Popular Psychology – Page 14 – Licensed Mental Health Counselor

8 Things About Your Mind You May Be Unaware Of

13 Apr 2015by Torey C. Richards, LMHCLeave a Comment

There are many things I love about psychology and one thing is how much it brings us altogether and yet makes us all unique individuals. There’s so much about our minds that we often aren’t aware of and don’t even know is happening most of the time.

Here I’ve shared 8 things that affect most of us to one agree to another, many of which you are unaware of even when it’s right in front of your face.

We all have a capacity for evil

Most people like to think that they could never be convinced, tricked or manipulated into doing something wrong, but the 1971 Stanford prison study showed how social situations can affect our behavior. In the study led by psychologist Philip Zimbardo, a mock prison was created in the basement of the Stanford psychology building and 24 undergraduate students were selected to play the roles of prisoners and guards.

Researchers then monitored the prisoners and the guards and watched in dismay as ordinary college students began to do unimaginable things to each other. The guards for instance became physically and psychologically abusive to the inmates who in turn began to exhibit extreme emotional stress and anxiety.

The experiment was supposed to last two weeks, but the researchers ended it in just six days due to the abusive behavior of the students playing the roles of guards.

“The guards escalated their aggression against the prisoners, stripping them naked, putting bags over their heads, and then finally had them engage in increasingly humiliating sexual activities,” Zimbardo said.

These were all thought to be physically and mentally healthy college students who within days had turned into someone else.

This reminds me of the soldiers in Abu Ghraib where seemingly normal American soldiers began to ruthless abuse, humiliate and torture the detainees committing humane rights violations that included rape, sodomy and murder.

We are all susceptible to “change blindness”

In 1998, researchers from Harvard and Kent university did a study where they had an actor ask a stranger on the street for directions. While asking for directions, they had two people carrying a large wooden door walk between the actor and the subject, completely blocking their view of each other. The actor was then replaced with someone else of a different height, build and voice. Half of the subjects in the experiment didn’t even notice the change!

“Change blindness” suggests that we are very selective when it comes to visual cues and that we rely on memory and pattern-recognition more than we realize. The same study has been repeated many times, including changing a main actor on stage with someone of a different build and voice and half of the audience didn’t realize that the actor had been swapped at all.

Some of us are more susceptible to “change blindness” than others.

Delaying gratification is inherently difficult, but is worth it

This one may seem like a no brainer, but researches in a 1960s Stanford experiment gave pre-school age kids one marshmallow and told them that if they could avoid eating it for 15 minutes while the researcher stepped out, they could have two marshmallows when he returned. Most of the students tried to wait, but struggled and eventually ate the marshmallow. Those who were successful in waiting used avoidance tactics such as turning their back to the marshmallow or covering their eyes.

The children who could delay gratification in the study also turned out less likely to use drugs, become obese or have behavioral problems later as teenagers or adults. The good thing is that delaying gratification is something that can be taught.

We can have strong conflicting moral impulses

In a famous study done in 1961, Yale psychologist Stanley Milgram showed just how far people would go to obey authority figures, even if it conflicted with their own morals. Part of the study was to try to understand how so many Nazi war criminals were willing to commit unspeakable horrors during the Holocaust.

In the experiment, one participant was called the “teacher” and the other the “learner”. The teacher was instructed to give an electrick show to the learner, who was in another room, every time they got a question wrong. If the teacher was reluctant to give a shock, he was urged on by the researcher. During the experiment, most participants, even though they were visibly uncomfortable and stressed, administered increasingly painful shocks, all the way up to the final 450-volt shock which was labled “XXX”.

This study was originally considered a study of blind obedience to authority, but recently has been thought of as a study in deep moral conflict, suggesting that many of us, in the right conditions, can be pushed to do things we are uncomfortable doing, even if that means hurting others.

We are corrupted by power

We’ve all known someone, most likely a co-worker, who was one person before they got promoted and then a totally different (not usually for the better) person after they got promoted. Research suggests that when we gain authority or power, we tend to change and not always for the better. Those in power sometimes act with a sense of entitlement and/or disrespect.

Many studies show that even implied positions of power can change the way many people act. “When researchers give people power in scientific experiments, they are more likely to physically touch others in potentially inappropriate ways, to flirt in more direct fashion, to make risky choices and gambles, to make first offers in negotiations, to speak their mind, and to eat cookies like the Cookie Monster, with crumbs all over their chins and chests,” say psychologist Dacher Keltner.

