Thursday, 19 July 2012

gnikaT evitcepsreP

"Some people there are who, being grown; forget the horrible task of learning to read. It is perhaps the greatest single effort that the human undertakes, and he must do it as a child."
~ John Steinbeck

Continue reading from the bottom up ...

noraa/moc.gnillesnuocroiretni.www  cCPR ,dnallelCcM .D noraA

.nac uoy tahw etanod ,snaem eht evah dna devom os leef uoy fI  .daer a evah ,knil eht no kcilC  .ti gniod peek ot pleh ruoy deen dna krow doog od yehT  .adanaC fo noitaicossA seitilibasiD gninraeL eht si orez ot tuc gnidnuf rieht nees sah ohw noitazinagro tiforp-non hcus enO

.dlrow evititepmoc siht ni laitnetop rieht hcaer nerdlihc eseht pleh ot gnidnuf erom dna erom gnivomer yllacitametsys era yeht tcaf nI  .gnorW  .seitilibasiD gninraeL htiw esoht tsissa ot gnidnuf gnisaercni eb dluow stnemnrevog laicnivorP dna laredeF ruo ,egral os srebmun htiw kniht d’uoy oS

.gniga ot detaler t’nsi taht adanaC ni seitilibasid fo sepyt gniworg tsetsaf eht fo eno ti gnikam ,elpoep 000,136 ot tnec rep 04 tsomla yb revo dna 51 dega snaidanaC gnoma 6002 dna 1002 neewteb ylbaredisnoc desaercni seitilibasid gninrael ,adanaC scitsitatS ot gnidroccA )6

.boj eht no dna ,segelloc dna seitisrevinu ni nrael ot meht rof gnignellahc erom ti gnikam ,ytilibasid gninrael a htiw evil yrtnuoc siht ni stluda noillim a flah naht erom ,adanaC scitsitatS ot gnidroccA )5

.laitnetop lluf rieht hcaer nac yeht os seitilibasid gninrael htiw esoht gnitadommocca nigeb dna nerdlihc ssessa ot deen ew hcihw gnirud emit yek a era sraey noitisnart esehT .%52 ylraen yb sworg ytilibasid gninrael a htiw desongaid rebmun eht ,loohcs ot emoh morf noitisnart eht ekam nerdlihc sa taht stroper adanaC scitsitatS )4

.nerdlihc fo lluf sub loohcs yreve ni dlihc eno fo tnelaviuqe eht s’taht – ytilibasid gninrael a evah nerdlihc naidanaC fo %2.3 taht stroper adanaC scitsitatS )3

.ytilibasid gninrael a evah )%8.95( flah naht erom ,yrtnuoc siht ni seitilibasid htiw nerdlihc eht lla fo ,adanaC scitsitatS ot gnidroccA )2

.denibmoc seitilibasid fo sepyt rehto lla naht ytilibasid gninrael a evah yrtnuoc siht ni nerdlihc erom ,adanaC scitsitatS ot gnidroccA )1

... scitsitats naidanaC emos ta kool s’teL

.emitefil a rof siht ecaf yeht seitilibasid gninrael laer htiw elpoep roF  .stnemom wef a uoy ekat ylno lliw ti ... no emoC  .dednetni saw ti yaw eht ti hguorht krow ot uoy egnellahc I ,/sdrawkcabetirw/moc.derob.www no siht gnitsap dna ypoc yb gnitaehc era ohw esoht rof dnA

.yad yreve ecaf ytilibasid gninrael a evah ohw esoht elggurts eht no evitcepsrep ekat ot ti gnidaer ni tsisrep lliw ohw esoht pleh ot os enod ev’I dna egnellahc a golb siht gnidaer edam ev’I ,seY

Monday, 16 July 2012

“Happy Thought Therapy” Can Be Deadly

We’ve all seen them; Those “happy thoughts” little posters that are plastered all over the internet, especially on sites such as Facebook.  They’re supposed to uplift our spirits and help us remain mindful of how wonderful life really is.

