Month: January 2012

Categories
Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Personality Disorder Therapy

Personality Disorders: Finding Solace in Therapeutic Care

According to the DSM-IV, “Personality Disorders are mental illnesses that share several unique qualities.  They contain symptoms that are enduring and play a major role in most, if not all, aspects of the person’s life.  While many disorders vacillate in terms of symptom presence and intensity, personality disorders typically remain relatively constant.” Further, the DSM-IV says that in order to be diagnosed, the following criteria must be met:

  • Symptoms have been present for an extended period of time, are inflexible and pervasive, and are not a result of alcohol or drugs or another psychiatric disorder. The history of symptoms can be traced back to adolescence or at least early childhood.
  • The symptoms have caused and continue to cause significant distress or negative consequences in different aspects of the person’s life.
  • The symptoms are seen in at least two of the following areas
    • Thoughts (ways of looking at the world, thinking about self or others, and interacting)
    • Emotions (appropriateness, intensity, and range of emotional functioning)
    • Interpersonal Functioning (relationships and interpersonal skills)
    • Impulse Control 1

In layman’s terms, someone suffering from a personality disorder often views the world in their own way. Because the perceptions of those around them are often skewed to meet a reality only they see, the subsequent social issues stemming from the inability to interact with others appropriately is troubling–both for the one afflicted and those on the receiving end of the negative behaviors and perceptions. For the Borderline Personality Disorder (BDP), the major symptoms revolve around interpersonal interactions, negative sense of self, significant mood swings, and impulsivity. Where Narcissistic Personality disorder presents itself as grandiose and uncaring yet hungry for recognition, Borderline Personality Disorders can often be summed up like this: “I hate you…don’t leave me.”

Unfortunately, personality disorders are sometimes used as a quick label for a difficult client. However, the criteria are pretty significant and the diagnosis itself should be made after significant assessment by a qualified professional. Those ensconced in the emotional turmoil of a legitimate personality disorder need be able to find some solace in their psychiatric care and trust in the individuals providing care, especially since treatment for personality disorders are long term. The type of therapeutic treatment used depends upon the type of personality disorder being treated. The various types of therapy used to treat personality disorders may include:

  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavioral Therapy (DBT)
  • Psychodynamic psychotherapy
  • Psychoeducation

Personality disorders are tricky and can be hard to address. Applying DBT, for example, has shown positive results in the treatment of BPD–recent studies have shown lower suicide rates, less self-harming incidents, and less self-removal from treatment. We must remember that psychiatry is a relatively young science, so the growth and change is happening quickly as practitioners eagerly seek resolution to some of the most challenging psychological quandaries. A therapist once said to me, “If someone were to observe a given client in a single session, they could come up with a variety of diagnoses, when the fact is, that client could have just been having a bad day.” So, whether a client is simply having that bad day or truly struggling with a bona fide disorder, it’s befitting to remember the words of Hippocrates as we unravel the mysteries of mental illness: “Cure sometimes, treat often, comfort always.”

1 https://allpsych.com/disorders/personality/index.html

Additional articles of interest:

 

Personality Disorder – What Is it, and What Does Diagnosis Mean?

With Mental Illness, “Serious” is a Slippery Term

Categories
Addiction Depression Mental Health Recovery

Privilege Doesn’t Mean Easy

Image via Wikipedia

Sometimes, teen angst is obvious. It shows up as truancy, poor grades, and sullen or surly attitudes. But sometimes, it’s subtle, and easily missed by parents desperate to feel their child is doing all right. After reading this remarkable article by Dr. Madeline Levine, I was reminded about the elusive nature of teen angst and the parental actions taken to limit pain, sadness, fear, and frankly, some of the pertinent life experiences which are part and parcel to learning about the human condition. Dr. Levine noted how common this is amongst those more privileged when she states, “It would be a stretch to diagnose these kids as emotionally ill. They don’t have the frazzled, disheveled look of kids who know they are in serious trouble.” In these cases, it takes time to really unravel the problem because the outsides are masked so skillfully. Levine notes this as well, “After a few sessions, sometimes more, the extent of distress among these teenagers becomes apparent. Scratch the surface, and many of them are, in fact, depressed, anxious and angry.” She also notes the fact that it’s the kids requesting help, not always the parents recognizing there might be a problem.