We seek out loyalty to social groups

In a social psychology experiment in the 1950s, an experimenter took two groups of 11 boys, all age 11 to a summer camp. He gave one group the name the “Eagles” and the other the “Rattlers”. They spent a week apart, bonding, having fun with neither group knowing the existence of the other. When he finally brought the two groups together they failed to integrate, instead they stayed in their tight knit groups, began calling each other group names, competing against the other group in various competitions, creating conflict and even refusing to eat together. This is only after each group bonded together for only one week!

This is one reason I disbelieve the thought that if everyone were the same race/color, there would be no racism. There will always be some type of prejudices against groups we perceive as different from us, even if the difference is only in name (the “Eagles” versus the “Rattlers”). It’s just the way humans are wired to bond socially. Even if we all looked alike, we would find something to separate “us” from “them”.

Love is all you really need to be happy

That may sound hokey, but a 75 year Harvard grant study that followed over 250 men around for 75 years suggests that love is all you really need to be happy and satisfied long-term. Psychiatrist George Vaillant, The study’s longtime director says, “One is love. The other is finding a way of coping with life that does not push love away.”

That is for many of us the hard part. We want to be loved, are afraid to love, to hurt or be hurt, therefore we find many, often creative ways to push love away and most of it is subconscious. We end up telling ourselves we don’t need love to be happy and that simply isn’t true. Even if it’s not romantic love, we all need to feel loved even if it’s the endless quest for love or passion for something.

We are always trying to justify our experiences so that they make sense to us

One day I’m going to sit down and write a whole post about cognitive dissonance. It’s such a fascinating topic. What cognitive dissonance says is that we are constantly telling ourselves lies to make sense of what is going on around us, especially when what’s going on around us doesn’t make much sense. We want the world to be a logical and harmonious place, which of course often it is not.

An example of cognitive dissonance is someone who smokes, knowing that it is bad for their health, but they justify it by saying that they enjoy it so much that it’s worth the risks, or that it’s not likely they will suffer serious health effects, or that they are going to die of something anyway they might as well enjoy smoking, or that if they quit smoking they will become an irritable, angry person no one wants to be around. So, they continue smoking because it is consistent with their idea about smoking.

Cognitive dissonance is another one of those things that is largely subconscious, but we all do it. We try to make sense of a world that often doesn’t make sense and when we can’t make sense of it we are often put into an uncomfortable, upsetting state of mind. We become unbalance and try to figure out away to become balanced again.

These 8 things are just some of the reasons I love psychology. It unites all of us, while at the same time making each of us different.

Popular Psychology

Andreas Lubitz; The Plane Crash And Mental Illness

31 Mar 201531 Mar 2015by Torey C. Richards, LMHCLeave a Comment

There’s been a lot of talk about the mental health of Andreas Lubitz, the co-pilot that crashed the Germanwings plane into the French Alps.

As more details come out, it appears obvious that he was suffering from some type of depression, psychosis and/or personality disorder. Without having examined him myself, I can only speculate by the information covered by the news outlets, but I do know that there are certain forms of mental illness that make a person more likely to not only kill themselves, but to take the lives of other people with them.

Sometimes severe depression can include psychotic features that come and go. This is often missed when the person sees a clinician because the psychosis may not be present during the examination, only the depression, therefore the person is treated only for depression.

If a person has psychotic depression combined with grandiosity, egocentricity and lack of morals/conscience, that can lead to a person who almost has a god like complex where they believe that not only is their lives in their own hands, but so are the lives of other people. Thank goodness that this type of condition coupled with violence is rare.

Usually people who are depressed and/or have suicidal tendencies are only focused on harming themselves. They would never take the lives of another person, much less that of a stranger. Depressed people and people who suffer from a mental illness in general are not dangerous, it’s only when these mental illnesses are combined with other conditions such as psychosis and/or a personality disorder that they can become disastrous.

For example, as we stated above, some forms of depression can have short episodes of psychosis . Conditions such as bipolar disorder sometimes may also include psychotic features, where the person may be depressed and hallucinating or manic, grandiose and delusional. The contents of the psychosis may or may not be aggressive.

Because people with bipolar disorder often only go see a doctor when they are deeply depressed, they are often misdiagnosed with depression and given antidepressants which can then send that person into a manic episode. I’m not saying that is what happened to this pilot, but his girlfriend reported that he made statements such as “One day I will do something that will change the whole system, and then all will know my name and remember it.” This is a very grandiose statement.

