Thursday, December 1, 2011

Learning Differences & Higher Education

Getting into college is not always the biggest challenge for students with learning differences. It’s the adjustment to college level work and a more independent lifestyle that can be the greatest hurdle.

Picking the Right College
The first step in successful transition to higher education is picking the right college. Every college and university is different and some are more accessible than others. It is important to research college disability service centers as a part of a prospective student's selection process. There are a number of good books and articles written especially for students with learning differences to help with picking colleges. The LDonline website has a great article addressing this.

After a college has been selected, it is up to the student to send in disability documentation and obtain appropriate accommodations. The school will not initiate this, so it is the student's responsibility to find out what is needed and gather the documents together. This information can often be found on a college's disability services web page or by giving the admissions department a call. It is important to note that most colleges require a comprehensive evaluation that is less than three years old to register a student with the disability services office and qualify them for accommodations.

The majority of colleges offer some sort of orientation to new students. It is a wise idea to attend this and find out about the resources that may come in handy as you go along. Remember that these orientations are geared toward the majority, so students with disabilities may need to be assertive and ask for specific information they need. It is also important to visit the disability services center early on and often. They can be a valuable support throughout your college career and they generally won't make retroactive exceptions for you if you run into trouble before registering with them.

Knowledge & Advocacy
In college, self-identification and self-advocacy is required. Nobody will be asking about an adult student's disability status as this is considered a breach of privacy. Therefore, students must be able to anticipate their own needs and be proactive about getting them met.

Some students with learning differences are not aware of their strengths and limitations or how their disability might affect their college experience. Even those who are aware may not understand their educational rights or be adept at communicating their needs. It is important for students to know how to explain their disability to others when appropriate, how to ask for what they need, and how to protect their rights. The Wrightslaw education law and advocacy website is a good place to educate yourself in these matters.

College vs. Primary/Secondary Education
Each college has its own specific documentation requirements and different accommodation options. At this higher level of education, options for remediation are limited or unavailable and there are often no modifications allowed.

New college students may find they need different or adjusted accommodations in the college environment as the demands are different from high school. Many students with learning differences learn best through doing rather than just through seeing or listening, so they need to put their accommodations into practice and try different things to find out what works for them.

In college there is less structure and feedback and generally things are less predictable. Having good habits in place before leaving for college is important. Also, students should be prepared to self-monitor and adjust their behavior rather than relying on others to give them feedback and direction. Students have limited time in class with their teachers and class sizes are larger; therefore, they must learn to be assertive and seek out what they need outside of class time. There is increased competition and greater expectations for the quality and amount of work produced, so good time management and study skills are necessary.

In light of the greater independence required, students need to arrive armed with solid independent living skills. Strong decision making and problem solving skills will also make the transition to an independent lifestyle easier.

Stumbling Blocks
In my experience working with children, adolescents and adults with learning disabilities in private practice, at colleges and at a university disability services center, I've become aware of a number of early missteps that can cause problems later on down the line.
  • Don't automatically assume students understand their disabilities just because they have been living with them. Children need to be told over and over again in ways that are appropriate to their changing development. Some students lack awareness of how their disability affects them and others avoid thinking about it because of shame or intimidation. These students will have trouble asking for what they need and may be reluctant to protect their rights.
  • Don't forget the saying "wherever you go, there you are". Some students think they will grow out of their disabilities or they hope that things will be different in college and they won't need the help they were used to in the past. Most research tells us that although people can compensate for their disabilities such that they are almost imperceptible, there is currently no cure. Students who believe otherwise often never even register for services at their college.
  • Use it or lose it. Some students register with disability services, but do not use their accommodations when they really need them. Often their grades do not accurately reflect their knowledge. It is true that not all college students with disabilities need accommodations; however, a good rule of thumb is if you needed it through high school, you are likely to need it in college and you may need things in college you didn't need in high school.
  • Stand up for yourself. Some students try to use their accommodations, but run into roadblocks and don't advocate for themselves. They may become discouraged and stop using their accommodations. Know your rights and don't be afraid to protect them.
Transition Planning
The law requires public schools to provide transition planning for students with disabilities once they reach a certain age. As with any service, the quality can vary from school to school and from district to district. It is important for parents to monitor this process and make sure it is meeting the student's needs. If you feel more is required, there are a number of good resources on the web. The National Joint Commission on Learning Disabilities has a nice brochure on transition planning (revised 2007).

Part of transition planning should involve helping students understand their rights, how their disability affects their current functioning, how to communicate this to others, and how to find and utilize the tools they need to succeed.

Some students have emotional and identity issues related to their disability that are getting in the way of reaching their potential. In counseling students with learning differences, often work has to be done to raise awareness and self-esteem.

