Categories
Recovery

Aleksandra Petrovic, LMSW — Trauma Specialist

Aleksandra Petrovic, LMSW, is a trauma specialist, coming to Visions via New York where she worked with underprivileged children and their families. Aleksandra’s work led her to a hospital outpatient program for dual-diagnosed adolescents, which used DBT (Dialectical Behavioral Therapy) as their primary modality of treatment. Continuing to help underprivileged youth, Aleksandra went on to work at a state-run adolescent recovery center with children ages 5-16 who had been shuffled through the foster care system until they could no longer be placed due to their behavior. Aleksandra earned her B.A at Columbia University, double majoring in psychology and French literature, with a minor in neuroscience. She went on to earn her masters degree in social work at Hunter’s School of Social Work in NYC.

Aleksandra has completed her training in EMDR at the EMDR Institute under its founder Francine Shapiro. She uses EMDR (Eye Movement Desensitation and Reprocessing) and TF-CBT (Trauma Focused Cognitive Behavioral Therapy) regularly when working with clients and their trauma(s).

EMDR is a

“one-on-one form of psychotherapy that is designed to reduce trauma-related stress, anxiety, and depression symptoms associated with posttraumatic stress disorder (PTSD) and to improve overall mental health functioning. (via SAMSHA)

TF-CBT is a

“psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the often multiple psychological traumas experienced by children prior to foster care placement.” (via SAMHSA)

Aleksandra will use TF-CBT by having a client paint or write their story several times until there is a full range of emotions expressed. The repetition of reading and writing eventually desensitizes the severity of the impact of one’s memories. Aleksandra also uses Internal Family Systems (IFS) to help her clients safely access their trauma, helping them “go back” into the traumatic scene and “save” their younger selves. Processes such as these require a commitment to doing difficult work, but they are worth the efforts.   Deep trauma work employed in the modalities Aleksandra uses is extremely beneficial for treating trauma in adolescents and helping them process their trauma in a safe, therapeutic way.

Aleksandra uses the treatment modality most beneficial to her client’s needs whether it’s EMDR, TF-CBT, IFS, writing, movement, or art. Her approach and style are right in line with the Visions’ holistic, client-based approach to adolescent treatment. Her work with the kids at Visions is very individualized–Aleksandra first focuses on building a rapport with the kids, and creating a trusting, safe environment for them to express themselves. When she treats trauma, she assesses where the client is emotionally, whether their trauma was chronic or an isolated event, their awareness surrounding their trauma, if it is repressed or glaringly present, and whether or not there are any psychological issues like mood disorders, depression, or mania present resulting in a dual diagnosis.

Aleksandra has taken her own trauma recovery and transformed it into a path of being of service to adolescents struggling with their own deep traumas. She believes that treating trauma is a crucial step in working on one’s recovery from addiction, eating disorders and other mental health issues. Aleksandra recognizes the influence of major and minor traumas as often being the underlying cause of substance abuse and self-harming behaviors.  We are so fortunate to have such a compassionate, caring trauma specialist as part of our clinical team at Visions Our clients now have access to trauma treatment in both our residential and outpatient programs, as we recognize the deep impact unresolved trauma has on one’s recovery.

Categories
Adolescence Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Recovery Spirituality Therapy Treatment

Recovery: Redefining Normal

(Photo credit: Wikipedia)

Stepping onto a path of recovery and beginning the removal of toxicity from one’s life is an arduous, often painful, but beautiful process. But I like to believe that some of our greatest lessons come from our difficulties. Those are the times that provide us with the most insight into what is actually going on with us. Take for instance your relationships with others. Is there a pattern? Have you continued to add links to an unhealthy chain be it consciously or subconsciously? Are you happy?

When there is a history of toxicity in one’s life, particularly when it’s introduced at an early age, what is considered “normal” tends to become skewed. For example, someone raised in a home with an abusive parent may inadvertently seek out relationships with similar personality types. This isn’t a conscious act but rather a direct result of being taught how to be in this world through violence (emotional, physical, visual, etc.). It feels familiar and therefore “normal” to be around toxicity. The question is, how do you break the chain? How do you make new, better choices that are healthy and nurturing?  How do you place yourself in environments that celebrate you for who you are instead of those that persistently denigrate you?

The 12 steps are a brilliant start. They allow us to begin the process of unpeeling the layers of the onion by asking us to turn our eyes inward and check out what’s going on in our minds and in our hearts. That oft-dreaded fourth step tends to help identify a pattern, particularly if we are honest with ourselves when we write it.  Personally, I’ve always liked that process because it feels like I’m stripping the layers of emotional dirt off of me. It’s uncomfortable, but it’s worth it. Frankly, it hurts like hell to look at ourselves and at our lives with a magnifying glass, but dang it, it’s liberating. You just don’t need to carry that stuff around anymore. Twelve-step work is just the start. If it were only that easy, right?

