Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about depression and antidepressants.
Note: If you are feeling suicidal or your depression is severe, contact a health professional immediately or dial 911 to be taken to your nearest emergency room. Online videos are not a substitute for the assessment and advice of a licensed healthcare professional.
Major Depression and Antidepressants
November 7, 2011 by
Understanding Addiction and Outpatient Group Therapy
November 7, 2011 by
Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about Addiction.
Note: If you are feeling suicidal or your depression is severe, contact a health professional immediately or dial 911 to be taken to your nearest emergency room. Online videos are not a substitute for the assessment and advice of a licensed healthcare professional.
Understanding Depression
November 7, 2011 by
Watch this video with Dr. Dawn-Elise Snipes to learn a bit more about depression.
Note: If you are feeling suicidal or your depression is severe, contact a health professional immediately or dial 911 to be taken to your nearest emergency room. Online videos are not a substitute for the assessment and advice of a licensed healthcare professional.
The Naked Therapy Alternative…
July 29, 2011 by
Awwww…..keep your pants on I am getting to it….
No, really, I mean keep your pants ON!
All seriousness aside, I have heard therapists complain that dress clothes are off-putting to their clients, supposedly creating more of a power dis-equilibrium, but I think getting naked it taking it to a pathological extreme? What is next, fetish dressing?
The naked therapist’s attempt to connect naked therapy with Freud is, at best, misguided. Freud used free association to let your mind go where it needed to, believing that if you talked long enough uncensored, the root of the issues would come out. She is proposing letting your hands wander, and let me tell you, what is coming out is certainly NOT the root of the issue. Considering she is targeting male clients, I wonder if Freud would say she is suffering from penis envy. HMmmmmm.
How exactly does staring at this naked woman really help JohnTom fix his marriage? The naked therapist is not licensed or certified as a counselor. She is not regulated by anybody.
When you look for a counselor, make sure he or she is licensed and in good standing. These people have been trained to identify signs that there may be a bigger problem or you are getting worse. They also take an oath to “above all do no harm.” Make sure you understand, by the end of the assessment, how he or she is going to help you solve your problems. If it does not make sense, question it. There are a lot of people out there (even licensed ones) using practices that are not commonly accepted. This does not mean they are bad, but it is important to make sure you believe it will work for you.
If you can think of a possible reason why it would make sense to pay $150/hour for a naked, unlicensed “therapist” to talk to you, please share. I am at a loss…
AA Alternatives
July 17, 2011 by
While AA is A way to recover, it is not the ONLY way. Unfortunately, due to the fact that the 12-step community is self-governed, and has no central oversight, there are some amazing groups with amazing sponsors, and groups where people are actively using crack in the bathroom or going out for drinks after an NA meeting. Additionally, AA tends to not be totally multiculturally sensitive. The emphasis on bearing your soul, speaker meetings, and the concept of a higher power is very off putting for many people. Therefore, while AA is, and will continue to be a very viable approach to recovery, we need to open our hearts and minds to alternative solutions. Failure to do so is just perpetuating the rigid, addictive mindset—”My way or the highway.”
At Gainesville-NOVA Counseling we take a more inclusive, solution focused and action-oriented approach. Is it spiritual? Sort of. Spirituality is a set of universal principles on which the majority of religions are based. However, spirituality is NOT religion. It is a lifestyle. We encourage you to nurture relationships; however, unlike AA, we believe that healthy family members can learn to be sober social supports (instead of mandating a sponsor). Our program uses the following 8 principles to help you change your negative thoughts, set and achieve realistic goals and stop relying on alcohol, drugs, sex, food or gambling to escape from the stress, anxiety, disappointments and frustrations of life.
1. Honesty: Fairness and straightforwardness of conduct; adherence to the facts. We start by talking about head-heart-and-gut honesty. If it is logically right, doing it or believing it does not make you feel bad and it does not tie your belly up in a knot, you are probably being honest. When one of those areas does not feel right, it usually means you are trying to do something, or convince yourself of something that is just not right. In recovery you need to practice not only being honest with others, but also being honest with yourself. If you grew up in an addicted household, this can be very difficult because you were taught to not trust yourself or anyone else and not feel. Many addicts have no idea what they like, want and feel, because they have never been allowed to figure it out. The first step in recovery is just that. Get honest with yourself. Figure out what is awesome about you. Evaluate all of those negative messages you have in your head, and figure out if they are true or messages/should that you can purge. Then figure out what you want 3 months from now, 6 months and 5 years. This will give you an idea about what path to start taking. It is important to remember that change is very stressful, and many times people change not to reach something, but to run or escape from something. To that end, AAs notion that you should avoid major changes for the first year are spot on.