Students may feel inadequate, weak, abnormal, or “dumb”, because they do not view their disability in the same way they might view a more visible disability. For example, a student with dyslexia may understand that her friend who has a spinal cord injury needs an elevator to get to the 2nd floor, but she cannot accept that it is okay for her to need books on tape to complete her reading assignments for her classes. People with "invisible" disabilities sometimes internalize the unrealistic expectations of others. Counseling can help such students learn to see their disability for what it is, capitalize on their strengths, understand their limitations, and positively incorporate these factors into their lives.

Please visit my website for more information about learning differences and other mental health concerns,

Saturday, October 1, 2011

Finding Balance in Relationships

Photo by Sean Ochester
Most of us understand that being repeatedly selfish, cruel and neglectful in relationships is a sure way to destroy them.  But, did you know you can also kill a relationship with kindness?  If you have been told you are “too nice”, you may be inadvertently skewing the balance of equity required for healthy adult relationships.  Successful long-term friendships and romantic relationships tend to have a fairly equal balance of power, but people who are too nice tend to give away their power and do more than their fair share of the work.

The following are some specific "too nice" behaviors that tend to cause problems in friendships and romantic relationships as well as some suggestions for finding a better balance.
  • Being overly-responsible for your relationships: When you do most of the work in a relationship, you show the other that its okay to do less and you risk eventually becoming burned out and resentful.  Resist being the sole cheerleader for your relationship, constantly pointing out the good things and going out of your way in an effort to convince the other person to stick around.  Avoid talking them out of their doubts regarding the relationship. Try instead to listen and really hear what they are saying, believe them and respond appropriately.  In the best case, you both may be able to identify problems and address them.  In the worst case, if you are not well-matched, it is better for you both to discover that as early as possible and move on to someone who is.  Not everyone you like is going to be right for you.
  • Over-focusing on others: We tend to respect people whom we perceive to be capable, confident and accomplished in their own right.  When you over-focus on someone else’s wants and needs, you neglect your own.  Legitimate relationships which are one sided or power-imbalanced include caregiver-patient, parent-child, or manager-employee.  Hardly anyone really wants a parent, nurse, or boss as a long-term romantic partner or a friend.  Invest time and energy in your own life:  try new things, spend time with other friends, engage in hobbies, take care of yourself (exercise, eat well, sleep) and place more focus on the parts of your life that are good.  Acknowledge and honor you own wants and needs - treat them as equal to those of other adults in your life.
  • Doing too many unasked for favors:  The danger is that the recipient feels uncomfortable or even irritated with you because they feel they owe you or they are inconvenienced by your unwanted favor. Over time, your acts of kindness can begin to appear ingratiating or manipulative to them.  You may start feeling resentful because you have put much time and energy into something that was unappreciated.  If in doubt, ask first or turn your energies to something more certain and productive.
  • Being overly available:  If someone in your life consistently expects you to take care of their responsibilities at the drop of a hat, set a boundary.  Being overly available sends the message that you don't have a life of your own, which is generally not an attractive quality to other people.  Say "no" sometimes and let them know you have your own life to attend to.  This way you will avoid a buildup of resentment and show them how to treat you in a way that is sustainable for the long term.
  • Being overly forgiving: When someone routinely mistreats or neglects you (unfairly criticizes or ignores you, hurts your feelings), you might be tempted to tolerate it because it's a hard time in their life, they are vulnerable in some way, or they were hurt in the past. Set a boundary and don’t continue to let them take their angst out on you - they will respect you more for it and they will be forced to find other (hopefully healthier) ways to cope with their problems.
  • Repressing your own feelings, wants and needs: Do you describe yourself as easy going, flexible and giving, yet you find yourself feeling increasingly irritable, angry, and resentful with certain people?  You may be ignoring feelings you consider unacceptable so you can continue to see yourself as a “nice person” or because you believe this is the only way others will accept you.  That’s not sustainable in the long term because your feelings are sending you important messages and will not go away if ignored.  Repressing your feelings also keeps others from learning important information about you which makes it hard for them to know how to treat you.  Acknowledge your feelings and assert yourself so that others in your life can make better decisions about how to relate with you.
If you suspect you are "too nice" and you want to learn ways to create greater balance in your relationships, it may be time to consult a mental health professional. You can find mental health professionals in your area through online therapist locators such as those hosted by the American Psychological AssociationPsychology TodayNetwork Therapy and GoodTherapy. You can also call the behavioral health number on the back of your insurance card or visit your insurance company website to get some referral options.