There’s even some reports that his vision problems he was so afraid would cost him his career may have been psychosomatic, meaning that they weren’t organic kn nature but psychological. His mental illness could have been causing him to believe he was losing his vision.

On top of that, perhaps the thoughts he shared with his girlfriend only alluded to even more grandiose and obsessive thoughts. Some people with mental disorders suffer from painful, oppressive, relentless, intrusive thoughts that may be scary and constant.

For example, a person with Obessive-Compulsive Disorder may know that they turned off the oven before they left the house because they checked 10 times, yet they can’t get the thought out of their head that they may have left it on and it will burn down their house so they recheck it again and again causing them to be late for work every day. Or the husband who has the obsessive thought that his wife is cheating, although he knows she’s not, yet he can’t get the thoughts out of his head so he is constantly accusing her, checking her phone, going through her things and driving her crazy.

Also, in some personality disorders and psychosis, there can be very grandiose ideas where the person thinks they are better than everyone else and that no ones life really matters. This could have played a role in the airplane crash and would help explain the selfishness and egocentricity of killing oneself with no regard for the lives of the other 150 people and their families.

For the most part, people with mental illnesses can maintain very successful lives and careers, such as being an airplane pilot, but only if they are diagnosed and treated properly. Often people with mental illness are misdiagnosed or don’t ever get treated because they don’t believe they need help or because of stigma.

People who suffer from bipolar disorder often like the high of the mania therefore they don’t get treated or take their medication accordingly. People suffering from psychosis often don’t realize that they are psychotic and therefore decline treatment.

I once spent several weeks trying to convince a successful business man suffering from bipolar disorder that he was not only bipolar, but needed medication to help control himself. At the time he was manic, had been arrested 3 times in 2 months for various reckless behaviors and was on the brink of losing everything. It was only after he had a long time to think in solitary confinement did he start to have some insight and agreed to treatment.

This pilot, suffering from real or psychosomatic vision problems he believed would end his career, seized the opportunity to not only end his suffering, but to live out his grandiose fantasy of going down in history, once he was alone in the cockpit. In his right mind this pilot wouldn’t have did what he did, but his mental illness made him impulsive and in that moment he did something that could never be undone.

Often times suicide is an impulsive act. A person may have the thought, but without adequate means they won’t harm themselves. However, if the impulse is strong enough and a weapon of destruction is within reach, the urge to kill themselves may win out over any desire to live.

Once again, at this point it is pure speculation as to what was actually going on inside of Andreas Lubitz mind at the time he made that fatal decision. However, this gives us a great opportunity to have an open discussion about mental illness no matter if it’s our own or others.

Popular Psychology

6 Relationship Tips for Empaths. | elephant journal

18 Mar 201518 Mar 2015by Torey C. Richards, LMHCLeave a Comment

http://www.elephantjournal.com/2014/12/6-relationship-tips-for-empaths/

Popular Psychology

Post Dramatic Stress Disorder

10 Mar 2015by Torey C. Richards, LMHC2 Comments

Today I counseled an inmate who was upset because he had been diagnosed with what he called Post Dramatic Stress Disorder (PDSD). What he meant and I quickly corrected him, was Post Traumatic Stress Disorder.

Initially my colleagues and I had a good laugh at the fact that he mistakenly called Post Traumatic Stress Disorder, Post Dramatic Stress Disorder, but then I thought about it. Can exposure to too much drama create a milder form of stress that can have a negative effect on an individual’s life?

Every day most of us are exposed to some type of drama, either in our personal lives or through the media where we are bombarded with images of war, devastation and danger just from watching the news. We are faced with even more murder, betrayals and violence from the television shows, books and magazine articles we consume.

Most of us don’t give a second thought to these images that slip into our brains, but for some of us, prolonged exposure to drama can create anxiety, difficulty sleeping, a sense of helplessness and agitation.

Think about it. How many times have you watched or read something that was provocative, suspenseful or violent and then found yourself dreaming about it that night, perhaps even having a nightmare that the dramatic even was happening to you? Many of us will push this aside as we wake up and get back to our realities, but for a few, they will remain hyper vigilant and uneasy for days.

My oldest sister had to stop watching one of her favorite movies because it would cause her to go back to work the next day angry. Why? The dramatic events in the movie didn’t happen to her, yet they affected her on multiple levels triggering an agitated response.

