptoms in neurological disorders is a dysregulation of electrical activity in the brain. He explains the sequence of activity caused by the PoNS may help the brain balance the electrical activity in its networks of brain cells. Balancing promotes rest and relaxation of these cells, allowing further stimulation alongside appropriate rehabilitative therapy. Stimulation reactivates dormant or dysregulated brain cells, and reintegrates them into functioning networks. Taken together, these changes make an ideal state for neuroplastic healing to take place.

Doidge shares a story about Broadway singer Ron Husmann’s remarkable recovery, which Doidge attributes to neuroplastic healing. Multiple Sclerosis led Ron to lose control of his bladder, mobility, and singing voice. Devastated by the loss of his voice and feeling he had nothing to lose, Ron travelled to the TCN Lab. He spent two weeks in intensive speech therapy, accompanied by brain stimulation with the PoNS device. By the end of his stay, Ron was singing and dancing again.

Brain stimulation and modulation are not new. They are central to established, FDA-approved treatments, such as deep brain stimulation (DBS), for neurological disorders. But, an important difference between the PoNS device and deep brain stimulation is that DBS is a highly invasive treatment. It involves the insertion of an electrode into the patient’s brain, and introduces several possible risks, including infections and strokes. And so, DBS is only used as a last resort. But the PoNS is non-invasive and presents few risks. Plus, the effects of the PoNS appear to continue even after the stimulation ends, whereas the benefits of DBS tend to end when stimulation is turned off.

Reported side effects for treatment by the PoNS, though, include increased salivation, mild headaches, and jaw pain. To reduce side effects, researchers teach participants swallowing and relaxation techniques that manage saliva and tension in the jaw.

Although early evidence for the PoNS device is impressive, skeptics point out that the number of participants used in the studies is small, which reduces confidence in reported outcomes. And although the team at the TCN Lab has shown that the PoNS increases activity in key brain areas, theories on how, precisely, it contributes to healing are still unclear.

Still, the PoNS shows promise as an addition to rehabilitation programs, and as a way of promoting physical and mental health. This technology is one to watch.

– Stefano Costa, Contributing Writer

Image Credits
Feature: UCI Research at flickr, Creative Commons
First: Helius Medical Technologies
Second: Helius Medical Technologies

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Using Mindfulness with Opioid Addicted Chronic Pain Patients

00Addiction, Chronic Pain, Featured news, Health, Mindfulness, Therapy, Therapy News 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