For more resources relating to relationships and other mental health concerns, please visit my website

Thursday, September 1, 2011

Getting Motivated

Motivation is our drive to meet basic and higher needs and pursue desires. It energizes us and directs our behavior. We need to be able to meet our more basic needs before we can expect to meet higher needs.

Basic and higher needs:
  • Belonging - love, acceptance
  • Survival – hunger, thirst, safety, shelter
  • Esteem – achievement, competence, approval, recognition
  • Self Actualization – personal growth, improvement
Motivation is a powerful force for change and growth. It can focus behavior on goals, increase effort, energy and persistence, improve thinking and performance, and enhance self-confidence and self-esteem.

Where Does Motivation Come From?

The source of motivation can be internal or external, positive or negative. Positive motivation involves obtaining desired or pleasant consequences (rewards) while negative motivation involves escaping or avoiding undesired, unpleasant consequences. Internal motivators are often more powerful and enduring than external ones.

Examples of internal motivators include:
  • Desire
  • Pleasure
  • Pride
  • Growth
  • Meaningfulness
  • Power
  • Guilt
  • Pain
Examples of external motivators include:
  • Money
  • Promotion
  • Good grades
  • Praise
  • Disapproval from others
  • Punishment
Business consultants and life coaches will say there is no simple formula for motivation, but expectancy theory makes an attempt at one (based on Vroom, V. H. (1964). Work and motivation. New York: Wiley):
Motivation = Perceived likelihood of success x Belief that success will lead to reward x Value of reward

This formula indicates that the more you believe you can succeed, that your success will be rewarded, and that the rewards will be great, the higher your motivation will be. We are most motivated when we feel capable, responsible, self-directed, respected, and hopeful.

Blocks to Motivation

When motivation is external, it tends to wane when the source is absent. Most children rebel against their parents' attempts to motivate them to keep their rooms clean. When we grow up and are living on our own, most of us are able to keep our living spaces relatively neat. This is because internal motivation eventually takes the place of our parents. We find our own important reasons for keeping our rooms clean.

Even internal motivation has its challenges. Many of us start out with high motivation, but we find it fading as time passes. This can be due to poor planning and limited short term rewards (see entry on goal setting). It can also be due to poor self-confidence or lack of resources to succeed. Or we may discover that the rewards we anticipated aren't as powerful as the challenges we meet and sacrifices we make along the way.

Some common blocks to motivation include:
  • Fear of failure
  • Fear of success (success leads to greater expectations from others as well as increased independence and responsibilities which can be overwhelming)
  • External locus of control – relying on luck, not taking responsibility, feeling that others will stand in your way
Increasing Motivation
Since internal motivation is more enduring and we work hard for rewards, it makes sense that finding internal and positive reasons for doing what you are doing is essential to staying motivated. Ask yourself why you are doing something – then ask five more times to see if you can find an internal and positive motivation. For example, lets say you want to become more organized.
  1. Why do I want to be more organized? So that my house will be neater and cleaner.
  2. Why do I want my house to be cleaner? So that I can find things more easily.
  3. Why do I want to find things more easily? So that I can be more efficient.
  4. Why do I want to be more efficient? So that I can save time.
  5. Why do I want to save time? So that I can spend more time relaxing and enjoying my family.
From the motivation formula mentioned above, you can see that self-confidence is also an important factor in motivation. Believing in yourself increases your perception of likelihood for success and increases your confidence that you can manage that success once you get there. Know your strengths and weaknesses and capitalize on natural talents and interests to increase your chances for success. Choose a source of inspiration and surround yourself with successful people to remind you it can be done and what you stand to gain by succeeding.

Build in smaller, short-term rewards along the way. The further away you are from your ultimate goal, the more likely you are to lose steam as time passes. Breaking tasks into manageable pieces, each with their own rewards, will help you stay on task and remind you of what you are working so hard for. Incremental rewards will also help prevent you from being overly discouraged by setbacks.

If you are having trouble getting motivated, a mental health professional like a psychologist can assist you in taking a look at your concerns and generating options. Please feel free to visit my website for more information and resources regarding a variety of mental health concerns.

Wednesday, May 18, 2011

Making a Change

When a person has been experiencing longstanding discomfort - perhaps months or years of unhappiness, anxiety, loneliness, anger - they certainly know they want to feel better, but they may be unsure of what to do about it. Breaking out of these uncomfortable feeling patterns often requires a change - and change is hard!

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Successful change involves a process. What follows are simplified suggestions for getting yourself into the change process.