What’s the solution? Certainly I am not advocating boycotting television or books filled with drama, but instead to take a break from it every now and then. Go for a walk, take up yoga, spend time with someone you love, try to avoid real life drama, do anything relaxing that can help bring you centered. Also, try to pay attention to how dramatic events affect you, which ones and how. Most of us are much more affected by the dramatic events in our real lives than in the media, but maybe watching a suspenseful movie before bed isn’t the best idea if they generally give you nightmares and poor sleep quality.

What started off this morning as a good laugh (with the seriousness we deal with every day we are always looking for a good laugh), a real topic was brought up. Post Dramatic Stress Disorder may not be a real disorder, but the effects of being dramatized are. The less drama (real or fictional) we have in our lives, the healthier we will be both mentally and physically.

Popular Psychology

TRAINING OFFICERS TO DEAL WITH MENTAL ILLNESS

4 Mar 2015by Torey C. Richards, LMHCLeave a Comment

The other day my girlfriend was looking at a video on Facebook. I wasn’t looking at the video, but what I heard was a lot of shouting and then finally multiple gunshots. It was obviously a violent video and I didn’t want to see it.

The next day I saw that she had shared the video on her page which to me meant that whatever the video was about, she felt either passionate about it or angered by it so I decided to watch it. What I saw was an unarmed man, surrounded by five overly aggressive, untrained police officers who end up shooting him.

You can find the video at the end of this post. Warning, some my find it graphic and hard to watch.

During my research for this post, Los Angeles police leaders insist that all of the officers involved in this altercation had some training on dealing with the mentally ill, with some having as little as 11 hours of training. They went as far as they say that the skills learned in the training were used during this encounter, which in some part may be true, but when I see officers taking violent punches at a person and being overly aggressive with little control or coordination, it’s hard for me to see that any crisis intervention techniques were appropriately used.

For over 4 years I worked in a psychiatric hospital where every day we had to deal with at least one hostile patient, some who had just been released from jail and brought directly to our facility. These patients in particular were aggressive and violent and often needed to be restrained for their safety and the safety of others. We often had to “take down” these patients with as little as three staff members actually going hands on. Patients very rarely got hurt. Matter of fact I can’t even think of one incident I was involved in where a patient got hurt. Staff rarely got hurt as well and when they did it was generally superficial scratches. No one ever died. Ever. No patient, no staff member.

Unlike in this video we weren’t armed with more than latex gloves and training in non-violent crisis intervention training. We practiced what is sometimes called “therapeutic hands on” actions, which means that when we did have to put our hands on a patient we did so in a way to quickly gain control of them without trying to hurt them, no matter how violent they are responding to us, unlike in the video where you will see at least one officer swinging away at the inmate as if he were in a mixed martial arts fight.

The officer who says the suspect was reaching for his gun and the officer who appears to have been the most involved with the suspect was the newest officer on the scene with the least amount of training in dealing with mentally ill people.

I’m not saying that all police officers are this way, but many officers when dealing with individuals are overly aggressive and don’t have the patience it takes to appropriately deal with mentally ill people. This is why we see so many unarmed individuals getting killed by police; over aggression and lack of patients. I know their job is dangerous and tough and often times they can’t wait to see what happens before putting themselves in danger.

However, when you have a job where it’s pretty much excepted if you kill someone it’s okay, it makes having to be patient and cautious a lot less likely. Working in the psychiatric hospital, if we killed a patient while trying to restrain him we would most likely get fired, loss our licenses and get sued by the family. Too many officers operate with impunity.

Where I live we are lucky to have Crisis Intervention Team (CIT) officers who have went through specialized training to deal with mentally ill individuals. Whenever I had to call law enforcement for someone I believed was mental ill I always requested a CIT officers for that individuals safety. CIT officers are more likely to approach mentally ill individuals calmly and take them to the mental hospital instead of jail. They generally don’t over-react or act aggressively. Unfortunately, not all police and sheriff’s departments have CIT officers or good training programs.

What I am advocating here is for more training like the training done by the Clark County Sheriffs Department.

With the appropriate training on how to calm a person down, even when restraining them, the number of unarmed killings by law enforcement officers would go down drastically, mentally ill or not.