Taking a clinical approach is incredibly beneficial, especially when dealing with trauma, addiction, and mental-health issues.  Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT), to name a few, are invaluable tools to help identify the psychological triggers and hooks we have embedded within us.

But you know what really seals the deal for me? Creating space for Spirituality. I can’t emphasize enough how invaluable it is to develop a spiritual practice. It is the very thing that will feed your soul. No, I’m not selling you religion or a canon of idealized thought. I am, however, urging you to find the calm in your breath, the grounding notion of having your feet planted to the earth, and the healing weight of your hand on your heart. You can break the chain of abuse. You can shut out the tapes that play in your mind, telling you you’re a piece of crap, a failure, not enough, stupid, fat, ugly, useless. You can take your power back. It takes work, but it’s worth all the sweat and tears. Trust me. Be patient. Understand that this process of recovery takes time. Nothing and no one is perfect.

I’ll leave you with this. I was involved in a series of abusive relationships growing up. I was doing the same thing, expecting different results. I eventually discovered I was continuing the pattern of emotional denigration established in my childhood and nurtured in my adolescence. When I finally smashed through that chain several years into my recovery and only after working tirelessly with a therapist, meditation, yoga, 12 steps, I was free. This doesn’t mean the trauma or triggers went away. It means I finally learned to identify them, and have garnered tools to help me respond to them differently. When I met my husband, I quickly discovered he was different. For one thing, he showed me unconditional support, which I hesitated to believe was true. It took me almost two years to accept the fact that I had, in fact, broken that chain and was capable of having relationships that were built on trust and respect. I realized I could believe someone; something this traumatized gal was never able to do. This was proof that I had redefined my “normal” and surrounded myself with a healthy, loving new family. In fact, I redefined my response to the world and its triggers, not just within my family, but also in my life. Ultimately, I took my power back. You can too.  You just have to do the work!

Categories
Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT) Mental Health Obsessive-Compulsive Disorder (OCD) Recovery Therapy

Body-Focused Repetitive Disorders

Trichotillomania (TTM) is a type of body-focused repetitive behavior (BFRB) specifically characterized by impulsive pulling out of one’s hair from the scalp, eyebrows, eyelashes, or elsewhere on the body. According to the DSM-IV of the American Psychiatric Association, TTM must meet the following five criteria:

  1. Repetitive pulling of one’s own hair that results in noticeable hair loss.
  2. A feeling of tension prior to pulling or when trying to resist the behavior.
  3. Pleasure, gratification, or relief while engaging in the behavior.
  4. The behavior is not accounted for by another medical (or dermatological) or psychiatric problem (such as schizophrenia).
  5. Hair pulling leads to significant distress or impairment in one or more areas of the person’s life (social, occupational, or work).

Though this criteria is useful, there is some debate within the clinical and scientific communities about whether or not all five of these criteria are present in every case. Since there are many who suffer from debilitating hair pulling behaviors but don’t meet all of these criteria, efficient and effective treatment is still paramount to one’s health and well-being.

Signs and symptoms of Trichotillomania often include:

  • Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well;
  • A strong urge to pull hair, followed by feelings of relief after the hair is pulled;
  • Patchy bald areas on the scalp or other areas of your body;
  • Sparse or missing eyelashes or eyebrows;
  • Chewing or eating pulled-out hair;
  • Playing with pulled-out hair;
  • Rubbing pulled-out hair across your lips or face.

Onychophagia (nail-biting) and Dermatillomania (skin-picking) are other BFRBs but are characterized by compulsive skin picking and nail biting. Nail-biting is the most common of “nervous habit.” I’m not talking about the occasional cuticle or hangnail, or the occasional blemish that someone may pick or squeeze. Instead, someone who suffers from onychophagia picks or bites their nails or skin until they bleed, finding themselves using Band-Aids like accessories. As those suffering from TTM will wear hats to cover bald spots and the like, nail-biters will keep their hands in their pockets, sit on them, wear gloves or those Band-Aids I mentioned. Those who excessively pick at the skin on their faces will try to cover up with makeup or when things get really bad, go so far as to stay inside and isolate. I mention these two together, because they often make intermittent appearances in the same individual.