When contemplating a change, the first thing to ask yourself is whether you are motivated. We often skip this step and dive right into looking for solutions, which can lead to setbacks and discouragement. To assess motivation for change, there are some questions you can consider:
  • Do I really want to make a change? What are the pros, cons, risks and benefits to change vs. keeping things the same?
  • Am I willing to do what it takes to make the change? Is it worth the effort?
  • Am I able to make the change at this time? Do I have the tools and resources I need?
If you determine you are indeed motivated to make a change at this time, you have four options to choose from. Ask yourself if you are willing and able to:
  1. Change the situation
  2. Change how you feel about the situation
  3. Accept the situation
  4. Keep everything the same
Changing the Situation
When you're ready to take action toward change, I find the best place to start is asking yourself if there is any way to change the situation. If you decide you are willing and able to change the situation you have several options:
  • Remove yourself from the situation
  • Assert yourself: Express your feelings and ask for or make a change
  • Negotiate a compromise
Weigh the pros and cons of each option. Many times, we have little control over a situation and are powerless to change it. If you decide that you cannot or will not change the situation, you can move to option #2, “Change how you feel about the situation”.

Changing How You Feel About the Situation
In order to change the way you feel about a situation, you have to understand that how you look at a situation influences how you feel and how you behave. Our perceptions determine our reality (and everyone’s reality is different). For example, if I perceive flying in an airplane to be dangerous, I will feel anxious about it and avoid it. If I perceive flying to be fun and exciting, I will be more willing to engage in it and might actually enjoy it.

The attributions we assign to things around us can be positive or negative and will impact how we feel about a situation. Negative attributions are generally:
  • Global vs. Specific (“That’s just the way it is” vs. “That’s how it is in this particular situation”)
  • Stable vs. Changing (“That’s the way it will always be” vs. “That’s how it is now”)
  • Internal or External (“It’s probably all my fault” or "I am at the mercy of circumstance" vs. “I’ll take some responsibility and I recognize there are also factors outside my control involved here”)
Sometimes our uncomfortable feelings are due to problematic thinking. This type of thinking involves automatic, distorted, and unhelpful messages we send ourselves that make us feel worse. To see some examples of problems in thinking that can lead to uncomfortable feelings, please visit PsychCentral's article by Sherrie Mcgregor, Ph.D. (2007).

Other times our uncomfortable feelings stem from deeper problematic beliefs we have about ourselves and the world. These beliefs are not necessarily true even though they may feel very real to us. Fortunately our problematic thoughts and beliefs can be challenged and replaced with more realistic and health promoting ones. This takes some hard work and practice; however, and may be best accomplished under the guidance of a mental health professional or at least a good self-help workbook.

If after learning what it takes to change how you feel about a situation, you decide you are unable or unwilling to do so, you can move to option #3, “Accepting and tolerating the situation”.

Accepting the Situation
Acceptance is allowing yourself to fully experience a situation in the present moment without distortion, judgment or intention to change. Finding acceptance is not easy. It involves an understanding that you are responsible for your own thoughts, feelings and actions and for the choices you make in your life and that these are the only things you really have control over.

Acceptance does not mean resigning yourself or giving up - rather, it means making peace with a situation that you cannot change or is better left unchanged. Acceptance can be the only healthy option available to people who find themselves in difficult situations they are powerless to change. It is an interesting fact that acceptance sometimes leads to unexpected change that is profound and lasting.

Keeping Everything the Same
After considering all your options, you may decide it makes more sense to keep everything the same and remain uncomfortable. Hardly anyone thinks this is a good choice from the outset, but it is important to acknowledge that change is a choice and everyone has a right to "stay miserable", as Marsha Linehan, Ph.D., ABPP would put it. Knowing you always have this option can sometimes give you the courage and freedom to move forward with another, more satisfying option.

If you would like help making a change in your life, a good place to start is by checking out or purchasing a reputable self-help book. I have some of my favorites listed in my "Required Reading List" in the right-hand panel of this blog. You can also find mental health professionals in your area through online therapist locators such as those hosted by the American Psychological Association, Psychology Today, Network Therapy and GoodTherapy.

Please also visit my website for more information and resources regarding a variety of mental health concerns.

Friday, April 1, 2011

Is Time on Your Side?

Photo by Sean Ochester
What troubles do you run into managing your time? Most of us don't ever seem to have enough of it. For others, having too much time on their hands is a dangerous thing.

Everyone's perceptions and beliefs about time are different. Some people strongly value time, work hard to be timely, and expect others to do the same. Others see time as flexible and renewable. They aren't particular about how they use it and it doesn't bother them when things don't run on schedule. In addition to this, some individuals have a better feel for the passage or time than others. They just always seem to know approximately what time of day it is and they are naturally better at predicting how much time something will take.

For those of us that struggle more with managing time, the following are some guideliness for getting the most out of your day.