Popular Psychology

Beyond Punishment: Taking An Inside Look At Child Abuse

24 Feb 201524 Feb 2015by Torey C. Richards, LMHC2 Comments

When I first saw this video yesterday it broke my heart. What I saw was not only in my eyes child abuse, but an angry man who probably not only beats his children like they were strangers on the street, but also probably abuses the women in his life. On top of that, what I saw was a culture where this type of physical abuse is not only excepted, but encouraged, hence the person video taping it and most likely the other people in the house who never intervened.

From my understandings, this father was “punishing” his thirteen-year-old daughter for being “rude”, “disrespectful” and talking to grown men. Obviously these are things that no parent would want from their child, but beating a child purposely with a belt on her face is not discipline. I can almost guarantee that this is not the first time that she has been beaten and yet her inappropriate, most likely defiant behavior hasn’t stopped.

Chances are that this parent has no real idea of how to be a parent or raise a child, if he did, there would have never been a need for him to discipline her physically because she would have been raised, taught, guided and disciplined more appropriately over the last thirteen years. If this father had any real ideal of how to raise a child in a loving way, he would have punished her in a way that wasn’t to hurt her necessarily, but to teach her right from wrong.

Most parents punish their children from a place of love. I didn’t see any love for this child during this beating. What I saw is a father who is psychologically disconnected in so many ways.

From a psychological point of view we have a young lady who is acting out for one reason or another and physical punishment isn’t going to stop that. She is acting out and only talking and trying to understand why she is acting out is going to stop that.

Secondly, we have a man in a wheelchair who probably already feels emasculated if not just outright angry at the world for whatever condition put him in a wheelchair and therefore is always a ticking time bomb. He may have been a mean and angry man before whatever put him in a wheelchair, but many people become more angry when they are injured, in pain or handicapped.

Read my article on physical punishment to understand some of the ways it can affect a child’s mental and emotional health. From my experience in working with children who have gotten punished like this, they rarely learn to stop the undesired behavior, but learn how to be more sneaky. The sad part is, a valuable lesson this girl may have learned from this is one many girls who grow up in abusive homes learn which is:

If a man really loves me he will hit me to show it
It’s okay if a man puts his hands on me, it’s all part of being in a relationship
I need a man who knows how to “handle me” and put me back in my place when I step out of line

To most of us those three responses may seem trivial, but I’ve worked with enough abused girls and young girls who ended up in abusive relationships to learn that many of them came from abusive homes where either they themselves were abused or where they witnessed abuse in their homes. They grew up thinking that it was not only okay, but the norm. Some even felt like it was a vital part of being in love because that is what they grew up seeing and thinking love is: Mom and dad fight, but they love each other and I see that. OR, mom fights with her boyfriend and then they go make love afterwards.

One young lady in particular saw her dad not only beat her mom, but he also beat her. Every relationship she got into as a teen and young adult was an abusive one. She didn’t understand it, but she unconsciously would seek out abusive men. She had two kids, each from an abusive man and the last time I met with her in counseling, she was with yet another abusive man. She couldn’t break the cycle. Her young boy and young girl are going to grow up witnessing and maybe even experiencing abuse.

This father in the video, in an attempt to raise a virtuous young lady may be in fact creating a woman who will go through a lifetime of troubled and abusive relationships because of the abuse she receives from her father.

No doubt some people may look at this video and see nothing wrong with the way he is disciplining his daughter and believe that people should mind their own business, but I personally hope that child protective services sees this video and rescues this child while the law punishes this “man”. I wrote this post not only because I am passionate about protecting children from abuse, but also in hopes of increasing the exposure of this video so that maybe someone will recognize the child and the father and contact child protective services in whatever city, state this took place in. It’s a new video so chances are something can be done relatively soon.

***Warning, the video may be hard for most people to watch.***

Being A Psychotherapist: Things School and Books Can’t Really Prepare You For Part Two: Suicidal Clients

3 Feb 2015by Torey C. Richards, LMHC2 Comments

Another thing school and books can’t really prepare you for are suicidal clients. Sure they cover the subject of suicide in graduate school, but the training of dealing with suicidal patients is usually very brief. There are many great books on working with suicidal clients and I have read a few, but I don’t think anything can really prepare you for sitting face to face with and working with a suicidal patient.

From my experiences, there are many types of suicidal clients and they all have to be taken seriously.