2. Hope: Desire accompanied by expectation of or belief in fulfillment; expectation of fulfillment or success; someone or something on which hopes are centered (including yourself and mankind). We have to have hope that if we start changing our thoughts and actions we will start to feel better and our relationships will improve. Hope is the foundation of motivation. In the first step, Honesty, you figured out where you want to go and started figuring out who you are. In order to do the hard work to stay true to yourself, you need to be motivated. Without hope there is no motivation.
3. Faith: Allegiance to duty or a person; loyalty; fidelity to one’s promises; sincerity of intentions; something that is believed especially with strong conviction. You must have faith in the process, faith in yourself that you can do it, and faith in others that they will do the best they can with the tools they have. This means you need to surround yourself with people with good tools (coping skills, social supports, resources and recovery skills). You need to see that you can have fun clean and sober. You need to have faith that if you do the work, good things will come.
4. Courage: Mental or moral strength to venture, persevere, and withstand danger, fear, or difficulty. Courage closely follows faith. Changing the way you interpret things, learning to trust people, persevering even when the immediate outcome is not positive and forgoing the short-term, immediate rewards for the greater rewards when you complete your journey. These all require great faith in yourself, faith in the process and courage.
5. Integrity: Firm adherence to a code of especially moral or artistic values; incorruptibility; an unimpaired condition. Once you have gotten honest with yourself and others, have identified a worthy goals (hope), realized that you can achieve those goals if you rely on yourself, the process and other people, and have committed yourself to change (courage) then it is time to talk about integrity. That is, the unwavering commitment to the aforementioned principles. Sometimes we call this grounding. We encourage people to have morning and evening reflection sessions (5 or 10 minutes) in which they assess where they are at/how they feel emotionally, mentally, physically, socially, spiritually, occupationally and environmentally. They also reaffirm their commitment to themselves to achieve their goals by asking themselves “What can I do today or what did I do today that is in line with where I want to go and the person I know I can be?” AND “What could I have done better?” Change is hard and you will not be 100% perfect —well ever. However, knowing what you did right and where you have room for growth is a huge step in maintaining that forward momentum.
6. Willingness: Inclined or favorably disposed in mind; ready; prompt to act or respond. As with all the other “steps,” willingness follows closely on integrity. Get honest about what you want. Cultivate hope that with work things will get better. Have faith that your goals can be achieved. Muster the courage to keep going even when there are easier choices. Maintain a constant focus on your goals, values and commitment to yourself (integrity), and be willing to do the hard work.
7. Humility: Sometimes the hard work required means getting over yourself. Having to admit when you are wrong. Saying I am sorry and remembering that we are all one bad choice away from devastation.
8. Brotherly Love: “Love thy neighbor as thyself.” Once we have humbled ourselves, and learned to love and accept ourselves, despite our shortcomings, we can move on to having compassion/brotherly love for others. This is one huge stumbling block for many people. The inability to forgive, accept or let go of resentments; and the tendency to get angry over even the smallest things trips up most people’s recovery. This anger festers and negatively colors everything else. Seeing the bright side. Looking for the compassionate explanation. Realizing that what most people do really does not have anything to do with you (that whole getting over yourself thing again). All of these things feel awkward at first, but eventually become second nature.
Who Said: Removing the shoulds (and the stress) from our lives.
July 14, 2011 by
So often we get stuck in the shoulda, coulda, woulda trap without even knowing why. Who said you should have been a lawyer instead of a teacher? Who said you could have been a millionaire, but instead you chose to be a cop. What makes you thing that you would have done anything differently? Shoulda, coulda, woulda, but didn’t. Through listening to our parents, teachers, friends and the media, we develop a litany of “Shoulds” in our head. Most of the time we take these things at face value without even asking ourselves if we believe it is something we should do, or if it is just something others are trying to convince us we should do. When we start to get depressed or stressed out, often it is because of all of the things we are telling ourselves we should be doing, but are not. For example, there used to be a commercial in which a very pretty woman sang about being able to bring home the bacon, fry it up in the pan and never let you forget you’re a man. In reality, how many women can work a full time job, do all of the house chores, errands and cooking and handle the bedroom as well without getting stressed out? Very few. Unfortunately, many women in the 70s and 80s grew up believing that they “should” be superwomen, able to be everything to everyone all of the time.
