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Anniversary Blogs Recovery Service Therapy Treatment

Garth LeMaster, MA, LMFT – Outpatient Therapist

Garth Lemaster is precisely the type of person you want around in a crisis: he’s level-headed, straightforward, respectful, and honest. He shows up when he says he will and he always gives his heart and soul to his work. Garth is one of those therapists the kids seek out for their check-ins, and as a result, he spends the majority of his time at Visions session. It’s also not unusual to see Garth helping out with the day-to-day operations of Outpatient and the Day School, which shows how much of a team player he really is. Since 2007, Garth has been a wonderful source of goodwill for all of us at Visions; we are lucky to have him as part of our treatment team. I really can’t say enough kind things about Garth and neither could the staff:

“Garth is an amazing person!  His patient and calm demeanor is unparalleled.  It takes a lot to rattle Garth’s nerves…on occasion I try simply for entertainment (I know, it’s terrible) but I end up giving in before he does.  This way about him is reflected in his approach with the kids he works with as well.  His ability to listen is one among many and I’ve witnessed the lives that he has touched as a result.  Garth is one of those people who “so rocks” and has no idea!” —  Love Always, Natalie (IOP Staff Member and huge fan of Garth!)

“Garth is the quiet warrior of our team.  Families always know that Garth will be there with kind words, thoughtful insight and strength.  He meets his clients where they are, and he helps them find their inner strength in therapy.  We respect Garth and I, over the years, have found myself in Garth’s office when overwhelmed or in need of advice, always getting what I need as a co worker. Parents tell us that Garth is solely responsible for the change in both their lives and the lives of their teens. He would likely scoff at this and respond back that the family did the work, but Garth truly led the way.  Patrick says it best when he says that Garth is a ‘therapy ninja’!!  Thank you, Garth, for being an anchor at our outpatient location.” — Amanda Shumow

“If I had to pick someone from work to team up with on Survivor, I would pick Garth. The thing I love about Garth is his quality of character. He has an integrity that can be counted on. I’ve had the privilege to really watch him blossom as a therapist over the last 5 years, and I really appreciate the work that he does. He genuinely cares about the families and kids he works with. He is respectful and I greatly enjoy our occasional  political détente in the mornings—and while we don’t always agree, I love that he always listens and genuinely has care and concern for people.” — Joseph Rogers

“Garth is quiet strength for the kids.  Now, to get him to paint with us…!  –  Susan O’ Conner who’s best known as “The Art Lady.”

And without further adieu, let’s hear Garth’s answers to some of our curious questions:

1.  If you had wings where would you go?

The Hotel Caruso in Italy.

2.  Favorite restaurant in Los Angeles?

IN N OUT: Double-double combo, hold the “animal,” I’m just a regular guy. 

3.  Last movie you watched in the theater?

The Gray.

4.  Favorite song to play on your guitar?

“Over the Hills and Far Away.”

5.  Have you watched any episodes of The Real Housewives on Bravo?

I’m proud to say no.

6.  What was your High School Mascot?

A wildcat.

7.  What is the best present you ever received?

Tivo.

8.  Soup or Salad?

Salad.

9.  Best word to describe your personality?

Mellow.

10.  Why do you choose to work for Visions?

I like helping kids, but I do so at Visions because the team is so good. It’s a really good place to work.

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
Bipolar Disorder Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Therapy

DBT, Mental Health & Addiction

Image by kenleyneufeld via Flickr

Sometimes someone comes into contact with treatment because their drug use got out of control only to discover their problem isn’t actually addiction, but rather, an untreated mental health issue. Often times the misuse of drugs and alcohol is an ardent attempt to quell the feelings of anxiety or lift the fog of depression. Sometimes it’s a way to disengage from the flashbacks of trauma. Sometimes it’s a way to close the door on a panic attack. However, many times, these modes of self-treatment go too far, and the claws of addiction sink in, creating another layer to uncover and treat. Still, once the addiction piece of the puzzle is treated, therein lies the deeper, more complicated issue of mental illness. What then?

At Visions, we have embraced the mental health component of treatment and are adding a mental health track to our existing treatment plan. We are utilizing a wider range of treatment methodologies and branching into the area of Dialectical Behavioral Training (DBT). DBT is a “comprehensive cognitive behavioral treatment developed by Marsha M. Linehan over the last 25 years,”[i] and has primarily been used to treat patients struggling with suicidal ideation, suicide attempts, a desire to self-harm, and self-mutilation. After discovering numerous problems with the traditional use of cognitive behavioral therapy (CBT) in treating this particular clientele, Linehan began to integrate validation strategies (also known as acceptance-based interventions) into her treatment methodology.  By integrating these validation strategies, Linehan inevitably began empowering her clientele and creating an environment of acceptance, while also encouraging them to begin to recognize the need to consciously change negative behaviors. DBT has also become one of the more successful treatments for patients suffering from borderline personality disorder (BPD), a group typically resistant to the traditional use of CBT.