Many parents will say,  “I just don’t want my child to feel pain or be sad, or get hurt.” While parents are providing tremendous resources and attention to these kids, there is still an internal sense of strife felt in many of them. This additional desire to protect and fix things with materialistic items is just a another way of muffling the reality of whatever it is we’re dealing with.  An iPod, or a new pair of Uggs won’t fix the emotional pain and loneliness of social anxiety or lift the spirits of the depressed. Sure, the thrill of getting something new may make us temporarily feel good, but those feel-good moments start to fade and we’re still left with the feelings we were trying to run away from in the first place.

This presents an interesting conundrum when it comes to asking for help. The suffering isn’t as obvious for these teens, and it becomes harder still to determine the root cause when the issues themselves are concealed. In this sense, the “privileged” may find it harder to reach out for help because their ability to acquire bigger and better things is easier, and their academic and social resources are more viable. In this case, the ability to stuff feelings comes at a higher price, both literally and figuratively.  And while some may view those who are more privileged as spoiled, I hesitate to think this is entirely the case. In fact, I would venture to say some of this is the manifestation of a larger issue: parental denial, a need to run from feelings and the financial ability to do it in bigger and more aggrandized ways.

Sometimes it’s harder to ask for help when it looks like you have it “together” from the outside. The assumption is that one is doing well because they may not have lost everything, or because they appear fine solely because their outsides are seemingly put together. Unfortunately, the outsides don’t always match the insides. I can’t tell you how many times I’ve felt low but was complimented on my appearance. It’s a trick we play to hide what’s really going on. That “trick,” however, leaves us lonely and sometimes isolated from the very people who can help us. Our kids need us to be there for them, but we can’t always intervene. In doing so, we teach helplessness, when what we really want to do is provide a safe foundation at home so our kids can develop the tools they need to experience life. As Hodding Carter once said, “There are only two lasting bequests we can hope to give our children. One of these is roots, the other, wings.”

Read the article in its entirety (I highly recommend this).

See here for more information about The Price of Privilege.

Categories
Mental Health Recovery

Facing Our Fears & Meeting Our Grief

It takes more strength to feel your feelings than it does to hide them. As counterintuitive as it may seem, I’ve found this to be true. Because we encounter so much anxiety and depression in our lives and in our recovery, it ‘s appropriate to also notice the element of grief which often acts as the undercurrent and silent driving force. If there’s a history of abuse or abandonment, neglect, or bullying, there is grief. If a parent suffers from a mental illness and/or addiction, there is grief. If there’s social anxiety, there is grief. It’s a pervasive feeling, and one which we often ignore or pass off as a phase, something that happens in passing. But in recovery, be it from addiction or mental illness or both, we need to address it.

How do we face our fears—especially when they are paralyzing? How do we defy this part of being human which urges us to avoid pain at all costs? We eat to feel better, drink and smoke to feel better, have sex to feel better, live on our phones to feel better, surf the Internet to feel better, ad infinitum. We do whatever it takes to go as far as possible from that nagging pain in our guts. With the addictive personality, this behavior is even more pronounced. If there’s a mental illness co-occurring but not acknowledged, the desire to resist the fear and feelings might be even greater. It can get pretty darn lonely, especially when one’s ego and fear kick in, coupled with a refusal to ask for help.

Certainly, there is an imperative to face these fears and the grief associated with them, but we can’t do it all at once. Since it requires us to look deeply within, I have found it far more beneficial to do in pieces. Even in a therapeutic environment, one doesn’t address every single issue at once. The trouble is, addicts and alcoholics don’t like to do anything in pieces. It’s usually all or nothing. It takes a new outlook and a commitment to slowing down to start to change that perspective. But it is possible.  Keep in mind, alcoholism and addiction are oftentimes symptoms of a much greater problem. The question is, are we brave enough to determine what that problem is?  If it’s a mental illness, do we have the courage to take care of it appropriately?

Instead of attempting to lift a tree to see its roots, try lifting one leaf at a time. Eventually, when it’s time to lift the tree, it may not be as heavy.

 

Categories
Communication Stress

Rest Your Thumbs: Communication Without Texting

Oh, technology, how far you’ve come.