Think Realistically
Most of us are relatively unaware of how we really use our time. It is typical of human beings to underestimate the amount of time spent unproductively and how much time it takes to complete a task. Another common trap is taking on more than we can manage and having a hard time delegating or setting aside relaxation time for ourselves.

Try this exercise - make a chart with 7 columns and 24 rows. Write each day of the week, Monday through Sunday, in the column headings. Then put each hour of the day, all 24 of them, in each row header. For the next week, write down what you are doing every hour of every day. This includes, sleeping, eating, driving, watching tv, or even just staring off into space. You may be surprised by what you discover. Do you actually have enough hours in the day to get things done? Do you see a good balance between obligations and self care? Are there changes you can make to better use your time?

Get Organized
Much time is wasted due to disorganization. How often have you found yourself running around trying to find needed items or taking care of last minute tasks? Plan ahead and do what you can in advance. Develop a routine so that the things you have to get done each day become automatic. Expect obstacles and be ready for them. Keep your frequently needed items in the same accessible place so that they will be easy to find each day. Keep spares on hand.

Make sure you have a time keeper on your person such as a watch or cell phone and know where the clock is in the room. If your time keeper has alarm functions, use them to alert you to upcoming events. Keep a schedule and update it frequently. You might have to experiment to find the type of scheduler that works best for you and some people benefit from having several scheduling methods at their disposal. If all else fails, hire a certified professional organizer to help you make headway and teach you some techniques for maintaining your gains.

Avoid Procrastination
Procrastination can be both a symptom and a cause of poor time managment. Most of the time, merely improving your time management skills reduces procrastination. Other times the procrastination needs to be addressed directly.

Procrastination is a learned behavior involving self-regulation skills, emotions, attitudes, as well as factors we may be unaware of. The causes of procrastination can vary among individuals and tasks. People procrastinate for various reasons and overcoming it requires getting at the heart of these reasons. The following are some additional causes of procrastination:
  • Doing things solely for other people or because we think we "should" rather than having our own reasons. We work harder for something that has meaning to us so it important to take ownership of the things we do.
  • Taking on something too big, too time consuming or too difficult. In this case, procrastination is a way of coping. Modifying the task or breaking it into smaller steps can help.
  • Relying on fear to motivate. A rush of nervous energy can help us get things done, but the cost to health, performance, and relationships may outweigh the benefits. Honestly appraising the pros and cons of doing things in advance versus waiting until the last moment may help you break out of this cycle.
  • Difficulty making a decision. Not making a decision can be a way of avoiding responsibility for the outcome. It is often the anticipation that is the hardest part and once the decision is made, there is a sense of relief. Developing strong decision making skills and consulting trusted others may help.
  • Feelings of low self-confidence and low self-esteem may result in a fear of failure (or success). Procrastination may help us avoid judgment by making others think we lack effort rather than ability. It may also keep others from expecting more of us than we think we can give.
  • There can be power in procrastination. It might enable you to be a "conscientious objector" or to indirectly show someone that you aren't happy about having to do something. You can also control others if they can't move ahead until you finish your task.
While everyone procrastinates, chronic procrastination can cause a number of serious problems. It can result in reduced productivity, failure to reach one’s potential, and feelings of shame, worthlessness, and despair. There can be health consequences to procrastination. Procrastination predicts higher levels of consumption of alcohol among those people who drink and college students who procrastinate show evidence of compromised immune systems such as more colds, flu, gastrointestinal problems, and insomnia. In addition, procrastination can damage relationships. When we procrastinate, we often shift responsibilities onto others, who in turn become resentful of us. Procrastination can undermine teamwork and keep others from accomplishing their own goals.

Get Motivated
Ask yourself why you are doing the things you do each day and remind yourself what you stand to gain. When we lose sight of our goals, we can't "see the forest for the trees". Stepping back and taking a look at the bigger picture every once in a while can provide a boost to motivation.

It seems to be human nature to take our successes for granted and dwell on our disappointments. When overdone, this can lead to discouragment or apathy. Acknowledge your accomplishments and reward yourself for completing tasks. This doesn't mean you have to brag or buy yourself presents. Sometimes patting yourself on the back and giving yourself a break is enough to feel good about your efforts.
Remember to take care of yourself and schedule in breaks and down time. Its hard to stay motivated when you are sick, exhausted or burned out. Set yourself up for success. Make sure you have the resources and tools you need to manage your time well. If you allow too many obstacles to lie in your path, you may become discouraged and get off track.

