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39899 Balentine Drive 310, Newark, CA 94560
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    Resiliency

    Posted 07:57 PM October 24, 2009

    How does one develop resiliency in the face of adversity?

    I think some people may have temperaments that are more naturally resilient. These people naturally see the glass half full, regardless. The rest of us have to work a bit at bouncing back from adversity, especially when faced with multiple adversities. It may take a little effort but resiliency can be developed.

    First, it is important to acknowledge ones feelings but not to be stuck in them. As a little girl, my mother used to remind me that feelings are not forever, they come and go just like the wind. Every day must be seen as a new day with new possibilities. AA gives great advice when it teaches us to take one day at a time. Tomorrow will bring new things.

    Second, it is easy to want to isolate and pull away from others when multiple difficulties arise. This may be okay for a very short period for a time of grieving, reflecting, or regrouping but is not a wise long-term strategy. People need people. Staying connected to encouraging and supportive family and friends is imperative to bouncing back and being resilient.

    Third and finally, I suggest always keep on going and take action. Movement is the key. By this, I mean take the next step whatever it may be depending upon the situation. For some, it might mean just getting out of bed. For others, continuing to apply for jobs even though past efforts may not have paid off.


          

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    ADHD

    Posted 11:32 AM April 08, 2009

    Attention Deficit Hyperactivity Disorder

    Definition. Attention Deficit Hyperactivity Disorder (ADHD) begins and is most often diagnosed in childhood. Some people are not diagnosed until adulthood, but, as they look back, they can document symptoms starting before age seven (Hallowell&Ratey, 1994). There are three sub-types of ADHD: primarily hyperactive, primarily inattentive, and a mixed type where one exhibits both hyperactive and inattentive symptoms. Regardless of type, ADHD is considered a cognitive and primary processing deficit disorder. The processing deficits found in those with ADHD are attention and effort, inhibition, arousal modification, and self-regulation. These problems cause symptoms such as impaired higher order reasoning, difficulty developing schemata, impaired metacognitions, and poor effectance motivation (Teeter, 1998). This processing problem leads to the various symptoms seem by parents, teachers, and doctors. Preston and Johnson (2008) note the symptoms for ADHD. They are impulsivity, difficulties with motivation, impaired attention and concentration, easy distraction, restlessness, hyperactivity, and emotional deregulation or impaired emotional control. Those who suffer from ADHD often suffer from learning disabilities and low self-esteem (Preston & Johnson), and they often have social-emotional problems and present with aggressive behavior (Teeter).

    Causes. It is generally thought that ADHD is caused by neurochemical problems. It is believed that there is dysregulation of both dopamine (DA) and norepinephrine (NE) in the prefrontal cortex (Preston & Johnson, 2008) and to a lesser degree, serotonin (SE) (Teeter, 1998). These transmitters, DA and NE, work together to control attention, inhibition, and motor planning. Their deficiency is related to the underactivity of the brain region involved with them. This underactivity related to DA and NE is thought to cause the behavioral symptom such as disinhibition, hyperactivity, and irritability. Dysregulation of SE may be the cause of aggression seen in those diagnosed with ADHD. Other nontraditional hypothesis suggest that ADHD may have many different causes such as food allergies, heavy metal toxicity, low protein and high carbohydrate diets, mineral imbalances, essential fatty acid (EFA) and phospholipid deficiencies, amino acid deficiencies, vitamin B and phytonutrient deficiencies, and thyroid disorders (Harding et al., 2003).