There’s the client who doesn’t really want to commit suicide, but they like to self-injure and that self-injurious behavior may lead to an accidental suicide. These are often the most common types of clients, often called “cutters” and they tend to be the most frustrating since a lot of them have cluster b type personality disorders such as borderline personality disorder.

When I worked in a high school I had a whole group full of students who self-injured and ended up involuntarily hospitalizing at least one every month because while they said they weren’t suicidal, they were definitely at times flirting with death.

This picture was taken of one of my former students who likes to cut. The next day she had twice as many cuts on her arm and I was forced to involuntarily hospitalize her.

There’s also the suicidal client who is extremely depressed or emotionally unstable and talks about death and suicide a lot. They typically don’t self-injure and have never tried to commit suicide and don’t think they ever would, but they talk about it so often and their emotional pain is so deep that when they leave your office you often wonder if this will be the last time you ever see them.

These type of clients can also be very stressful to deal with. Often when I have had clients like this I found myself worrying about them when I wasn’t even at work, when I was on vacation, when they didn’t show up for an appointment and sometimes I even dreamt about them.

One patient in particular was diagnosed with a terminal disease and she didn’t want to die a slow death. She didn’t think she would kill herself, but all she talked about was death and dying and her depression was so deep that it was hard to not be concerned about her when she missed an appointment. Eventually I had to hospitalize her after one particularly draining and emotional session when she couldn’t promise me she wasn’t going to go home and try to kill herself. Everything inside of me was screaming she would. She was angry that I hospitalized her against her will, but told me in later sessions that she had every intent of going home and killing herself that day and thanked me.

Another type of suicidal client is the one who never talks about suicide. Some are impulsive, but many just keep their thoughts and feelings buried deep inside. They may never even tell anyone that they are in pain. They just attempt or commit suicide without any real warning signs. These clients take not only you by surprise, but everyone else in their lives too.

I once worked with a student for two years dealing with the grief of a parent and then one day he gave me a card thanking me for helping him. It was our last session, he was doing great. Less than a week later I got a call from his family telling me he had attempted suicide and was in critical condition at a local hospital. I was stunned. I rushed to the hospital and nearly broke down in tears as I looked down at his lifeless body. I kept replaying our last sessions together, our last interactions, his last words to me, trying to figure out what did I miss. Thank goodness he came out of his comatose state after a few days and I was grateful that he not only lived, but that I had the opportunity to process his suicide attempt with him. I didn’t miss anything. He had suddenly decided he didn’t want to live any more and wanted to be with his deceased parent.

A couple of years before that I had been part of a crisis team that was sent to two different schools after two students had killed themselves apparently out of the blue. One was a popular jock that killed himself and stunned the whole community because no one, not even his closes friends knew that he was in so much emotional and psychological pain. His friends, family and even school staff members were blaming themselves for not seeing signs that weren’t even there.

The other student apparently killed himself on impulse in the midst of an angry dispute with his girlfriend. He told her he was going to hang himself. She didn’t believe him, but that’s exactly what he did. He had no history of being suicidal and no one saw it coming.

In my nearly 8 year career as a psychotherapist I’ve dealt with hundreds of suicidal clients. My main job right now is interacting with inmates who have been flagged as suicidal. Luckily I have not had one client commit suicide although I have had a few who have made serious suicide attempts landing them in the emergency room.

Studies suggest that:

1 in 4 interns/trainees will have a patient who attempts suicide at some point during their training and 1 in 9 will experience a completed patient’s suicide.
25% of psychologists and 50% of psychiatrists will experience a patient’s suicide.
1 in 6 psychiatric patients who die by suicide die in active treatment with a healthcare provider.
Approximately 50% of those who die by suicide in America will have seen a mental health provider at some time in their life.
Work with suicidal patients is considered the most stressful of all clinical endeavors. One third of psychotherapists who experienced a patient’s suicide subsequently suffer from severe emotional distress. Several factors may contribute to such severe distress including failure to hospitalize a suicidal patient who then died; a treatment decision that the therapist may feel contributed to the suicide; negative reactions from the therapist’s institution; and the fear of a lawsuit by the patient’s relatives.
25 % of family members of suicidal patients take legal actions against the patient’s mental health treatment team.

As a coincidence, just as I was finishing this post I was informed that an inmate just purposely swallowed 18 Ativan pills in an attempted suicide and is being rushed to the hospital.