When I was a teen, a computer was something only geeks or millionaires had; cell phones were something futuristic and reminiscent of the 80’s show Hart to Hart

and their “fancy” car phones. So when the first phones came on the scene back in 1983, coined The Brick, and weighing in at two pounds with a mere half-hour of talk time, the collective response was amazement. The price tag was hefty, which raised its status, making it all the more desirable and of course, cool. There were even rap songs about the Brick! Realistically, if you had one at that time, they served no other purpose than for social status and of course, “emergency” phone calls. The Brick couldn’t do much more than make a phone call anyway.

In 2012, we now have miniature tools of technological genius, which allow for us to communicate via text messaging, voice, email, and various social-media outlets via a host of apps. What we’ve ended up with are varying forms of non-confrontational and non-contiguous means of communication. This type of communication works for many people, especially when one considers the amount of multi-tasking we do these days. Unfortunately, texting has evolved and become the primary form of communication for many, particularly teens, whose need to stay connected socially is often a key component to their social survival. Let’s face it, it’s far less scary to test the waters of a burgeoning relationship via text than it is in person. The trouble with this is two-fold:  texting lacks sincerity, and it lacks accountability – two things which are crucial in building the bedrock meaningful friendships and relationships are based upon. The non-contiguous factor also has its positives and negatives: you can share a nugget of information that’s not time sensitive, therefore not requiring immediate response. But you can also say things you’d never say in a million years to someone’s face and “walk” away.

This comment, “Words are bullets,” which I once heard in a meeting seems to really ring true in the case of text messages and digital communication. In this sense, a text can be like a virtual Uzi. I’ve experienced this phenomenon myself, where I’ve received a nasty message via text but upon direct confrontation, I was met with sheer nervousness, darting eyes, and denial. What’s concerning is the deterioration of our communication skills, particularly amongst adolescents. As a culture, we’ve gotten lazy when it comes to expressing ourselves, though our thumbs might disagree.

My own goal this year is to minimize the use of texting as a primary form of communication. I’ve been successful thus far, and have experienced more meaningful conversations with people. Try this: put your phone away for a prescribed period of time. If you need to tell someone something, pick up the phone!  You might be amazed how the quality of your ensuing conversations increases. I know I did, and I multi-task with the best of them.

Categories
Recovery Service Treatment

Visions Hits Double-Digits: Celebrating a Decade of Adolescent Treatment

This past decade, Visions has set a mission to provide a treatment plan that truly caters to youth and their families. We’ve coexisted alongside a myriad of recovery centers, working hand in hand with them to bring a sense of healing to the entirety of the family dynamic. As we celebrate 10 years of providing treatment, our professional growth, and the program development we’re embarking on, it behooves us to acknowledge and celebrate our treatment team and the culture they have built at Visions.

There is something that lies within every single person at Visions, something which connects all of us in a very unique way. As I’ve sat and pondered what that “thing” is, I‘ve realized it’s the sense of being of service which we all embody. The thing that drives us to get up and “do it again” isn’t the promise of a paycheck or the gratification of completing a task on time; instead, it’s the desire to put forth the effort in watering the seeds of recovery planted at the very beginning of treatment. It’s a continuum, this process, one which starts at intake and continues on to supporting healthy living. There is no “end” to the dedication and perseverance of our team. Selflessness is what I continue to notice about those who’ve been here since the beginning and in those just planting their feet. There is an element of altruism within the team, not forced, just naturally there and engaged beyond any expectations placed upon us by simply being an employee.

Amidst all of the selflessness and service, however, runs an underlying tone of never taking ourselves too seriously.  The team wears their hearts on their sleeves and carries laughter in their hearts. Frankly, we can’t see any other way to show our clients our authenticity.  As we know, adolescence is strife with the mistrust of adults and a deep need for autonomy; having adults who care for them and are willing to share their ability to be themselves while maintaining positive boundaries is crucial. There’s nothing forced about this, and the organic factor allows us to be consistent in our care and treatment. Remember, teens can suss out a fake in two seconds flat…especially when it comes to adults.

The treatment world understands a language all its own.  It feels the pain of the mentally ill, the addict, the depressed, the eating disordered, the anxious, and the suicidal. From our perspective, there’s no judgment, just the sincere effort to help someone heal. There comes a point where the need to “just” be of service ceases to solely focus on recovery and begins to seep into paving the path to living better lives. At Visions, we shoot for the families’ new beginning and aim to be the best examples of recovery, compassion and fun. As Dr. Seuss liked to say, “Fun is good.”

Exit mobile version