A common time management problem is discovering you are spending most of your time doing the things that are least important to you. Do you have your priorities straight? Take a sheet of paper and fold in half, then in half again. When you unfold it, your paper will be divided into four sections. In each section, write the following headings:
  • Important/Urgent
  • Urgent not Important
  • Important not Urgent
  • Not Important/Urgent
In the Important/Urgent section, write down things you need to do that have significant consequences for you and must be done ASAP. In the Important not Urgent section, write down tasks that mean a lot to you, but can wait or have no real deadline. In the Urgent not Important section, write down tasks that must be done quickly, but don't have significant consequences. Finally, in the Not Important/Urgent section, write down things that don't mean much to you and have no time urgency. Notice the types of things you place in each category. Is there a category that has many more or fewer items than the others? What might this mean about the way you manage your time? Do any changes need to be made in the way you think about your obligations?

The Evils of Micromanaging
It is possible to be overly conscientious about time. There are many things in life that are outside our control and trying to control the uncontrollable can be overwhelming. Some people become obsessive, making endless lists, worrying, and planning the next day when they should be sleeping. This ultimatley backfires and their health and performance are compromised. As we all know, our time is finite and we can only stretch it so far.

It is also important to remember that not everyone thinks about time the same way. Some things may be more important than timeliness, and you may have to compromise to maintain your health and relationships with others.

If you or someone you love is having trouble managing their time, consulting a professional may help. You can find mental health professionals in your area through online therapist locators such as those hosted by the American Psychological Association, Psychology Today, Network Therapy and GoodTherapy. If you have health insurance, you can find out who is in your network by visiting their website or calling the behavioral health number on the back of your card.

Please also visit my website for more information and resources regarding a variety of mental health concerns.

Tuesday, March 1, 2011

The Power of Referral

Photo by Sean Ochester, ©2010
Like a bridge spanning an otherwise challenging obstacle, a referral is meant to take its recipient safely and efficiently from point A to point B.  An excellent healthcare referral can be a powerful intervention, but many such referrals are made in haste without much forethought.

It can be especially difficult for mental healthcare consumers to obtain a good referral because of the shame and stigma that still lingers.  They can be afraid to ask for fear of being judged. This is unfortunate, because mental health problems are very common in the United States and nobody should have to feel alone. According to NIMH, "An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year."

In addition, many consumers are not aware of the differences in types of mental health providers such as marriage and family therapistspsychiatrists, psychologists, licensed professional counselors and social workers.  They may become overwhelmed, discouraged and give up more quickly when the first referral or two doesn't pan out.

Providing an Effective Referral
When providing a mental healthcare referral, it first helps to know what the client really wants and needs.  This involves asking good questions and listening closely.  Factors such as type of insurance accepted, location of the practice, years of experience, specialty areas, gender of the provider, and openness to different cultures, ethnicities, and religions may be of varying importance to clients.  Some mental health consumers want a more practical approach to managing symptoms where others want a less structured forum for self-exploration.  Knowing the therapy styles of the providers you refer to can be a big help in making a successful referral.

In order to give a good referral, it helps to know what's out there.  This requires research and networking.  Reaching out and making contact is an excellent way to learn the specifics about what other providers offer and how they operate.  You may want to ask other providers what their impressions have been of your prospective referral sources.  It is also helpful to ask clients about their experiences with other providers.

Obtaining an Appropriate Referral
It takes skill to obtain a good referral as well.  Formulating a clear and concise summary of your wants and needs is an important first step.  You may want to survey several sources such as other types of healthcare providers, friends and family who have experience with the services you need, and professional organizations such as certifying or licensing bodies.  Internet rating sites may be of some help, but keep in mind that many of them are unmoderated and biased (unhappy or angry customers are much more likely to weigh in than satisfied ones).  Finally, reaching out and making contact with the various referral options may allow you to ask good questions and see if you would be a good match.

Unsolicited Referrals
What do you do when you believe someone may benefit from a mental healthcare referral, but they haven't asked for one?  This can be a very sensitive situation.  Your best chance of being heard and considered is to first convey your concern and caring for the person.  Then tell them specifically how you think the referral may benefit them.  Self-disclosing your own positive experiences with mental healthcare can be especially helpful when appropriate.  Perhaps you've had a friend or relative that found good help in the past.  Conveying a personal experience can be quite convincing, comforting and normalizing to the other person.

Referral Resources
It is good stewardship for busy healthcare providers to take the time to give a referral when someone comes to us for something we can't provide.  If you've ever struggled to find a specialist and been on the receiving end of a great referral, you know the gratitude you feel toward the person who provided it.

The following are some good places to start in your search for a mental health professional:

Please also visit my website for more information and resources regarding a variety of mental health concerns.

Wednesday, February 2, 2011

Can I Trust Again?