To illustrate some of the problems Marsha Linehan and her team encountered, here are the three issues they found to be the most troublesome with traditional CBT:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop out rate. And, obviously, if clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. In other words, therapists were unwittingly under the control of consequences outside their awareness, just as all humans are. For example, the research team noticed through its review of audio taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, or emotional withdrawal, or shame, or threatened self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they didn’t want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients – suicide attempts, urges to self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, etc, AND have session time devoted to helping the client learn and apply more adaptive skills.[ii]

In addition to utilizing validation strategies, DBT also employs the use of mindfulness as one of the core concepts behind this therapy. Mindfulness is beneficial in the treatment of addiction and mental illness: it introduces the concept of non-judgmental observation, where we can observe our own actions and behaviors without criticism; Being mindful requires that we are engaged in present-time awareness: the here and now. This is where mindfulness is truly invaluable. If we are aware of our actions in the here and now, we are less likely to get caught in the destructive patterns of “what if? and “remember when?” In the practice of meditation, the act of “coming back to the breath” helps one stay in the present. Learning how to label emotions and feelings that may present themselves can help sufferers from getting lost in negative thought patterns. For example, if we are feeling scared or triggered, paranoid or angry, naming that emotion with non-judgmental observation will help us retain our present-time awareness.

In time, hopefully, the implementation of treatments such as DBT and mindfulness will help provide sufferers with some valuable tools for regulating emotion, distress tolerance and managing interpersonal relationships.


For more detailed information on DBT, please visit these sites:
Categories
Addiction Anxiety Depression Mental Health Obsessive-Compulsive Disorder (OCD) PTSD Recovery Therapy Treatment

MDMA: Is This Psychotropic Drug Helpful, Harmful, or Both?

Image via Wikipedia

Last time I wrote about ecstasy, it was about the rise in ER visits and the inherent dangers of using a drug that inevitably depletes one’s levels of serotonin and has the potentiality of long-term brain damage. So, when I came across an article talking about using MDMA (ecstasy) to treat post-traumatic stress syndrome (PTSD), my curiosity was sparked. Psychedelic drugs have been used to treat mental illness before, and with some success: In the 50s and 60s, psychology was in a Freudian phase, viewing psychological issues as conflicts between the conscious and unconscious minds. At that time, psychedelics were used to allow patients to face their unconscious minds while awake, which purportedly eliminated the variables of memory retrieval. Still, these methods of treatment weren’t without controversy.  With the influx of street use, and folks like Timothy Leary telling people to “”Turn on, tune in and drop out,” the use of psychedelia to treat mental illness was met with great discernment and fell to the wayside.

Currently, interest in using MDMA and other psychedelics to treat depression, obsessive-compulsive disorder (OCD) and PTSD is gaining traction. MAPS is doing extended research on this subject, and states that MDMA isn’t the street drug we call ecstasy, noting that while ecstasy contains MDMA, it also may contain ketamine, caffeine, BZP, and other narcotics and stimulants. According the MAPS site they are “undertakinga 10-year, $10 million plan to make MDMA into an FDA-approved prescription medicine.” They are also “currently the only organization in the world funding clinical trials of MDMA-assisted psychotherapy. For-profit pharmaceutical companies are not interested in developing MDMA into a medicine because the patent for MDMA has expired. Companies also cannot profit from MDMA because it is only administered a limited number of times, unlike most medications for mental illnesses which are taken on a daily basis.”

The use of this drug has leaned so far from its psychotherapeutic roots, proving to be one of the most popular, highly sought-after street drugs around. Because of this, the useful aspect of this drug may easily be overlooked, forcing us to question how we can take something that has morphed into a social enigma and call it useful. I’m curious, will sufficient research place this drug at the discerning hands of medical professionals once again? And how do we, as a recovery community accept this when we have kids coming in suffering from the long-term, negative effects caused by this very drug?