    Treatment Interventions for Attention Deficit Hyperactivity Disorder

    Medication. Medication for all subtypes of ADHD target the hyperactive and inattention symptoms. As well, the associated symptoms such as anxiety, depression, and aggression are addressed with other medications as appropriate. The use of stimulant medication is the first choice for both the hyperactive and the attentive symptoms. These medications work by increasing the level of dopamine at the synapse (Ratey, n.d.). The most common stimulants used are Ritalin, Concerta, Dexedrine, Adderal, and Cylert. All of these except Cylert have abuse potential (Preston & Johnson, 2008). However, Cylert is not often the first line of treatment because of several possible deaths as a result of liver malfunction, which, according to Ratey, is sad. He feels that because Cylert is long-acting, working all day, it has better effects and is generally more stabilizing than shorter acting stimulants such as Ritalin, the shortest acting of all the stimulants. Dexedrine and Adderal are longer acting than Ritalin but not as long-acting as Cylert. Some antidepressants can be used to specifically treat ADHA. They are Wellbrutrin-SR and Strattera (Preston & Johnson) and Norpramin and Tofranil (Teeter, 1998). As well, there are two alpha-adrenergic agonists prescribed for the condition. These are Catapres and Tenex. These other medications are usually used in conjunction with a standard stimulant but can be used alone as well (Preston & Johnson).

    Alternative Intervention. Nutritional supplements and fresh air can be used to address ADHD. Several are used together to address the dopamine and norepinephrine imbalances that are believed to be caused by several factors such as allergies, toxins, insufficient diet, and vitamin deficiency. One study prescribed tyrosine, B vitamins, cooper, iron, vitamin C, phospholipids, and EFA to 10 patients and Ritalin to 10 other patients. The research found that the nutritional prescription to be as efficacious as Ritalin in calming the symptoms of the patient (Harding, 2003). Another study found that if children spent more time out-of-doors in green and grassy areas, they exhibited fewer ADHD symptoms (Lawson, 2008).

    Psychotherapy. The primary treatment modality for this disorder is supportive and psychoeducational. Both the sufferer and their families need understanding, compassion, and a way to manage this illness. Hallowell and Ratey (1994), suggest that this be accomplished by not only explaining the diagnosis to the parents and teachers but to the child sufferer, too. Once the diagnosis is thoroughly explained and the sufferer is also educated as to his or her active part of the treatment plan, learning to use structure becomes the focus. Structure means learning to use tools like lists, reminders, notepads, appointment books, filing systems, schedules, bulletin boards, an alarm clock, etc. Essentially, structure sets up external systems that are reliable because internal systems of the ADHD suffer are not. The therapist’s job is to help the sufferer and the families set up and utilize a structured environment.

    References

    American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

    Hallowell, E. M. & Ratey, J. J. (1994). Driven to distraction: Recognizing and coping with Attention Deficit Disorder from childhood through adulthood. New York: Simon & Schuster.

    Harding, K. L., Judah, R. D., & Gant, C. E. (2003). Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Alternative Medicine Review 8(3): 319-326. Retrieved on March 21, 2009 from Alternative Mental Health.com under ADD article “ADD: Nutrients Perform as well as Drugs.”

    Lawson, W. 2004). ADHD’s outdoor cure. Psychology Today Magazine Mar/Apr 2004. Retrieved on March 20, 2009 from http://www.psychologytoday.com/articles/pto-20040406-000015.html via AlternativeMentalHealth .com ADD article titled, “Outdoor Greenery Improves ADHD Symptoms.”

    Preston, J. & Johnson, J. (2008). Clinical psycholpharmacology made ridiculously simple (5th ed.). Miami, FL: MedMaster.

    Ratey, J. (n.d.). An update on medications used in the treatment of Attention Deficit Disorder. Retrieved on March 20, 2009 from http://www.add.org/articles/updatemed.html

    Teeter, P. A. (1998). Interventions for ADHD: Treatment in developmental context. New York: Guilford.

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    Healthy Families

    Posted 12:39 PM December 03, 2008

    Healthy Families

    As therapists, we are trained to look for and focus upon family dysfunction.  Sometimes though we are so caught up trying to find the maladaptive aspects of our clients that we fail to see the adaptive or healthy characteristics they possess. Perhaps, we inherited this from the medical or disease model of treatment. Simply stated, this model encourages us to find the problem and fix it. It does not encourage us to find the good, healthy, or productive aspects of family life. Naturally, we want to make things better. However, perhaps we have been going about it in slightly the wrong way. It is not much easier for families to build on their strengths rather than to try to learn completely new ones. So, what are some family strengths we could build on?