Most of us have been hurt or betrayed at some point in our lives.  Its a terrible feeling that can have lasting repercussions, if we let it.  When our experiences of hurt and betrayal linger, they can seep into our future relationships and impact our functioning with our families, friendships and colleagues.  These negative feelings can also impact our physical and emotional wellbeing.

However, as human beings we need relationships like we need air, water and food.  So if we want to survive and thrive in our lives, we must expose ourselves to potential hurts and betrayals.  Being willing to trust involves an element of risk.  You make yourself vulnerable to another person when you put your faith in them.  This is why it so courageous that we continue to love and reach out to others despite the hurts we experience.

Wikipedia defines trust as "the willingness of one party to be vulnerable to the actions of another party".  Your first task is to decide if it is worthwhile for you to trust again and this may involve an examination of the pros and cons of making yourself vulnerable to another person.  Deciding to trust is a very personal choice, and only you can determine whether the benefits outweigh the risks. 

Things That Build Trust
Like a precious porcelain vase, trust is very easy to break but very difficult to repair.  Fortunately, there are some behaviors that you can engage in that are trust enhancing.
  • Consistency – showing a regular pattern of behavior with few contradictions
  • Reliability – doing what you say you will do or what is reasonably expected of you
  • Honesty – being truthful, sincere and authentic without intending to deceive
  • Open Communication – sharing information freely, often without being asked
  • Competence – demonstrating the skills, wisdom & experience necessary to do what is promised or expected
Acceptance and Forgiveness
Acceptance is experiencing and acknowledging the reality of a situation (whether good, bad, fair, or unfair) without avoidance, judgment or intention to change - in other words, being at peace with what is.  Sometimes the decision to trust also includes accepting what happened and moving on from it.

Forgiveness is letting go of the need for revenge or punishment as well as any negative thoughts, grudges, bitterness or resentment toward the person who wronged you.  Contrary to popular belief, one does not have to forget to forgive and reconciliation with the person who wronged you is not a necessary component.  For some people, the decision to trust again must also include forgiveness of the person who betrayed them.

What is the difference between acceptance and forgiveness?  They are very similar, however, forgiveness tends to involve people rather than situations and usually includes a percieved wrong or injury rather than merely unfortunate circumstances.

How Do I Accept or Forgive?
Try a symbolic act or ritual to make your forgiveness concrete and tangible.  You may destroy or toss away some item that reminds you of your pain.  Some people pray or write a letter to their transgressor.  Others may create a visual representation or reminder of their forgiveness.

Cultivate compassion.  Move the focus from your own pain and suffering to an attempt to understand the situation of the transgressor.  Recognize that "the victimizer is, truly, the most unfortunate of all" (Abhayagiri Buddhist Monestary - Universal Loving Kindness).  This involves recognizing there is courage in forgiveness, that being betrayed is not a reflection on the victim, and that the betrayer experiences their own suffering and pain.

Is it Safe to Trust Again?
There are no guarantees and relationships inherently involve some risk.  Although the decision to trust ultimately involves a leap of faith, there are some things you can look for to help you make a wise choice.

Is there genuine remorse?  Remorse is when a person understands they have hurt someone or done wrong, accepts responsibility for their part in it, and feels regret for what they have done.  The only way to know if someone is truly remorseful is if they are demonstrating this to you in their words and actions.  Demonstrations of remorse may include things such as a sincere apology, an attempt to make amends, changes in perspective or behavior, and most importantly - not repeating the offending action.  

Making amends may include reversing the effects of a wrong (where possible), offering restitution, or doing good deeds. A sincere apology is more complicated than it might seem.  A good apology is specific, owns up to the mistake, acknowledges the victim's pain, and doesn't contain excuses or explanations.  Remember, a sincere apology is for the person who has been wronged, not for the benefit of the transgressor - it should be intended to help the other person heal, not to obtain forgiveness.

There is not enough evidence in the world to prove someone trustworthy.  As Ernest Hemingway said, "The best way to find out if you can trust somebody is to trust them."  I might add that it is the only way to truly know.  This is the leap of faith.

If you or someone you love is struggling with relationship issues, it may be helpful to consult with a professional. You can find mental health professionals in your area through online therapist locators such as those hosted by the American Psychological AssociationPsychology TodayNetwork Therapy and GoodTherapy.

Please also visit my website for more information and resources regarding a variety of mental health concerns.

Saturday, January 1, 2011

Mental Health Emergencies

Many of us have had the misfortune of experiencing a medical emergency; either our own or that of someone we care about.  But did you know people can also experience mental health emergencies?  While mental health emergencies can be just as urgent and distressing as medical emergencies, people are often quite confused as to how to recognize and respond to them appropriately.