Being A Psychotherapist: Things School and Books Can’t Really Prepare You For Part One: Mental Fatique

25 Jan 201525 Jan 2015by Torey C. Richards, LMHC5 Comments

To be a psychotherapist takes years of school and a lot of reading and writing about various aspects of human behavior. Many students fresh out of school with not much patient contact or real therapeutic hours under their belt, think that they fully know what it is like to be a therapist. They don’t. While school and books definitely prepare you for sounding like a trained therapist, nothing but real experience and hundreds of hours of patient contact, can prepare you for even the basics of what it’s like to be a therapist.

Many people who see me doing my job say, “I want to do that” and I never discourage them. I just tell them that if they are doing it from their hearts then they should pursue it. If they are doing it because they think it pays well, then they should seek another career. If they are doing it because it looks easy, then they should definitely seek another career. Even students who have spent years in undergrad and then graduate school are disillusioned and thus disappointed when they actually start seeing clients of their own. A few, those meant to truly be in the field, will love it, even when it’s frustrating. Others will hate it, but stay because they’ve fooled themselves to believe they are supposed to be therapist, and most end up becoming very bad therapists… or program directors. A large portion will leave the field altogether and seek employment that is more fulfilling and they should.

So what are the things that school and books can’t prepare you for when it comes to being a psychotherapist? Well I will cover one topic every now and then instead of trying to cram a top 10 list, but we’ll start with mental fatigue.

Being a psychotherapist is exhausting. Sure it’s not the same as lifting bricks all day, but it’s a different kind of exhaustion. People will say, all you do is sit and listen all day, how can that be exhausting. Well actively listening, being thoughtful, sustaining alertness, using your memory and paying attention to someone for 50 minute stretches throughout the day is very draining. Not to mention the stories you hear and have to process. Stories that are sometimes so sad that you have to hold yourself back from tears, or stories that trigger counter-transference issues because they remind you of some part of your own life.

There is also other things that make it taxing such as doing notes, scheduling, dealing with insurance companies and billing. There’s also that part about managing risks, having to figure out how much of a risk someone is to themselves or others. My main job right now is assessing suicidality in inmates who have exhibited a risk for suicide. It can become very stressful.

On top of that, sometimes your friends and even strangers who meet you and find out you’re a psychotherapist will treat you differently.

Strangers will either be fascinated and want to tell you about their problems, or a “friends”, or they will not talk much out of fear that you are always analyzing people. We do know how to turn it off, well at least turn it down. Your friends will most likely have you as their default free therapist, yet will not offer you much advice/help since “you’re a therapist, you should be able to figure out your own problems.” Oh, I’ve heard that too many times.

It can be exhausting because being a therapist, once you’ve done it long enough, becomes who you are. You don’t leave it behind at 5pm, even when you think you do. It’s always there with you and if you aren’t careful and don’t take care of yourself, it will drain you.

The link below is to a very well written article that details some of the hardest and most exhausting parts about being a therapist.

The One Thing Every Psychotherapist’s Partner Doesn’t Get.

Popular Psychology

Family Shares UPenn Student’s Suicide Note

23 Jan 2015by Torey C. Richards, LMHCLeave a Comment

Suicide affects thousands of families each year. Last year, many people were shocked to hear about Madison Holleran’s suicide. She was a beautiful, intelligent college freshman, but like many college students, she was having difficulty adjusting. Her suicide took her family by surprise and if you read her suicide note, it appeared to have taken her somewhat by surprise as well.

I’ve read a number of books on suicide and have unfortunately read a number of suicide notes during my career as a psychotherapist.

Reading suicide notes, especially from people who have completed suicides, can help us understand what that person was going through at that time and may be able to help us prevent other suicides.

Many times families and friends have no real ideal of the internal struggles and emotional pain that suicidal people are dealing with.

Madisons’ family recently released her suicide note to the public. If you’d like to read it, it gives a brief but heart wrenching account inside of Madisons’ mental and emotional state.

Family Shares UPenn Student’s Suicide Note – FOX 29 News Philadelphia | WTXF-TV.

Abnormal Psychology, Popular Psychology

Too Scared To Talk: Children with Selective Mutism

15 Jan 201515 Jan 2015by Torey C. Richards, LMHCLeave a Comment

The other day I was speaking to a mother who was describing her son’s symptoms to me. She reported that he had difficultly and sometimes just couldn’t speak at all in various social situations, especially at school and around strangers. He had been tested for Autism and that was ruled out. She was very frustrated with her son, but also felt bad for him because she could tell that he was also in distress. She just couldn’t understand why her son would suddenly become mute in social situations when he was such a funny, outgoing and talkative kid at home.