    Family Strengths

    1. Accepting Influence, Repair Attempts, and Turning toward Each Other (See John Gottman’s work).

    Being connected to one another and bonding are protective elements to families under stress. If family members know how to listen to each other and to accept influence, know how to turn the volume down when necessary and enact repair attempts, and can come together responsively, they can solve almost any problem. These habits cause families to be united against the struggle, not against each other. Some researchers call this trait cohesion. Strong families who exhibit a good amount of cohesion are like super glue. They stick together under pressure. They do not pull apart.

    2. Flexibility.

    Flexibility in the family is both a strength and a benefit. Flexibility is the ability to bend or change when necessary. The term, flexible, when referring to families, extends to their ability to change roles, rules, and behaviors when necessary. Families that have this quality are more prepared to change or shift gears when trouble comes or times change. Essentially, flexible families are more adaptable. They do not keep doing the same thing repeatedly hoping to get different results. Change does not scare them; it mobilizes them to think, feel, perceive, and behave or interact in new ways. Combined with cohesion, this is a powerful trait.

    3. Resilience.

    Resilience is protective in nature. Resilience is the remarkable quality of being able to come out on top when the odds are against coming out on top. Families who are resilient know how to make the best of their circumstances, regardless of how grim. They somehow are able to maintain a realistic but positive attitude. They keep on going and do not give up. They take charge of the situation. Their nature or disposition draws support toward them. If no support is available within the immediate system, they know how to get it outside of the system. They seek support because they know it is important to survival. Even if they rely primarily on their own abilities to overcome, they know and believe in the importance of interconnectedness and community.

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    Dealing with Depression and Suicide

    Posted 03:09 PM November 30, 2008

    Sunday, September 14, 2008

    Reflections on Depression


    My husband came home from church today to tell me that he just found out that his favorite author, David Foster Wallace, died by suicide. Even though I have not personally read any of his works or do not know this author, I was deeply anguished upon hearing this. This man was not only an author but a professor and scholar. By the time he was in his mid-thirties, he had written a 1,000 page novel. Most of his contemporaries would probably say he was a genius. He was only 46 years old and recently married. Looking from a distance, one would think he had a great future ahead of him and a lot to look forward to.

    So why? The honest truth is, "I do not know. I did not know him." My guess, being a mental health professional, is that he was a sufferer of some type of Mood Disorder such as Major Depressive Disorder or Bipolar Spectrum Disorder. It makes me so sad to think that an illness can drive someone to kill themselves. But it can. Both Bipolar Disorder and Major Depression are extremely painful, physically and psychologically. Not having control over one's mood, appetite, energy level, thoughts, sleep, and attitude is extremely disheartening.

    People who have never witnessed the suffering of another who has been diagnosed with a mood disorder or have never experienced a mood disorder personally, may find it very hard to understand that the person is really ill and cannot just get over it or snap out of it. People can and do recover from episodes of depression or mania. But it may take a lot of work, tons of patience, some medication, and much support. The prognosis varies for different people, and most sufferers, whether bipolar or depressed, per my experience as a mental health worker for almost 20 years now, will have to fight more than one or two episodes during their lifetime. Often, these mood disorders are lifelong illnesses and, like diabetes or other chronic conditions, they need to be managed carefully over time.

    I wish I could take away the stigma and shame associated with these and other mental illnesses. It seems to me that we still have a long way to go in this area. We live in a world which teaches us that it is possible to get rich quick. We also are constantly exposed to the "just think positive" mentality which says, "If you have a good attitude (think positively, that is), all will be well." I call it the fast food and quick fix mentality. These ideas and cultural attitudes are not necessarily bad, but they can put a lot of undue pressure on people who cannot live up to the unspoken expectations beneath them.

    Do these cultural ideas make a depressed person die in this manner? Probably not. I do not really know. A good attitude is a great thing to have. It helps a lot of people get though difficult times. What I do know is that those who suffer from any type of mood disorder put themselves under a lot of pressure to get well and not be "sick" or to just be "normal." These sufferers do not need more pressure but more acceptance and the genuine support of friends, family, professions, and the world in general.

    For more information on depression and suicide contact the American Foundation for Suicide Prevention: www.afsp.org.