A mental health emergency is when an individual presents with a high level of risk factors for serious harm to self or others with relatively few protective factors.  Risk may involve a combination of factors like:  suicide thoughts with potentially lethal means and plan, family history of suicidality, experiencing a recent loss, having limited social support, serious mental illness, physical illness, substance misuse, hopelessness, poor judgment, treatment non-compliance or unwillingness to seek help, impaired self-care, and/or impulsivity.

A person who is at high risk of harming themselves or others often needs acute intervention and 24 hour availability from a team of professionals who are trained and experienced in managing emergent situations.  As with medical emergencies, this type of intensive and acute care is best provided in a hospital setting and is not generally available in a small, private clinic.

Putting a Band-Aid On It
Weekly therapy sessions are the standard for most clients.  However, in some situations, one or even two meetings a week with a private practitioner is not enough.  In fact, it can be downright dangerous for a therapist to treat a serious condition in a clinic when a high risk of harm to self or others is involved.

Imagine if someone went to their family physician with chest pains and the doctor said, "You are having a heart attack.  You need to go to the hospital."  And the patient replied, "I'm more comfortable with you treating me here.  Can I just come back next week and we'll see how I'm doing?"  This is a medical emergency that needs to be treated right away in the appropriate facility and most private practitioners do not have the equipment needed in their offices to manage a health emergency.

Similarly, a private mental health practitioner treating a mental health emergency in their outpatient clinic is like putting a Band-Aid on a gaping wound.  A private practitioner can be helpful in guiding clients to the appropriate treatment facility, offer suggestions and make recommendations.  This is why most psychologists and counselors make arrangements in advance with their at-risk clients regarding how to contact them in an emergency.

Sometimes a client needs a more rigorous therapeutic environment such as intensive outpatient treatment, parital hospitalization, or inpatient treatment.  These programs are designed to meet the needs of people in crisis and they can often manage a variety of complex needs such as safety monitoring, medication management, alcohol or drug abuse treatment, individual and group therapy, and case management.  A private practitioner can provide referral options if this is something a client needs.

Responding to Mental Health Emergencies
Mental health professionals respect autonomy and will offer a client some choices for keeping themselves and others safe.  They make every effort to balance autonomy and safety and generate the least restrictive options wherever possible. However, in high risk situations, a mental health professional will take decisive action to protect a client or others they may pose a threat to.  Psychologists are required by law and by their ethical code to do so.

In general, a mental health professional cannot "hospitalize" a client.  It is up to each particular facility to decide who they will admit or not admit for inpatient treatment.  However, if the risk factors are high and the client is not cooperative, a mental health professional can call the authorities who may then decide to take the client to a hospital for an evaluation. This is not a decision a counselor takes lightly and will only do so in the most serious of circumstances.

Once a client presents at a hospital, the staff there will do their own assessment and make their own recommendations. Although the private practitioner may provide the hospital staff with information and make recommendations, it is ultimately the decision of hospital staff whether or not a client should be admitted, the type of treatment needed, and for how long they should stay.

What Can I Do in a Mental Health Emergency?
If the emergency is immediately life threatening, you should do what any person would do in any immediately life threatening situation (mental health or otherwise) - which is to call 911. You may feel reluctant to do so, but remember it is better to have someone angry with you than in serious trouble, injured or dead.

Barring an immediate life threatening emergency, you can try to contact the current health provider whether that be a psychologist, psychiatrist or primary care physician.  Hopefully the provider has already offered instructions on how to contact them in an emergency, but if not, it is okay to ask "just in case". My emergency contact instructions are posted on my website where my clients can access them at their convenience using their password.

If there is no current provider or you are unable to contact the current provider in a timely manner, you may wish to call a 24 hour crisis line such as 1-800-273-TALK or 1-800-SUICIDE.  There are also state and local resources that may be of help such as your local hospital emergency room or state department of mental health crisis line.  The following are some examples I use in my office, many of which I include on the back of my business card:
  • Johnson County (KS) Mental Health Center  913-384-3535
  • MO CommCare Crisis Line  1-888-279-8188
  • Kansas Child Protective Services  1-800-922-5330
  • Missouri Child Abuse and Neglect Hotline  1-800-392-3738
  • Domestic Violence Hotline  1-800-799-SAFE
  • MOCSA Sexual Assault Hotline  913-642-0233
  • Kansas Poison Control  1-800-222-1222
  • Missouri Poison Control  1-888-268-4195
For more information on suicide prevention, please visit the American Foundation for Suicide Prevention (AFSP) or National Suicide Prevention Lifeline. Please also feel free to visit my website for more information and resources regarding a variety of mental health concerns.