What is truly alarming, however, is when mental health practitioners – some armed with very little knowledge of how deep some psychological wounds can be – build their practice around this “happy thoughts” fad.  Unfortunately I see far too many people claiming to be counsellors or therapists who have built their practices around this pop-culture, quick-fix trend, some going so far as to declare all other therapeutic approaches and psychiatric measures as part of a global conspiracy to keep people ill.

Let me be clear in my message: Being exposed to prepackaged “happy thoughts” WILL NOT cure serious mental illness, nor alter an Axis II personality disorder, nor alleviate the devastating symptoms arising from exposure to trauma, such as war, rape, child abuse, or sexual abuse.

I call upon my colleagues who employ this simplified “think yourself happy” approach to mental health issues to do some serious reading of current research, especially in the field of neuroplasticity and epigenetic research.

An example to illustrate my point is research conducted at McGill University in Canada and published in January, 2011, that found early childhood trauma not only impacted the function and structure of the brain, but also altered the expression of DNA in the affected person.

For The epigenetics of social adversity in early life: Implications for mental health outcomes, [McGowan, et al, 2011] researchers studied the brains and DNA from 24 men who had been abused as children and completed suicide.  They compared their findings with those from men who had died suddenly through accidents or suicide and had no history of abuse. 

Their findings indicated that the men who had experienced early childhood abuse had altered function of the hypothalamic-pituitary-adrenal axis [HPA] – this is a trio of glands that produce an array of hormones including cortisol, the “stress hormone”.  The NR3C1 gene is part of this system and produces a protein called a glucocorticoid receptor that sticks to cortisol.  When cortisol latches onto this receptor it triggers a chain reaction that deactivates the HPA axis, dialing down the body’s response to stress.  In those who experienced early childhood abuse, the NR3C1 gene is often blocked from proper function.

With diminished glucocorticoid receptors, the body’s affect-control system becomes dysfunctional and the HPA remains active in normal situations as well as stressful ones.  A person’s ability to tolerate stress is severely compromised and the result may find them living in perpetual distress which can lead to anxiety disorders, depression, and suicide.  This state of being is not the fault of the affected individual and no amount of “happy thoughts” will change the epigenetic damage that early childhood abuse caused.

But how does a person who is struggling with post traumatic symptoms feel when all around them, people purporting to be counsellors and therapists are espousing the effectiveness of simply “thinking yourself happy”?  How does that person feel when no matter how hard they try, their symptoms persist?  Are they able to recognize that it is the “therapy” that is the failure?  Or do they conclude that they are?  And there-in lies the danger of declaring a single pop-culture technique as a cure-all for mental or emotional problems.

This is not to say that there is no hope for those whose HPA system has been affected.  Recent studies into the efficacy of a number of therapeutic approaches such as Trauma-Focused, Dialectic, and Cognitive Behaviour Therapies, Eye Movement Desensitization & Reprocessing, and other techniques, combined with tailored mindfulness practice have shown remarkable changes in the brain’s function and structure.  But any therapy must be tailored to fit the individual and the therapeutic goals and pace must be arrived at in collaboration with the individual.

My greatest fear is that an individual who struggles daily with distressing thoughts and feelings as a result of abuse, will bypass proven successful approaches by trained and experienced therapists and buy into the “happy thoughts” trend - Then do their best playing a game they cannot possibly win and declare themselves a failure, losing all hope and begin to believe that the only relief they will find lies in suicide.

To those practitioners who employ this “happy thoughts” philosophy, please cease claiming it is an answer for all mental health conditions.  Presenting such philosophies falls in the realm of a life-coach, not a therapist.

To those who find themselves experiencing ongoing distress from trauma, I would offer the words of Jamie Tworkowski, founder of To Write Love On Her Arms; “Hope is real.  Help is real.  Your story matters.”  Keep searching until you find a therapist who will truly listen to you and offer real therapeutic interventions, not just a rehash of slogans from internet feel-good posters.