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    Why I Hate War

    Posted 03:05 PM November 30, 2008


    Published 19 October 2008
    by Evelyn Schmechtig-Cochran
    on Blogger

    Last night my husband and I watched the movie "Stop-Loss." It is about an American soldier who was called back to Iraq after serving his full tour. It exposed his anguish about going back, an anguish fueled by severe and unrelenting Posttraumatic Stress Disorder. It got me thinking and feeling. Even though I know that sometimes war is unavoidable, I remembered how much I hate war and how this feeling developed in me at a very young age.

    I grew up in a suburb outside of Milwaukee, Wisconsin. It is called Wauwatosa. "Tosa" for short. It was a great place to grow up. I loved my neighborhood and all the kids in it. Everybody in the neighborhood knew each other, and it felt like one big family. Summers were the best as we kids often stayed up late and hung out under the street light eating popcorn and laughing at who knows what. During the daytime, we would ride our bikes around the block repeatedly. It never seemed to get boring.

    In 1968, one of the older kids in the neighborhood was drafted into the Vietnam War. His name was Johnny. He was the older brother of one of my good friends, Tommy. At the time he was drafted, it really had no meaning for me. It was only when he came home that I began to understand what war was about and how it affected people.

    When Johnny left for Vietnam, he was your average 18-year-old. As far as I knew, he was clean cut and wholesome. When he came back, he was a very different person. He grew his hair long, smoked pot and took other drugs regularly, drank all day, and drove his car recklessly around our quiet suburban neighborhood. I remember hearing his car roar down our street screeching as it would round the corners. My parents would just shake their heads. Often commenting, "Look. See. This is what the war did to him. He will never be the same." They could only guess what happened to him. But I actually knew.

    You are probably wondering how a ten-year-old would know what happened to a Vietnam Vet. I knew because I asked. We would sometimes hang out around Tommy's house where Johnny would be drinking beer, smoking cigarettes, and listening to very loud music. One day I took the opportunity to ask him what it was like for him in Vietnam. He did not hesitate to tell me and the other children around what it was like for him. He talked about not knowing who was the enemy and who was your friend, and about having to kill children with his bayonet because they were going to pull the pin on a hand grenade and blow them both up. He told us how scary and confusing it all was for him and how he had nightmares and flashbacks. He talked about feeling angry all the time and not being able to feel anything else.

    Most adults would probably be disturbed that Johnny exposed children to the horrors of war and to his pain, but I am glad he told us. It had no adverse affect upon me. It helped me understand him and his pain, and the compassion I had for him only grew deeper and wider. I now felt sadness and compassion for anybody who had to face war. As well, I started to formulate my own beliefs and ideas about what I thought about war in general. I knew I did not like it.

    My father grew up during World War II in a region of Germany called Silesia. It is now a part of Poland. He and his brother grew up in the country on the farm my grandmother ran. My grandmother's father bequeathed it to her on her wedding day. Before the war, my grandfather was a tailor and went to the city everyday to work. During the war, he served as a medic assisting medical doctors in surgery. Fortunately, he never faced battle or used a gun. This kept him out of prisoner of war camps after the war ended.

    One day when I was in ninth grade studying history, we were given an assignment to go home and ask our parents about World War II, what they were doing during it, and how it affected them. I ask my mother who said, "Well, it did not really affect me in Brazil. You need to ask your father because he was in Europe during the war." Therefore, I did. He told us the worse thing for him was when the Russians came through his city after the war had ended and Germany had lost. They took everything. They made him and his brother watch as they raped his mother. Everybody was forced to leave his or her home and walk to many miles to West Germany. Many years later as my understanding of war grew, I wondered if my father and brother were also raped.

    My father was 15-years-old and my uncle was 13-years-old when the war ended. The horrors they were exposed to never left them. My uncle, who is now deceased, never recovered. He had severe depression and Posttraumatic Stress until he died several years ago. My father suffers from chronic alcoholism and suffered from nightmares at least until he was fifty. My mother would tell us that he would often wake her with his screams about the Russians coming.

    So why do I hate war? Because, as far as I can tell, nobody wins. We are all losers: the soldiers who fight it, the women and children who have to endure it, the civilians who have to support it and pay for it.

    If you suffer from PTSD and are a victim of war, please check out this web site:
    http://www.survivorcorps.org
    It was forwarded to me by a reader. Thank you!

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