There are times when we are unable to do things and we wish we could have. However, many times these things we “should” have done are simply overly high standards or goals someone else has tried to convince us that we care about. If you are going to beat yourself up over something you “shouda” done, then at least make sure you are the one that believes that and why. Try filling in the following statements: “I believe I should have done this because ______. The fact that I did not do it means that I am _________.” If you can fill in that statement with something that is reasonable and true, then move to the next step. If you cannot complete the exercise with reasonable answers, then you have to ask yourself why you are beating yourself up for something that really does not make that much difference anyway.
There is a basic principle that we do the things that are most rewarding (and least painful). Sometimes there is something that you truly believe you “should” do, like going on a walk instead of eating another piece of chocolate cake. If it is something that you really want (as opposed to something someone else tells you to do), then the challenge becomes figuring out how to make the desired activity(exercise) more rewarding than what you currently are doing (eating cake).
The first step is to do what we call a decisional balance exercise. Identify the pros and cons of eating a second piece of cake and the pros and cons of exercise. It is important to make the pros of exercise and the cons of eating cake strong arguments for exercise. If you need to, add incentives. For example, under the pros of exercise, say that you will get to go buy a new outfit every time you successfully complete 20 miles of walking (over multiple days of course).
So, to sum it all up. Identify what is important in your mind to do and why. Those are the goals you focus on. The rest of it can be delegated, ignored or compromised.
Responding to the Needs of Returning Veterans
July 6, 2011 by
Appropriate responses to the needs of returning veterans will include:
• A strength- and recovery-based focus
• An empowering, skill-training approach
• Careful, individualized, respectful, veteran-specific assessment and treatment planning
• A primary emphasis on stabilization and development of internal and external resources
• Education for veterans and families on the physical, cognitive and emotional aspects of trauma and substance use disorders
• Assertive linkage to ongoing support within the community—and in the larger military and veteran community nationwide
Effective responses to the needs of veterans with post-employment stress effects include a consistent approach that integrates trauma-informed addictions and mental health care, but what does that mean? It means that when treating a veteran for mental and/or substance use issues the clinician must realize that the traumas experienced have changed how the person feels, reacts and perceives the world. These changes are normal reactions to abnormal events. Unfortunately, they often persist even when the danger is past. This is the mind’s way of making sure the body survives. In order to help consumers to regain a sense of balance, we must create an environment of safety, trustworthiness, choice, collaboration and empowerment.
Safety means ensuring physical and emotional safety not only in the treatment session, but also in veterans’ daily lives. Even Abraham Maslow believed that safety helped form the foundation of mental health and wellness. When people do not feel safe, they are on guard, and they cannot rest well which negatively impacts their health, mood and relationships which could be supportive. So the next question I am often asked, is “What do they need protection from?” They need places where they are not subject to judgement or evaluation, and are not concerned they will have to defend their actions or the actions of the military in general. If they have been deployed for a while, they need a community that can help them feel less like a stranger in a strange world. They need places where people understand what they are going through, who have survived the nightmares, the insomnia and the feeling of utter isolation, not knowing who they can trust. They need to learn the skills to deal with the flashbacks and the nightmares, and to relaxs at the end of the day.
Trustworthiness is developed in the process of creating safety by maintaining clear, appropriate, consistent boundaries and objectives. Many people—veterans included—will not tell you everything until they believe you are trustworthy. Those things that haunt them at 2am are not things they are going to tell just anybody. Throughout the process that led to the PTSD–whether it be one single incident or years of traumas—the person regularly was stripped of their control, second guessed for every move and, often questioned on their decisions. Trauma informed treatment not only relies on consumers learning to trust their therapists, but also on them learning to trust themselves. Failure to keep promises reinforces the notion that the world is an unpredictable, terrifying place. Failure to help consumers see the logic in what they did, or are doing, reinforces the notion that their behavior is unpredictable and they are out of control. Remember to ask yourself what the benefit is to any behavor. Our brains are programmed to survive. How is the behavior helping the person survive. Substance abuse numbs pain and helps people survive until they develop alternate skills. Fear reactions/fleeing protect the person from imminent danger. Explosive anger can neutralize a perceived threat.
Choice means allowing consumers to prioritize what issues will be dealt with, when and to what extent. The caveat to this merges with collaboration. While it is certainly advised to maximize consumer input and control, there are some things which may need to be negotiated. When consumers are putting themselves at risk, even before treatment starts, the chances of them engaging in highly dangerous behaviors when they are in the midst of a crisis is much greater. For example, if Johnny is drinking a fifth of whisky each night and chasing it with hydrocodone, I would certainly not recommend delving into deep, emotionally charged issues in a traditional outpatient environment. It is likely when the pain increases, so will the desperation to stop the pain. Johnny first needs to get safe—mixing hydrocodone with whisky is just a slow way of committing suicide. If he can create a support plan that includes a drastic reduction in drinking (preferably 100%) and at least 3 people who will be there to support him, then I might consider working with him on the trauma issues in outpatient. My preference is for people with dual disorders (i.e. PTSD and substance abuse) who live alone or do not have a strong support system to enter into either intensive outpatient or a 3-5 day retreat in which they can have 24-hour access to a therapist and have their medication and substance intake monitored.