Aaron D. McClelland, RPCc

Tuesday, 3 July 2012

Home Therapy Sessions

As a practitioner in the mental health field, I am very aware that there may be serious barriers that prevent people from traveling to my office to find the help, support, and therapy they may require.  Examples of these barriers can include; depression; agoraphobia; contamination phobia; obsessive-compulsive issues; suicidality; hoarding; cultural preferences; transportation limitations; physical challenges; dependant children or adults they cannot leave unattended.  For people who face these and other challenges, Home Therapy Sessions may be the answer.  Others may require home visits to help them learn and develop parenting or life skills.

In order to best serve those in need, I have chosen to offer home visits for consultation, assessment, and therapeutic counselling on a case-by-case basis.  Any client wishing home visit counselling will be asked to weigh the pros and cons, and to determine if they can meet the conditions for a therapeutic visit to take place.

The main advantage of Home Therapy Sessions is comfort for the client - it removes the stress or inability to travel and allows them to remain in a familiar and - hopefully - safe environment.  For the therapist it allows us to see our client on their home turf, allowing for assessment and therapeutic interventions to take place in context and helps us understand the client better following the adage “Health isn’t a diagnosis, it is how we live.”

Therapy sessions can take place anywhere appropriate; in a living room, porch, backyard, car, nearby park, library, school, church, during a car ride or a walk on a trail.  So long as the chosen place is safe and conducive to building a healthy therapist/client relationship and is free of danger, the choice of location for the session is unlimited.

Another advantage of Home Therapy Sessions is that they can help reduce Emergency Room visits and hospitalizations by dealing with problems before they become a crisis.

The therapist and client must establish healthy boundaries both for the client’s protection and to help the therapist maintain their role.  Because it is outside of the office structure which is designed to be free of distractions, a home visit can be more fluid and unpredictable, such as; other family members present in the home; pets; phone calls; friends visiting unannounced.  Because of this, the therapist and the client must agree on ways to minimize these distractions.

The Client & Therapist Roles
It is important during Home Therapy Sessions to maintain the roles each person has in the therapeutic relationship.  The therapist is not a “guest” in the home, they are there in a professional capacity.  Clients should understand that they do not have to cater to their therapist as they would a friend coming to visit and understand that the therapist isn’t being rude if they decline the offer of a snack or beverage.  The other rule for therapists that is the same whether in their office or in a client’s home is - they cannot accept gifts.  To do so can result in the therapist being brought before a disciplinary board of their association and may have their right to practice removed if the incident is serious enough.

Session Length and Fees
The length of sessions for each client is up to each therapist to determine; depending on how the session progresses or the issues involved, many therapists [myself included] will work to what is known as “end point” instead of sticking precisely to the clock.  That is; to complete the therapeutic part of the session even if it goes over the one hour time limit by 15 minutes or so.

It would seem logical to assume that the hourly rate for a home visit would be less than an office visit, because there is no need for the overhead costs of maintaining an office.  However, most therapists who offer home visits also maintain an office where they complete their session notes, do research on behalf of clients, and consult with other professionals on general topics that can benefit their clients.  The other costs to the therapist doing home visits is travel time and expenses that can amount to more than the hourly in-office percentage.  So, typically, Home Therapy Sessions are not discounted for those reasons.

Safety & Confidentiality
Great care must be taken both by the therapist and the client during home visits to maintain safety for all and confidentiality for the client.  For example; It would not be good practice to have an abusive or controlling spouse or child present during the session.  Neighbour and friend visits should be discouraged during the session, and care must be taken to ensure no one can hear what is said during the confidential session - The same rule in the office must apply at home; “What is said in session, stays in session.”  it is the client’s decision on what they share with their family and friends.

Another issue that cannot be compromised is the use of alcohol or illicit drugs prior to or during a session.  If the client has or is consuming either alcohol or mood-altering non-prescription drugs prior to or during the session, the therapist will end the session immediately and offer to book a new appointment.  Clients should understand that if this occurs, they may be billed for part or all of the terminated session.

Providing for healthy boundaries, Home Therapy Sessions can be a positive option for some clients.  If you or someone you know might benefit from a home visit by a therapist, please contact one in your community to see if  they are willing to offer this service.

Aaron D. McClelland, RPCc