Nail-biting (onychophagia) facts include:

  • Common in individuals of all ages.
  • Up to 33% of children ages 7-10 bite their nails.
  • Nail-biting can be triggered by stress, boredom, or nervousness.
  • About half of all children between the ages of 10 and 18 bite their nails at one time or another. Nail-biting occurs most often during puberty.
  • Some young adults, ages 18 to 22 years, bite their nails.
  • Only a small number of other adults bite their nails. Most people stop biting their nails on their own by age 30.
  • Boys bite their nails more often than girls after age 10

Chronic skin picking (dermatillomania)is characterized by:

  • Inability to resist urges to pick at real or perceived blemishes in one’s skin
  • For some, mounting tension before one picks
  • For some, gratification and relaxation while picking
  • Noticeable sores or scarring on the skin
  • Increased distress and/or interference with daily life

BFRBs have been linked to obsessive-compulsive disorder (OCD). They can sometimes be linked to a sign of emotional or psychological disorders. They are all compulsive disorders, but their manifestations have varying presentations: For some, the picking or pulling will occur during sedentary activities like watching TV, reading, driving or being a passenger in a car, talking on the phone, sitting in class, or sitting at a computer or a desk. At times, there might be focused intent which drives the behavior–for example, planning on picking or pulling at an area as soon as one arrives home. At other times, it’s happens without conscious awareness, and the individual only realizes they’ve picked or pulled when they see the resulting pile of hair, open scabs or bleeding fingers.

This can feel overwhelming, but there is help. For starters, you have to say something to someone and let them know you’re suffering.  Your doctor and/or therapist will then work with you and help you redirect the negative behaviors and create new, innocuous behaviors.

The following therapeutic modalities are typically used to treat BFRB:

(Sometimes, elements from some or all of the aforementioned modalities are used to meet the BFRB client’s needs.):

Alternative therapies are also used, but are not as researched or predictable in terms of their success.

Support groups can provide a wonderful place for fellowship and to create positive social reinforcements.

Keep in mind, What works for one person may not work for another. The key will be in finding the treatments that do work and committing to them. Nothing is impossible, but everything takes effort. Feeling better is worth your treatment endeavors.

 

For more info, check out:

https://www.trich.org/

Mayo Clinic

https://www.trich.org/dnld/ExpertGuidelines_000.pdf

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
Anxiety Mental Health Obsessive-Compulsive Disorder (OCD)

Destigmatizing OCD

 

Image via Wikipedia

OCD is a form of anxiety occurring when the brain has difficulty dealing with worries and concerns. As a result, someone with OCD will constantly worry and obsess over things that may seem banal to a non-sufferer. For some kids, their worries are focused on cleanliness or germs, resulting in repetitive hand-washing rituals. For others, it could be repeatedly straightening out an area, trying to achieve perfection. These obsessive and repetitive behaviors are done ritualistically or compulsively in order to quell the pervasive anxiety induced as a result of obsessive thought patterns. Often, an OCD sufferer will focus on things being in “order” or “just right,” also as a means to reduce the lingering, scary thoughts infiltrating their minds.  While some kids may recognize they don’t need to act on these behaviors, the disorder itself propels then to do it anyway. It’s not their fault. Interestingly, acting on the repetitive thought patterns does minimally reduce the anxiety, albeit temporarily.

I want to point out that worrying is also a natural part of childhood, so is having small rituals (like wearing your lucky t-shirt before a game), being super organized, double-checking to make sure the door’s locked, et cetera. Kids and teens naturally worry about things, be it school, whether they’re liked, whether they “look cool” for school or to impress that guy or girl, or whether their parents are ever going to get along. With OCD, these rituals become extreme. So, if you notice repetitive, ritualistic, and compulsive behaviors becoming more extreme and negatively impacting one’s day-to-day life, then it’s appropriate to take a closer look at the cause and take action.

That means seeing a psychologist or psychiatrist who will ask questions about obsessions or compulsions. Some of these questions may include:

  • Do you have worries, thoughts, images, feelings, or ideas that bother or upset or scare you?
  • Do you feel you have to check, repeat, ask, or do things over and over again?
  • Do you feel you have to do things a certain number of times, or in a certain pattern?

Once the diagnosis is made, then treatment can begin. Cognitive Behavioral Therapy (CBT) is a preferred treatment for OCD. A CBT therapist will work with a child or adolescent with OCD and help them learn that they are in charge, not the OCD. Often the CBT will integrate Exposure and Response Prevention (ERP) as part of the treatment. With ERP, the strategy is to gradually expose the sufferer to their trigger (fears) so they can develop skills and learn not to respond to them with such urgency. The process allows the OCD sufferer to begin to recognize that their fear is just that: a fear, not a reality; it also helps the brain “reset” the very mechanisms that trigger the obsessive behavior. It’s important to remember that treatment for Obsessive-Compulsive Disorder takes patience, time, diligence and hard work.

Remember, there is no shame in asking for help or in getting treatment. Having OCD doesn’t mean you’re crazy, or broken in some way. There is a solution.