After listening some more, I realized that her son did not have an autistic spectrum disorder as she still believed, but that he had what is called Selective Mutism.

Selective Mutism is the inability to speak and communicate in social settings, but the ability to speak in settings where the child feels comfortable, relaxed and secure. Many parents think their child has absolute control over this, hence their frustration, but Selective Mutism is an anxiety related disorder .

90% of children with Selective Mutism also have social anxiety or social phobia. While many parents initially think their child is faking or playing games, Selective Mutism is very painful and debilitating to the child.

Children with Selective Mutism have a real, paralyzing fear about speaking and therefore this totally impairs their ability to develop social relationships or to participate in social situations.

Not every child expresses Selective Mutism in the same way. While some children are totally mute in social situations, others can only manage to whisper while some will remain perfectlu still, seemingly unable to speak or move, while less severe children can manage to speak totally normal to a select few individuals in social situations. This type of anxiety goes well beyond the normal range of shyness seen in other children.

A very select few children with Selective Mutism don’t appear to be shy at all. They actually do a very good job trying to mime their way through social situations. In these children, Selective Mutism may be a symptom of something else, such as the child initially being mute and never grasping communication and are basically stuck in the nonverbal stage of communication.

Why Does A Child Develop Selective Mutism?

Most children who have Selective Mutism have a genetic predisposition to anxiety. This means that it is inherited. Almost from infancy on, these children may show severe separation anxiety, moodiness, frequent tantrums, inflexibility, show extreme shyness and have sleep problems.

Some children with Selective Mutism may have Sensory Processing Disorder (DSI), which basically means they may be sensitive to sounds and lights, and that they may perceive environmental and social cues differently than most people. They become easily frustrated, angry, confused, withdrawn or act out because the signals they are receiving from their brain are alerting them to danger and fear causing them to have anxiety.

Up to 30% of children with Selective Mutism also have a speech, language, processing or learning disorder which can increase their anxiety and inability to communicate effectively in social situations.

There is no evidence that abuse or trauma causes Selective Mutism, which is different from Traumatic Mutism.

In Selective Mutism the child can usually speak normally at least in situations where they are comfortable. In Traumatic Mustism, a child witnesses or experiences a tragedy so devastating that they can’t comprehend it, they stop speaking altogether in every situation suddenly.

Selective Mutism can progress to the point where the child stops speaking and becomes totally mute, but that is usually gradual and when negative reinforcements cause the child to slowly start limiting the places and people he/she feels comfortable talking to.

Diagnosing Selective Mustism

Most children are diagnosed with Selective Mutism between the ages of 3 and 8. Most of these children have already exhibited severe symptoms of anxiety. If a child stops speaking for more than a month than the parents need to take the child to a doctor.

Here is the diagnostic criteria for diagnosing Selective Mutism. Note that this criteria shouldn’t be the only criteria used to diagnose or rule out Selective Mutism since each child and case is different:

DSM-IV-TR (2000):
1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
2. The disturbance interferes with educational or occupational achievement or with social communication.
3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
5. The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.
Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning. Teasing or goading by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive- Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation. Mental Retardation, hospitalization or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings children with Selective Mutism are almost always given an additional diagnosis of Anxiety Disorder, especially Social Phobia is common.

Many parents, teachers and even professionals do not understand Selective Mutism because research is so limited. Many think the child is being defiant, controlling, that they are just shy and will grow out of it, or that they have some other disability such as autism.

Children with Selective Mutism tend to want friends, they are just too anxious to develop friendships easily while children with autism tend to not care to have any friends at all.

When considering seeking treatment for a child with Selective Mutism, parents should be careful not to find a professional who believes that Selective Mutism is behavioral and about the child being defiant or controlling. These type of professionals tend to try to use punishment and forcing the child to speak as treatment, which consequently increases the anxiety of the child and worsens the condition.

Good professionals who understand Selective Mutism will focus on making the child feel comfortable, decreasing anxiety and helping the child learn coping skills to deal with anxious feelings. This is often done with a combination of therapy and medication and as a collaborative approach with the professional, parents and the school.

Dealing with a child with Selective Mutism can be frustrating, but understanding what Selective Mutism is and is not helps decrease the frustration.

For more information and help, go to http://www.childmind.org