Finally, empowerment means providing consumers with the tools to help them create safety, trusting them to do the next right thing and encouraging them to make educated choices regarding their recovery and their life. Empowerment means helping them find positive ways to use the energy they are currently using to try and contain their anger and devastation. In PTSD, people often have a lot of “I should haves.” They cannot change the past, but with the knowledge of what they believe they should have done, what can they do now? That is to say, they cannot change the past, but what can they do to prevent it from happening in the future and/or make ammends if they believe they have done something wrong.
Trauma informed care identifies the trauma, and all of the associated mental, emotional, physical and social changes as the primary cause of people’s mental health and substance abuse issues. Likely things will never be like they were before the trauma, but they can get better. The terapists job is to help people define what “better” looks like, provide needed skills to help the person achieve their goals and empower them to start doing the hard work necessary to recover.
Biological Needs: The Foundation of Mental and Physical Health
June 29, 2011 by
The quantity and quality of sleep people get each day significantly impacts their mood. Think about the last time you were exhausted (maybe the last time the time changed?) Did everything take a lot longer to get done? Did you lack motivation to do much of anything? Were you all but mainlining caffeine to stay awake? Was it difficult to make decisions or remember anything? Okay, point made. Despite the fact that it forms the foundation of our mental and physical health, all too often, the first things people forego are sleep, exercise and nutrition. When people are awake, their energy is diverted across a wide spectrum of activities. When they sleep it is a time for their bodies to focus all of the energy on rejuvenation and repair. Not only repair of things that are broken, but also restocking the supply of neurotransmitters that produce feelings of relaxation and happiness.
When people sleep it is also the time for the body to focus on building immunity. When I was in college I used to stay up cramming for exams the entire week of finals. As soon as finals were done, it seemed inevitable that I would be sick. Coincidence? I think not. I don’t know about other people, but when I am sick, I am not so pleasant to be around, I lack motivation and feel like I am in a fog. Sound familiar? Yup, being sick and sleep deprived have a lot of things in common.
What about nutrition. Did you know that the symptoms of dehydration and depression are very similar—fatigue, confusion, constipation, loss of appetite… Similar things happen when blood sugar levels drop. My husband is hypoglycemic, and I can tell when he has not been eating right. He gets irritable, sluggish, has difficulty hearing and processing what I say and tends to seek caffeine and processed sugar to keep him going.
So what is the point? Simple changes in people’s lifestyles can have a huge impact on their mood, motivation and ability to be on their game. When they are rested and nourished, they will have more energy to be motivated, sociable and focus on the positive, and will need less energy to concentrate, make decisions and get things done. All that combined can be a great stress relief.
TIPS for GOOD SLEEPING
- Don’t eat right before bed. Drink a small glass of milk or water if necessary
- Keep a note pad, pencil and small lamp next to the bed. When something pops into your mind, write it down
- Keep the bedroom a comfortable temperature
- Try to make it as dark as possible
- Make a wind-down routine each day to cue your body to start releasing melatonin. We do it for children, why not for ourselves.
- Minimize annoyances. One of our dogs licks the sheets incessantly. She cannot sleep on the bed anymore.
- Reduce (or eliminate) caffeine 12 hours before you want to sleep. Yup. It stays in your system that long.
- Try stretching, meditation or partner massage to relax your muscles and work out the tension knots from the day.
- Drink plenty of water, but not right before bed.
- Cammomile and lavender essential oils can help calm you.
- Try creative visualization. When I am trying to get to sleep, I plan my garden or some other interior or exterior decorating project. It diverts my mind from stressful thoughts, and before I know it, I am asleep.
TIPS for GOOD EATING
- Keep a water bottle with you
- Eat small meals every 3-5 hours
- Drink 4-8 oz of water before each meal. It will help you get your water intake as well as fill you up a bit
- Eat colorfully–at least 3 colors on every plate.
- Fiber, protein and fats help slow down sugar absorption. Try to combine foods to prevent a spike (and crash) in blood sugar.
- Use a salad plate instead of a dinner plate
- Put back half. Only serve yourself 1/2 of what you would normally. Often you will find that is just as satisfying, and it saves a bunch a of calories.