Related articles:

MDMA May Help Relieve Posttraumatic Stress Disorder(time.com)

Ecstasy As Treatment for PTSD from Sexual Trauma and War? New Research Shows Very Promising Results (alternet.org)

Clinical Study of MDMA Confirms Benefits Noted by Therapists Before It Was Banned (reason.com)

Neuroscience for Kids

Ecstasy Associated With Chronic Change in Brain Function

 

Categories
Body Image Eating Disorders Mental Health Recovery Therapy

Starving at 8

image © sarit photography

I know an 8-year-old who’s been known to choose an outfit specifically because it makes her “look thin.” This same 8-year-old often doesn’t finish meals because she thinks she’s fat. She’s the same 8-year-old that has begun to develop food rituals, often leaving the table with a reorganized plate full of uneaten food. Simply put, she already has an irrational fear of getting fat.
It’s hard being a girl. It’s hard to find a way to look at your unique self without comparing it with images of Barbie or Bratz. It’s hard to accept that  the beauty standard set by Cinderella or Sleeping Beauty isn’t actually real. But children, whose minds are filled with wonderful imagination and fantasy, aren’t going to cognitively recognize images that are potentially harmful. Instead, many will attempt to achieve the pink, thin, fluffiness of a Disney princess, or the skinny sass of a Bratz doll. Often times, even when parents are encouraging a healthy body image, the education on the school yard has a dramatically different lesson plan than the one from home. I’ve overheard conversations on the school yard that have made me pause – -it’s clear that body-image issues are in abundance and the pressure to look thin and svelte is invasive and intense.

So what can parents do? Start with eliminating the shame game. This might mean letting your daughter dump that maple syrup on her pancakes or having a cupcake at a birthday party. It’s a treat, not a vehicle for punishment!  Encourage healthy eating, but can you do it with compassion rather than the mallet of criticism?  Eliminate “fat talk”: your kids don’t need to hear it and frankly, it’s not good for you either. Stop trying to control what those around you eat. It’s not your job!  I’ve seen dads controlling the food intake of their wives and daughters to the point of devastating eating disorders (my dad was one!); and I’ve seen moms spewing “fat talk” or signing up for any and every diet fad while their daughters learn to eat in secret or restrict because they’re terrified of the incendiary reaction of their parental food monitors. These behaviors certainly don’t encourage self-love. If anything, they sow the seeds of self-destruction.

If you’re worried that your son or daughter might be developing an eating disorder (note: boys are not immune to this!), look out for some of these signs.

(Please note, certain behaviors are warning signs, but in combination and over time, they can become quite serious):

Behaviors specific to anorexia:

  • Major weight loss (weighs 85% of normal weight for height or less)
  • Skips meals, always has an excuse for not eating (ill, just ate with a friend, stressed-out, not hungry).
  • Refuses to eat in front of others
  • Selects only low fat items with low nutrient levels, such as lettuce, tomatoes, and sprouts.
  • Reads food labels religiously; worried about calories and fat grams in foods.
  • Eats very small portions of foods
  • Becomes revolted by former favorite foods, such as desserts, red meats, potatoes
  • May help with meal shopping and preparation, but doesn’t eat with family
  • Eats in ritualistic ways, such as cutting food into small pieces or pushing food around plate
  • Lies about how much food was eaten
  • Has fears about weight gain and obesity, obsesses about clothing size. Complains about being fat, when in truth it is not so
  • Inspects image in mirror frequently, weighs self frequently
  • Exercises excessively and compulsively
  • May wear baggy clothing or many layers of clothing to hide weight loss and to stay warm
  • May become moody and irritable or have trouble concentrating. Denies that anything is wrong
  • May harm self with cutting or burning
  • Evidence of discarded packaging for diet pills, laxatives, or diuretics (water pills)
  • Stops menstruating
  • Has dry skin and hair, may have a growth of fine hair over body
  • May faint or feel dizzy frequently

Behaviors specific to bulimia

  • Preoccupation or anxiety about weight and shape
  • Disappearance of large quantities of food
  • Excuses self to go to the bathroom immediately after meals
  • Evidence of discarded packaging for laxatives, diuretics, enemas
  • May exercise compulsively
  • May skip meals at times
  • Teeth may develop cavities or enamel erosion
  • Broken blood vessels in the eyes from self-induced vomiting
  • Swollen salivary glands (swelling under the chin)
  • Calluses across the joints of the fingers from self-induced vomiting
  • May be evidence of alcohol or drug abuse, including steroid use
  • Possible self-harm behaviors, including cutting and burning

If you notice even one of these, it’s time to address it. Talk to your daughter or son, talk to your doctor. If necessary, elicit the help of a treatment facility. In other words: Get help. Showing our kids that we care and are willing to stop our own negative behaviors in order to help them is invaluable. It’s a family problem, not an individual one.

Some helpful links:

NEDA
WebMD
Voice in Recovery
Peggy Orenstein
maudsleyparents.org
Also, check out “Brave Girl Eating: A Family’s Struggle With Anorexia” By Harriet Brown